Often misunderstood during the journey of pregnancy, written by Mikaela Kelly, MD, MPH.
Introduction:
The process of becoming a parent is often coupled with a variety of expectations, typically characterized as a time of happiness and excitement. However, the journey of pregnancy often presents with moments of joy in addition to moments of challenge and hardship. Perinatal mood and anxiety disorders (PMADs) represent a variety of conditions that impact pregnant and birthing people, as well as their partners, during pregnancy and postpartum.1 They are common, impacting at least 1 in 5 birthing people and are often underdiagnosed.2 PMADs are treatable, utilizing a variety of modalities including medications, individual and group therapy, as well as complementary treatment modalities. This piece will focus on signs and symptoms of PMADs, a brief primer to medications, and support options available.
What are Perinatal Mood and Anxiety Disorders?
PMADs represent the most common complication in pregnancy.3 They are characterized by mental health conditions with onset that can occur before, during, or after pregnancy, including conditions such as depression, anxiety, bipolar disorder, post-traumatic stress disorder, panic disorder, and postpartum psychosis.3 As a result, symptoms of PMADs can vary widely, but may include:3
It is important that if you are experiencing these symptoms, that you seek help and support from a licensed and qualified professional.
Is Psychiatric Medication Safe During Pregnancy and Postpartum?
Pregnant and birthing people may have concerns regarding the safety of psychiatric medications both during pregnancy and while breast/chest-feeding. Evidence demonstrates that a number of psychiatric medications for all of the conditions listed above are safe during pregnancy. For example, SSRIs (selective-serotonin reuptake inhibitors) are a commonly used medication to treat depression, anxiety, and post-traumatic stress disorder (PTSD) that many providers utilize in pregnant and non-pregnant individuals. These medications are well-studied in pregnant and breast/chest-feeding individuals, with safety data that supports their use with minimal risk of harm to the pregnancy.4 It is important to note that all medication carries some degree of risk, which can vary widely depending on the medication. It is also important to note that untreated mental illness also presents risk to the parent and child.4
As a result, this decision requires an in-depth discussion with your provider, weighing both the pros and cons of either decision. Notably, there are a number of myths regarding the utilization of psychiatric medication in pregnancy and postpartum, including information from older research studies that have since been disproven by more recent and higher quality research. Speaking to a qualified professional, who is aware of current and up to date data is key in ensuring that you are making a well-informed decision regarding your health and the health of your child.
What other resources are available in addition to medication?
In addition to medication, there are a variety of other resources available that may be of use to individuals navigating PMADs, including individual and group therapy as well as support groups. The organization Postpartum Support International (PSI) has a variety of resources including:5
*Note that this is not a crisis hotline – please contact your mental health provider, the national suicide hotline (dial 988), or present to your local emergency room in the event of crisis, including suicidal ideation.
Conclusion:
Remember, you are not alone, and seeking help is a sign of strength. Perinatal mood and anxiety disorders (PMADs) are common but treatable conditions. Recognizing the symptoms, seeking appropriate treatment, and accessing supportive resources are key steps toward healing and well-being. If you or someone you know is experiencing PMADs, know that help is available, and recovery is possible.
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