Increased attention to Postpartum depression, anxiety and psychosis can obscure an important fact: many perinatal mental health disorders begin during pregnancy rather than after delivery. These conditions are commonly grouped under the term Perinatal Mood and Anxiety Disorders, or PMADs, which covers depressive, anxiety and bipolar disorders during pregnancy and the year following birth.
According to the information reviewed, around one-third of perinatal depression cases begin during pregnancy. Anxiety symptoms may be even more common in early pregnancy, affecting about a quarter of pregnant women before declining to 20 percent during the rest of the peripartum period. Perinatal obsessive-compulsive disorder affects approximately 8 percent of women during pregnancy and about twice as many after birth.
New-onset bipolar disorder is uncommon during the perinatal period, but more than half of women who already have bipolar disorder experience at least one episode during pregnancy or the year after childbirth. Symptoms can continue unnoticed for weeks or months when women, relatives and healthcare professionals do not discuss mental health concerns.
Mild PMADs may respond to individual or group psychotherapy, improved sleep, stress reduction and social support. Moderate-to-severe symptoms may require medication. The source emphasizes that avoiding treatment is not necessarily safer: in the United States, suicide or overdose associated with PMADs account for 20 percent of maternal deaths.
For moderate-to-severe disorders, the reported benefits of medication generally outweigh the risks. Women taking perinatal medication have similar rates of miscarriage, birth defects, birth complications and infant problems to women without PMADs. By contrast, untreated moderate-to-severe conditions are associated with higher rates of complications, including preterm birth, cesarean sections, low birth weight and preeclampsia, as well as developmental and behavioral problems in children.
The article recommends seeking advice from a clinician experienced in perinatal mental health, particularly for women with a previous psychiatric diagnosis or those taking medication before pregnancy. Telehealth may provide access to specialists when local options are limited.
Treatment decisions should be individualized. Although some medications, including SSRIs, have extensive pregnancy safety data, changing a treatment that has successfully stabilized a patient may not always be the best option. A specialist can weigh the available evidence, the person’s history and the risks of relapse.
The goal is to use the lowest effective dose rather than reducing medication to the point that symptoms return. Medication requirements may also change during pregnancy because blood volume rises and the body can process drugs more quickly, with dosage adjustments sometimes needed during or before the third trimester. Higher doses may continue after birth, particularly during lactation.
Anyone who is pregnant, considering pregnancy or experiencing symptoms of anxiety, depression or bipolar disorder is advised to discuss them with a healthcare provider and seek appropriate support early.
Sources: Psychology Today.