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More than just the baby blues: Understanding and treating mood disorders in pregnancy and early parenthood


Pregnancy and welcoming a child into the world can be some of the most joyous times in life. They can also be some of the most stressful.

“Pregnancy glow.” “A bundle of joy.” “No greater blessing.”

There are many positive, heartwarming terms for expectant mothers and fathers and their babies. And while pregnancy and early parenthood can be some of the most joyous times in people’s lives, they can also be some of the most stressful.

“The stigma is out there, because the common perception is that when are expecting a child or have a newborn, we should be happy,” says Dr. Albert Wu, a board-certified psychiatrist at Horizon Blue Cross and Blue Shield of New Jersey. “But in actuality, that’s not always the case. And like all forms of depression and anxiety, it’s not always easy to talk about or share with others.”

Pregnancy and early motherhood are marked by significant hormonal and life changes that can profoundly affect mental and emotional health. Many people have heard about postpartum depression (PPD), which can arise post-birth. But in recent years, medical professionals have taken a closer look at the broader scope of issues experienced by pregnant women and mothers. Perinatal Mood and Anxiety Disorder (PMAD) describes the array of mental, emotional and physical challenges that women may face both during and after pregnancy. 

PMAD encompasses everything from depression and anxiety (roughly 10 and 17 percent of new mothers, respectively) to more severe issues like the development of bipolar disorder and psychosis. 

The spectrum of severity: Baby blues vs. PMAD

Further complicating issues is a far less severe yet more common mood-altering postpartum phenomenon: the baby blues. 

The baby blues can include crying episodes, irritability, and sleep disturbance. All women are different, and some may feel the hormonal fluctuations and physiological developments that come with childbearing more acutely.

“Roughly 70 percent of new mothers will experience the baby blues,” says Dr. Wu. “Generally, this is not a long-lasting phenomenon. Symptoms don't interfere with daily activities. It typically goes away by itself.”

If you or someone you love begins to experience these symptoms, know first that you are not alone. Friends and loved ones will often ask a new mom who may be juggling a multitude of new tasks, “How can I help?” Not being timid about telling them can go a long way toward alleviating stress and anxiety.

If symptoms become more intense, last beyond a few weeks and start to impact daily functioning, however, it’s a different story. PMAD symptoms can include:

  • Ongoing depression
  • Inability to bathe or feed oneself or one’s baby
  • Changes in appetite, whether increased or decreased eating
  • Disrupted sleep
  • Loss of energy and/or interest
  • Guilt or shameful feelings
  • More significant symptoms: Thoughts about hurting oneself or harming the baby.

Those experiencing these more intense symptoms should also not hesitate to bring them to the attention of a health professional as soon as possible. Please refer to our Horizon Behavioral Health resources below. Postpartum Support International has also established a helpline for non-emergencies, available in both English and Spanish: 1-800-944-4773.

If symptoms involve thoughts about inflicting harm, seek immediate attention such as calling the National Suicide Prevention Hotline at 1-800-273-TALK (8255) or going to the emergency room.

Why screening for and diagnosis of PMAD is so important

Prompt diagnosis and treatment is important, as PMAD can have long-term effects on the well-being of mother, child and family if not addressed. Dr. Wu says, “In the short term, it could contribute to premature birth and lack of bonding. Long term, it could lead to issues with the baby’s overall development, including problems with communication, social skills and connection with others.”

Fathers and families are affected by PMAD, too. Outside stressors, such as concerns about financial pressures brought about by supporting a new baby, can cause fathers to develop mood symptoms.

Fortunately, the awareness of PMAD among medical professionals has increased. In January 2016 the US Preventative Service task force—an independent, volunteer panel of national experts in disease prevention and evidence-based medicine—recommended screening pregnant women and those who have recently given birth for depression and anxiety. This screening is now more common among obstetrician-gynecologists (OBGYNs), pediatricians and primary care doctors.

PMAD treatment

Treatment for PMAD depends on the severity. Dr. Wu explains that “Many people think that doctors are gung-ho about medication.”  He stresses that if symptoms are on the mild side, talk therapy is the first line of treatment. This type of counseling includes helping people develop coping skills/finding coping networks or other support networks. If symptoms are more severe, however, then doctors may also prescribe medication.

What Horizon is doing to help

Horizon is working with partners to help them diagnose, treat and support women with PMAD. Horizon Behavioral Health (HBH) is a network of more than 8,000 providers who offer a full range of mental health services to treat the whole person. HBH’s network has grown by 40 percent over the last two years and continues to grow in size and diversity to better serve our members. As part of our pledge to eliminate health disparities, we have also been partnering to address PMAD in communities of color.

Here are several options to help you find the care you need, when you need it:

  • If you would like to speak to someone who will point you in the right direction, any time day or night, just call Horizon Behavioral Services at 800-626-2212.
  • You can also visit Horizon’s doctor and hospital finder to search for in-network care.
  • Horizon CareOnline℠ enables eligible members to speak with licensed psychiatrists, psychologists and social workers via video or phone, 7 days a week between 7 a.m. and 11 p.m. You can read each doctor’s profile and patient reviews before selecting one for your care. Access Horizon CareOnline by logging in to our secure member portal at HorizonBlue.com or by downloading the HorizonBlue app. Don’t have the app? Just text GETAPP to 422-272. There is no charge to download the app, but rates from the wireless provider may apply.
  • Continuing a trend that grew significantly during the pandemic, Horizon offers behavioral health services virtually via its teletherapy program, in addition to in-person care. Teletherapy costs are covered through eligible members’ health plan, with either low or no co-pays.

Horizon Health News is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Horizon CareOnline is a service mark of Horizon Blue Cross Blue Shield of New Jersey.