What are perinatal mood and anxiety disorders (PMADs)?
PMADs are disorders of anxiety, depression, OCD, PTSD, bipolar, and psychosis that begin during pregnancy and/or postpartum (up to 1 year after birth).
They are the most common complication of pregnancy.
Postpartum depression (PPD) affects at least 1 in 7 women. When all PMADs are included, that number rises to at least 1 in 5.
(This Isn’t What I Expected, Kleiman and Raskin, ix-xi)
Unpacking the terms:
Perinatal:
PMADs begin during pregnancy or the first year postpartum. We talk most about mood and anxiety disorders postpartum, but they happen in pregnancy, too. We think of the perinatal period as one of joy, but most women struggle in some way, and 1 in 5 will develop a PMAD.
Mood and anxiety:
PMADs include more than just depression and anxiety, but encompass bipolar, OCD, PTSD, and sometimes psychosis as well. It’s far more than just being sad.
Among many other symptoms, moms may feel:
overwhelmed
unable to cope
scatterbrained
guilty
irritable
sense of dread
impulsive.
For more details on different disorders and their symptoms, Postpartum Support International is a valuable resource.
Sleep may be elusive or it may be hard to get out of bed. Intrusive thoughts – scary or “sticky” thoughts are also common. Some women become suicidal or psychotic, but PMADs don’t always have these symptoms.
If you are experiencing psychotic or suicidal thoughts, seek help immediately. These are treatable symptoms and when treated, usually improve quickly.
Some Christian women experience spiritual growth and a sense of closeness to God during their PMADs. Others enter into the “dark night of the soul,” where it feels as if God has abandoned them.
Disorder:
Although many women experience PMADs, they are disorders. They are not normal. Your pregnancy and postpartum are not supposed to feel this way. The way your whole person—body and soul—is responding to the changes you’re facing is beyond what it should be. There is a degree of “normal sadness” or anxiety you may face in the perinatal period, but PMADs go beyond this.
What Causes PMADs?
Studies often conflict as to what causes PMADs. Hormonal changes, sleep deprivation, vitamin deficiencies, and relational stressors may all contribute, but there is no one known cause. While the pressures PMADs exert can reveal our hearts and the way we respond may be sinful, PMADs are not sinful in and of themselves.
As people who are made up of body and soul, what happens in our bodies affects our souls and vice versa. Because much changes in the prenatal or postpartum body, it makes sense that our souls will also be impacted. But more than our bodies change; our identities, relationships, and circumstances are also in flux in the perinatal period.
PMADs can happen to anyone, no matter how well prepared or well supported you are. Preparation and support lower your risk, you can still get PMADs in a “perfect” situation (this was true for me two out of the three times I’ve had PMADs).
PMADs do not mean you are a bad mother. They are not your fault. You are not failing. You are not crazy. There are real, treatable reasons you feel this way.
What helps?
While some doctors are less than helpful, many are equipped to help you heal and make sure you have the resources you need. If your doctor is unhelpful, find one who is.
Medication can be effective to relieve symptoms, especially when symptoms are more intense, but counseling should play a role in recovery for all women, whether formally or through wise women in your church or community. You are not made to mother alone; the church is meant to support its members.
Nutritional support and lifestyle changes can also make a difference. These may seem too simple to be effective, but they have been for many women. Vitamin D, iron, Omega 3 fatty acids (especially DHA), light therapy, exercise, and magnesium are most often recommended.
Anemia, diabetes, adrenal fatigue, and thyroid imbalances can masquerade as PMADs, so it is wise to talk with your doctor even if non-medical interventions alleviate your symptoms.
The sooner you get help, the sooner you will be well. Healing is not passive. There are some things that only time can heal. Yet you must take the initiative in caring for your body and renewing your mind to align yourself with what is true about God and yourself.
Where is God in my Suffering?
We live in a fallen world where childbearing carries risks because life doesn’t work as it’s supposed to. But God is not absent in pain and suffering, even PMADs. Christ entered into our suffering to make a way out of it, and His Spirit is present with us in the midst of it. PMADs are not the end of your story. When in the throes of PMADs we lose hope, we can cling to the hope of the better, truer story of redemption God is bringing us into and forging in us even through our suffering.
I realize this is a hard word for women with PMADs. The promises of God often feel trite and unbelievable amidst suffering. They can even be upsetting. We balk at the idea of God working in our suffering, because our suffering hurts and is hard. But God using our pain doesn’t mean PMADs are good or that He likes them or sends them glibly.
It means that God is good and powerful enough to bring light even in the darkest place, light that darkness will not overcome.
Cameron Cole, Therefore I Have Hope
“..the resurrection offers you the hope of redemption. Nothing is hopeless. No chapter closed. No shame or trauma is beyond God’s restoration. No wound beyond his healing power. If God can raise a man from death, he can certainly resurrect your life from the ashes… the life of my Worst is buried with Christ in death and will be raised with him in resurrection power.”
The Sorrows of Eve 