Maternal Mental Health

What are PMADs? How Do I Know if I have one?

Twenty years from now you will be more disappointed by the things that you didn’t do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore.To begin my posts on Maternal Mental Health Month it’s best to start with the basics- the what, why, when, and now what?. Just what are Perinatal Mood and Anxiety Disorders (PMADs)? And how do you know if you have them?

What-

Before I even begin to describe PMADs its important that I have a brief disclaimer about mental health diagnoses. There is much stigma surrounding these labels but its important to note their function. We need to give these symptoms a name for two important reasons-1)so we can classify them for research and best practices and 2)so we can bill health insurance. Mental health diagnosis are not labels that have to follow you around for life. They are not something to be ashamed or fearful of what it will mean for the remainder of your life. Nor do they come with judgements within in the mental health community. Any good therapist looks past the diagnoses to see the person that is uniquely you. You may have the same diagnoses as another mother out there but your treatment will be unique to your own needs which includes your symptoms, your culture, your life situation, and most importantly – your thoughts, feelings, and perceptions.  Labels serve the mental health community a purpose but they are not you.

Perinatal Mood and Anxiety Disorders are a group of mental disorders that occur during or after pregnancy. They include anxiety, depression, and obsessive-compulsive disorder (OCD), with Post Traumatic Stress Disorder and psychosis also being disorders that can occur postpartum. Disorders accompany the period during and after pregnancy have different terms associated with when they occur that may be confusing. When it comes to recognizing your symptoms and getting help these terms are not really that important. However, for your understanding here is a brief breakdown.

Perinatal- during and after pregnancy

Prenatal-during pregnancy only

Postnatal or Postpartum– after pregnancy

When it comes to what you may experience psychologically during or after pregnancy symptoms fall under several main categories:

Depression- a period of low mood or heightened irritability and can be accompanied by symptoms such as fatigue or low energy, sleep difficulties, weight gain or loss, lack of interest in the baby, lack of pleasure from things you usually find pleasurable, as well as feelings of low self-worth, guilt, or hopelessness (this is usually labelled as Major Depressive Disorder or Persistent Depressive Disorder if you have had the symptoms for 2 years)

Anxiety – a period of heightened worry, racing thoughts, fear of something bad happening, and physical symptoms such as nausea or dizziness, sleep difficulties of changes in appetite(this is usually labelled as Generalized Anxiety Disorder or Panic Disorder)

Obsessive Compulsive Symptoms– similar to anxiety in terms of heightened worry but accompanied by unwanted and intrusive thought patterns that are very distressing to the mother (usually surrounding the safety of herself or her baby) as well as urges to engage in certain behaviors (compulsions) in order to reduce anxiety (for example: continuing to check locks, repetitive washing of self or baby, or counting or placing things in order)

There are two other important diagnoses that can occur in the perinatal period

Post-Traumatic Stress Disorder– if you may have experienced a very difficult pregnancy or traumatic birth  this may have led to symptoms of high anxiety or distress when you recall the event, avoidance of anything that reminds you of the event, feelings of detachment, flashbacks or nightmares, hypervigilance, and sleep difficulties

Psychosis– a more rare condition but very important to pay attention to Postpartum Psychosis presents with symptoms of paranoia, mood swings, strange false beliefs that lead to distress (for example-irrational fear of someone harming the baby or the mother herself) and sometimes hallucinations (seeing or hearing things that are not there)

Why-

There are many factors that can contribute to the occurrence of Perinatal Mood and Anxiety Disorders. It is difficult to pin down exact causes due to the fact that many of the potential causes co-exist in each mother. Causes can be medical, psychological, or situational. Some believed medical causes of PMADs are a genetic predisposition or a sensitivity to the levels of hormones released during and after pregnancy. Psychological factors that have been researched to be potential causes include tendencies for perfectionism, previous mental illness, or past trauma. Situational or environmental stressors can also contribute to PMADs occurring such as health challenges in the mother or baby, lack of access to resources, traumatic birth, and lack of social support.

 

When-

A common misconception with PMADs is that you experience them shortly after childbirth. However, we know that not only can women experience these symptoms during pregnancy but they can also begin to occur up until a year postpartum. Many women report onset of symptoms even as late as 6-9 months postpartum. Does that mean if you experience these symptoms and have a 2 year old you shouldn’t seek help? Absolutely NOT. Mental health symptoms can wax and wane and sometimes we are unaware of how they are truly affecting us. What’s important is to get educated and get help.

So, what now?

So how do you know if you are experiencing any of these disorders?

  • Complete a screening tool. Screening tools are instruments designed to take a brief picture of your symptoms to see if you possibly meet critieria for a PMAD and should follow up to get professional help. They are NOT a diagnosis. Once you contact a mental health profession you will participate in a full assessment that is unique to you.

The Edinburgh Depression Scale is the most commonly used screening tool for PMADS. Print and complete and share with your healthcare provider. Download a copy here or take an online version here.

One very important thing here to note is that if you have only one or two symptoms of any of these disorders but feel very distressed you should still seek help. Seeking professional counselling or the advice from a doctor does not require you to present with all the symptoms of one disorder. What is most important to focus on here is how these symptoms are impacting your daily life, not necessarily whether or not you have them all.

  • Ask yourself some questions.

Do I feel safe? Do I feel safe with my baby?   Answering No to either of these questions means you may require immediate help. Tell a family member or trusted friend and contact your local emergency room or general practitioner immediately.  Check out my resources page for suicide hotlines in the US and Australia here.

Do these symptoms impact my day to day activities? Are there days where it seems impossible to get out of bed? Do you never leave the home due to anxiety or depression? Do you avoid certain everyday situations because you are worried that someone may be trying to harm you? If you are not functioning in your usual manner or engaging in the daily activities you used to because of these symptoms it is time to seek help.

Do I have a support system? Are there people in your life you can turn to when you are struggling? Is there someone to help with your baby? Is there someone to provide you with emotional support? A support system is an integral part of recovery. Having one in place can be of great value in being able to make counseling appointments, have someone help with the baby when you are struggling, and provide essential emotional support.

How would I describe my quality of life? You may be completing your daily responsibilities but if you feel that each day is miserable or full of distress and you are just keeping your head above water it is important to still seek help. You deserve to have a good quality of life and not carry through life just trying to make it through the day.

Do I know where I can go for help?  Do you have access to a general practitioner? Can you contact your insurance provider to get a list of local mental health professionals? Do you know local agencies that have support groups for moms? Be proactive and do some research to find out what is out there. Help is available. Keep speaking up until someone hears you. Click here for my resources page that will point you to national and international organizations that specialize in PMADs. Their pages are amazing and contain directories of local resources as well as online support communities.

Stay tuned for next week’s post on what to expect from treatment and the many avenues you can seek for support with PMADs.

 

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