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Why do we screen for depression and anxiety so often in pregnancy?

by Misha Russ, CNM


We have all heard of postpartum depression. Most of us know someone who had postpartum depression after their baby was born, had it ourselves, or wondered whether we or a friend might have had it, but never sought help.

Most parents do not get help.

One reason some of us do not recognize postpartum depression is that it does not always look like depression, or what we usually think of as depression. That’s why we are now calling postpartum depression something else: Perinatal Mood and Anxiety Disorder or PMAD.

This is because the mood changes caused by pregnancy can start before we deliver; Perinatal, which means “around pregnancy.” The perinatal period starts with pregnancy and ends one year after birth.

More importantly, PMAD includes much more than depression.

Anxiety, Obsessive Compulsive Disorder, Panic, PTSD, Bipolar, Psychosis

And it can feel different than depression:

  • Totally overwhelmed

  • Weepy

  • Anxious or nervous

  • Angry

  • Scared by your thoughts

  • Like you’re not yourself

  • Guilt

  • Regret

  • Shame

Many of us have our first experience with one of these disorders in pregnancy. This is especially true for Bipolar Disorder. There are certain risk factors that have been identified, but anyone can experience PMAD, even if they have no risk factors.

PMAD does not discriminate.

The number one risk factor for postpartum depression is Anxiety and Depression in pregnancy.

Perinatal Mood and Anxiety is the most common complication of modern obstetrics.

So we screen for anxiety and depression every trimester.

PMAD happens more often than Gestational Hypertension or Gestational Diabetes

We screen for PMAD, just like we screen for hypertension and diabetes. And like hypertension and diabetes, untreated PMAD increases our chances of pregnancy complications including: preterm birth, small babies, and neurobehavioral disturbances in childhood.

How do we treat PMAD?

Treatment includes counseling, social support, relaxation techniques, sleep, exercise, diet and supplements, as well as medication.

We have more safety data on the most common class of medication for anxiety and depression (selective serotonin reuptake inhibitors, SSRIs) than any other medication prescribed in pregnancy, other than prenatal vitamins.

The risk to the baby of untreated PMAD is greater than the risk of medication.

The way we treat PMAD is a personal choice, a decision we make together. Often the approach is a combination of strategies. Most of the non-medical treatments are valuable tools for all of us to build resilience. Resilience is the ability to cope with difficult or challenging life experiences. Like a new baby!

The best thing we can do for our children is be well.

If you think you or a loved one may be dealing with a PMAD, please call us at 406-300-4511. In case of emergency or a mental health crisis, call 911 or the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262).


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