Ask the Expert: The Worst Kept Secret

Understanding perinatal mood and anxiety disorder

By Melissa Snider

Let’s be real: Becoming a parent is terrifying! I remember the sweet baby snuggles after our first daughter’s birth, as well as the hard moments. Like sobbing when we were ordered back to the hospital for jaundice treatment the same day we’d been discharged. Reluctantly revealing to a friend about what might happen to my daughter due to my feelings of helplessness. Being deeply sleep-deprived during the darkest days of the year, unfamiliar with my leaky, squishy body. I felt completely alone.

What I—and up to 80 percent of other new moms—experienced is commonly referred to as the “baby blues.” The blues normally resolve within three weeks after giving birth, but one in seven new moms and one in ten new dads endure something more serious: a perinatal mood and anxiety disorder, or PMAD.

Normalizing the Conversation

Mood disorders can develop any time during pregnancy and for up to a year after giving birth. Symptoms of PMAD can manifest as depression, anxiety, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or bipolar disorder. Perinatal psychosis is a separate and rare, but very serious, disorder, affecting 1 in 1,000 and requiring immediate intervention.

Child and family therapist Jean Abrams is the clinical director of the Victor, Idaho, office of Teton Behavior Therapy. She and several other therapists in their practice are trained to identify and treat PMADs.

“Many mothers and fathers do not receive treatment for PMADs and frankly don’t even know what they’re experiencing most of the time,” says Abrams.

Symptoms vary depending on the type of mood disorder, but she says to watch for excessive crying, anger, irritability, changes in sleep patterns—like an inability to sleep or sleeping too much—changes in eating patterns, or frequent worrying. Dads may isolate themselves socially or experience acute disconnectedness from their partner or baby.

“If you are experiencing extreme thoughts like ‘I can’t do this’ or ‘I’m not fit to be a mom,’ there are concerns,” says Abrams, who adds that parents often minimize their difficult feelings. “There’s a perception that it’ll just go away and that [it] is just part of being a new parent, when that’s not necessarily the case.”

Charlotte Souter—Postpartum Support International (PSI) support coordinator for western Wyoming and Teton Valley, PSI Wyoming chair, and founder of the local organization It Takes a Valley—is a two-time survivor of perinatal anxiety disorder. Souter says it’s easy for parents to blame themselves for things they cannot control or to think they’re alone in their experience.

“You can get through it” on your own, she says, “but there are resources to help you move through [the feelings] more quickly and efficiently and with a healthier outcome.”

Mood disorders have no specific cause, but Abrams highlights certain risk factors. They include hormonal shifts during pregnancy, birth, and weaning from breastfeeding; traumatic birth experiences; hospitalization of a newborn; and domestic violence. Isolation from social circles, returning to work, and financial stressors can also trigger a PMAD.

A father’s risk increases if the mother is experiencing a mood disorder. It’s important to be transparent with your health care provider about your personal and family mental health history, as prior mood disorders can increase your risk of suffering a PMAD.

Seeking Support

A continuum of support awaits parents who reach out for help, explains Abrams. “Not everyone ends up needing medication, but some do. Medication can help bring you out of that darkness so you can do things like go to that support group or go to that therapy appointment.”

Souter says she first sought out medication and therapy, and then incorporated a daily mindfulness practice. Finally, she shared her personal experience with the community, which she found healing both for herself and for others.

“I think it’s important to share our stories,” she says. “It’s not just mothers who feel like this, it’s fathers, adoptive parents, foster parents, and grandparents who are acting in a parent role, too.”

Although Souter suffered anxiety with her first child, it wasn’t until her second child was six months old that she had a panic attack, compelling her to seek the treatment she needed. If a parent develops PMAD once, the likelihood of it happening again is high. However, Souter points out, “If you experience [PMAD] with your first birth and you get help, you’ll know how to handle it in your second birth.”

Abrams says parents often struggle to admit when they need help. “It goes back to that stigma that motherhood or parenthood should be joyful and filled with loving moments. And if it’s not, you hide it.”

Abrams and Souter agree that partners are often the first to notice a shift in their loved one’s behavior. Souter says it can be tough to point out a partner’s abnormal behavior, but it’s essential to be honest.

Friends, doulas, midwives, pediatricians, OB-GYNs and other medical professionals all carry the responsibility of recognizing unhealthy behaviors and thoughts in new parents. Friends can help by paying close attention and going beyond “How are you?” to asking, “How are you, REALLY?”

Abrams says it’s best for friends to make themselves available to help. Whether offering to bring a meal on a certain day or scheduling a walk, think of tangible ways to express support and to encourage the parent to say yes to the help.

Reaching Out

If you suspect that you, a friend, or loved one is experiencing PMAD, start by calling a local practitioner. Souter will return any individual’s call or text within 24 hours and can connect them to resources that offer the treatment they need.

The bottom line, according to Souter and Abrams, is that a perinatal mood and anxiety disorder is a temporary experience. Souter reminds parents: “You are not alone. You are not to blame. With help, you will be well.”

Recommended Resources

  • Postpartum Support International,, 1-800-944-4773
  • Charlotte Souter, PSI Advocate for Western Wyoming,, 307-200-9328 (text or call)
  • It Takes a Valley,

Jackson Hole

Teton Valley