Are you a new parent feeling sad, tired or anxious? Here is a guide to help.

Contributing Authors:

Tiffany Gladdis, PsyD – Child Psychology

While many moms and other birthing people experience the “baby blues” in the first 2 weeks after having a baby (worry, sadness and tiredness), these symptoms usually resolve on their own. However, Perinatal Mood and Anxiety Disorders (PMADs) can be more serious. According to the CDC, about 1 in 9 birthing people experience symptoms of depression and 1 in 7 birthing people experience symptoms of anxiety during or following pregnancy.   

Keep reading for answers to frequently asked questions about what PMADs are, who might experience them, what to do if you’re struggling and how to get help.

What are Perinatal Mood and Anxiety Disorders (PMADs)?

The shift from using the term “Postpartum Depression” to PMADs is 2-fold:

To recognize that depression and anxiety can occur during pregnancy as well as in the postpartum period, and
to acknowledge that depression is not the only experience that could occur during the pregnancy or in the postpartum period.

Many people have heard of postpartum depression but not perinatal/postpartum anxiety or perinatal/postpartum psychosis. These are the 3 categories of PMADs. Additionally, new parents can experience perinatal/postpartum obsessive-compulsive disorder or posttraumatic stress disorder under the umbrella of anxiety. 

Can fathers or partners experience PMAD?

Yes. There is more research to be done with individuals who are gender non-conforming, transgender and partners who may not identify as ”father,“ however, there has been extensive research with men who identify as fathers. About 10% of fathers experience paternal depression and this number increases to about 18% for families with other life stressors like income or disabilities.. Additionally, fathers often experience anxiety at an even greater rate than depression, affecting up to 16 % of fathers during pregnancy and up to 18% postpartum. The Edinburgh Postnatal Depression Scale (EPDS) has been approved for use with fathers and partners to screen for PMADs and fathers and partners should be sure they are included in the screening process at medical visits.

When are birthing people most at-risk for developing a PMAD?

It varies. Most birthing people experience the onset of depression within the first 3 months after delivery; however, it can occur up to 1 year following the birth of the baby. Studies show that for non-birthing people/partners, depression is most likely to occur between 3-6 months after delivery. Anxiety most commonly occurs within the first 6 months. Psychosis, where birthing people begin to experience disorientation, bizarre thinking or thoughts of hurting or killing themselves or the baby, occurs in less than 1% of birthing people and usually presents itself in the first 4 weeks, but can happen beyond this time frame. Additionally, parents whose baby might end up in the Neonatal Intensive Care Unit (NICU) are 3 times more likely to develop a PMAD.

What should new parents do if they think they may have a PMAD?

Systems are moving towards having new parents screened for PMADs at OB/GYN offices, pediatric offices and during NICU stays; however, this is not yet universal. New parents should be sure to tell a medical professional if they are concerned their mood or behavior is unusual or different than pre-pregnancy. Partners and support people also play a major role in the identification of symptoms, as they are usually the first people to notice a shift in their partner’ behaviors. If parents are unsure, there is a great website that has free, printable questionnaires (in multiple languages that are culturally specific) they can fill out about their symptoms and take with them to their doctor.

What are the treatment options for PMADs?

It depends on the individual and their symptoms. Therapy is always a great first line of treatment. For some, individual therapy works best, while others may prefer group therapy or even couple’s therapy if the diagnosis has affected their relationship. Some people require medication in addition to therapy to help them re-stabilize. There are several medications that are approved for birthing people to take while breast/chest feeding or providing human milk through pumping, so that should not be a deterrent from seeking psychiatric help.

Are there medications specifically for PMADs?

Yes and no. Many PMADs are treated with typical psychiatric medications that address the specific mental health condition. However, there are 2 new medications approved by the Food & Drug Association (FDA) specifically for the treatment of postpartum depression in birthing people, Zulresso and Zurzuvae. Zulresso (generic name: brexanolone) is a drug to treat postpartum depression in individuals 15 years of age and older. It is given directly into the veins continuously over 60 hours and requires monitoring by a medical professional in a medical facility during this time. Zurzuvae (generic name: Zuranolone) is the first oral drug designed to treat postpartum depression in adults. Zurzuvae is prescribed by a doctor and taken as a pill by mouth, once daily for 14 days. It has been shown to alleviate symptoms as early as day 3 of treatment.

*This is not an endorsement of these medications. You should see a health care professional to determine what form of treatment is best and safest for you.

How can friends and family help new parents?

Friends and family can help in many ways, and new parents should let them! Our society puts a lot of pressure on parents to take on a lot, which sometimes causes parents to feel they can’t ask for or accept help from others. Accept help. Friends and family can offer to purchase or cook meals, watch the baby so the parents can nap, clean or do laundry or simply be a listening ear. Friends and family should be sure they aren’t dismissing the parents’ feelings or being overly positive, which may make parents feel like their feelings are bad or wrong. Instead, they should try to validate, listen and provide reassurance when appropriate.

What is the biggest takeaway for new parents?

Being a parent is hard work and there are many challenges and adjustments for the whole family in the first year of a baby’s life. It is normal to experience depression or anxiety and it is okay to receive help. If being a parent is not turning out to be how you’d hoped, you are not alone. If parenting feels hard or unsatisfying, it does not mean you are a bad person and you don’t have to “just deal” with your feelings. You can receive help to manage your emotions more effectively and improve your parenting journey. An untreated PMAD could become dangerous to you or your family, especially your baby. Do not wait if you are concerned, there are professionals who can and will help you.