Written by: Virginia Kuhn, LPC
Pregnancy and the first year after birth can bring major changes in mood, identity, relationships, and daily life. For some people, this time also brings mental health symptoms that feel intense, persistent, or hard to manage. These experiences are sometimes called perinatal mood and anxiety disorders, or PMADs.
PMADs are not one single diagnosis. The term describes a range of mental health conditions that can begin or become more noticeable during pregnancy or after a baby is born. While “postpartum depression” is a familiar term, it does not describe every perinatal mental health concern. Anxiety, OCD, trauma-related symptoms, bipolar disorders, and postpartum psychosis can also occur during this period. ACOG’s guidance covers several of these conditions, including depression, anxiety, bipolar disorder, suicidality, and postpartum psychosis.
What Does “Perinatal” Mean?
“Perinatal” generally refers to pregnancy and the period after birth. Many clinical resources include the first year postpartum. Some also discuss mental health challenges connected with pregnancy loss.
Symptoms may start during pregnancy, shortly after birth, or months later. They can also involve a mental health condition that began earlier and becomes harder to manage during the transition to parenthood.
What Conditions Can PMADs Include?
PMADs may involve:
Depression, including depression during pregnancy or postpartum depression
Anxiety disorders, such as generalized anxiety or panic
Perinatal OCD, which can involve unwanted, distressing thoughts and compulsive behaviors
Post-traumatic stress symptoms, including symptoms related to a difficult or traumatic birth
Bipolar disorders
Postpartum psychosis, a rare but serious condition that requires immediate medical attention
These conditions can look different from person to person. Someone might feel persistently sad or numb; another person may feel constantly on edge, overwhelmed by intrusive thoughts, or unable to sleep even when given the opportunity. PMADs can affect daily functioning, relationships, and a person’s sense of connection with themselves or their family.
PMADs Can Affect More Than One Kind of Parent
PMADs can affect people across income levels, professions, and backgrounds. Financial resources do not guarantee protection from mental health symptoms, and struggling does not mean someone is weak or ungrateful.
Mothers, fathers, non-birthing partners, and other parents can experience perinatal mental health symptoms. Estimates vary depending on the condition, the population studied, and how symptoms are measured. Postpartum Support International reports that about one in five mothers and fathers experience depressive and/or anxiety symptoms during the first year postpartum; it also notes that about one in ten fathers experience postpartum depression.
Recognizing Possible Signs
A person experiencing a PMAD may notice changes such as:
Persistent sadness, hopelessness, guilt, or irritability
Loss of interest or pleasure
Constant worry, racing thoughts, or feeling unable to relax
Panic symptoms or a persistent sense that something bad will happen
Unwanted thoughts that feel frightening or upsetting
Repeated checking, reassurance-seeking, or other behaviors that are difficult to stop
Trouble sleeping beyond what is explained by infant care
Difficulty managing daily responsibilities or feeling increasingly disconnected from others
Not every difficult day is a disorder, and a list of symptoms cannot diagnose anyone. If symptoms persist, intensify, or interfere with daily life, it is appropriate to bring them up with an OB-GYN, primary care provider, midwife, or mental health professional.
Why Early Support Matters
Untreated perinatal mental health conditions are associated with increased strain on the parent, the parent–infant relationship, and family life. They may also be associated with pregnancy or birth complications and challenges in children’s emotional, behavioral, or developmental well-being. These are possible risks, not inevitable outcomes—and they are not a reason to blame a parent. Support and treatment can help.
A 2019 economic model estimated that untreated PMADs associated with the 2017 U.S. birth cohort carried a societal cost of $14.2 billion, following parent–child pairs from pregnancy through five years postpartum. This was a historical model estimate, not a current annual price tag.
PMADs Are Treatable
A healthcare provider can help assess symptoms and discuss next steps. Treatment is individualized and may include therapy, medication, peer support, and practical help from family or community. ACOG recommends screening for depression and anxiety during pregnancy and postpartum care, with follow-up when a screen indicates concerns.
Getting Therapy at Bloom & Breathe Therapy
At Bloom & Breathe Therapy, we offer compassionate, evidence-based counseling for people navigating pregnancy, postpartum adjustment, perinatal depression or anxiety, perinatal OCD, birth trauma, and other life changes connected with becoming a parent. Our clinicians work collaboratively with each client to understand what they are experiencing and shape therapy around their needs and goals.
Treatment may draw on approaches such as CBT, ERP for OCD, ACT, or EMDR for trauma, depending on the person and what they want help with. Therapy can offer space to process difficult feelings, build coping skills, and take manageable steps toward feeling more grounded and supported.
Bloom & Breathe offers in-person therapy in the Phoenix area and Lander, Wyoming, along with telehealth for people located in Arizona, Wyoming, Idaho, and Missouri. You can learn more about our clinicians or request an appointment through Bloom & Breathe Therapy.
When to Seek Immediate Help
Postpartum psychosis is rare, but it is a medical emergency. Symptoms may include hallucinations, delusions, severe confusion, or a loss of contact with reality. Seek immediate medical care if these symptoms occur. ACOG advises immediate medical attention for postpartum psychosis.
If you or someone you love may be in immediate danger, call 911 or go to the nearest emergency department. For non-emergency perinatal mental health support and referrals, Postpartum Support International’s HelpLine is available by call or text at 1-800-944-4773. You can also call or text the maternal mental health hotline at 1-833-TLC-MAMA 1-833-852-6262.
You do not have to wait until things feel unbearable to ask for help. PMADs are real, common, and treatable—and support is available.