Perinatal Mood & Anxiety Disorder (PMAD)

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About PMAD

Overview of Symptoms for Perinatal Mood and Anxiety Disorder (PMAD)

Discover the signs and symptoms of different perinatal mood and anxiety disorders:

  • Are you feeling sad or depressed?
  • Do you feel more irritable or angry with those around you?
  • Are you having difficulty bonding with your baby?
  • Do you feel anxious or panicky?
  • Are you having problems with eating or sleeping?
  • Are you having upsetting thoughts that you can’t get out of your mind?
  • Do you feel as if you are “out of control” or “going crazy”?
  • Do you feel like you never should have become a mother?
  • Are you worried that you might hurt your baby or yourself?

Any of these symptoms, and many more, could indicate that you have a form of perinatal mood or anxiety disorder, such as postpartum depression. While many women experience some mild mood changes during or after the birth of a child, 15 to 20% of women experience more significant symptoms of depression or anxiety.

Please know that with informed care you can prevent a worsening of these symptoms and can fully recover. There is no reason to continue to suffer.

Women of every culture, age, income level and race can develop perinatal mood and anxiety disorders. Symptoms can appear any time during pregnancy and the first 12 months after childbirth. There are effective and well-researched treatment options to help you recover. Although the term “postpartum depression” is most often used, there are actually several forms of illness that women may experience.


Postpartum Depression versus “The Baby Blues"

The term “baby blues” is often used to refer to the mild mood swings occurring after the birth of a child. Many women can relate to the emotional roller coaster that dominates the first few weeks after a baby is born— who wouldn’t be a mess? Sore, sleep deprived, in a totally new role (even if this is not your first child), a mother’s hormones are imbalanced and she has little time to take care of herself.

The baby blues are common – they are something nearly 80% of women experience. Perinatal mood and anxiety disorders are also common, but require treatment.

So how do you know if you or a loved one is experiencing baby blues or something more serious?

Perinatal Mood and Anxiety Disorders

  • Have an onset any time during pregnancy until two years after the baby is born and symptoms last longer than three weeks.
  • The highest time of risk is six months after childbirth.
  • Symptoms can include excessive worry, sadness, guilt, hopelessness, sleep problems, fatigue, loss of interest in normally pleasurable activities, change in appetite, irritability and difficulty making decisions.

Baby Blues

  • Baby blues usually begin a few days postpartum and last about three weeks.
  • Symptoms include moodiness, tearfulness, anxiety, inability to concentrate and sadness.
  • These feelings come and go but the predominant mood is happiness.


Depression During Pregnancy & Postpartum

Depression during and after pregnancy occur more often than most people realize. Depression during pregnancy is also called antepartum or prenatal depression, and depression after pregnancy is called postpartum depression.

Approximately 15% of women experience significant depression following childbirth. The percentages are even higher for women who are also dealing with poverty, and can be twice as high for teen parents. Ten percent of women experience depression in pregnancy. In fact, perinatal depression is the most common complication of childbirth.


Symptoms can start anytime during pregnancy or the first year postpartum. They differ for everyone, and might include the following:

  • Feelings of anger or irritability
  • Lack of interest in the baby
  • Appetite and sleep disturbance
  • Crying and sadness
  • Feelings of guilt, shame or hopelessness
  • Loss of interest, joy or pleasure in things you used to enjoy
  • Possible thoughts of harming the baby or yourself

Risk Factors

It is important to know the risk factors for antepartum and postpartum depression. Research shows that all of the things listed below put you at a higher risk for developing these illnesses. If you have any of these factors, you should discuss them with your medical provider so that you can plan ahead for care should you need it.

  • A personal or family history of depression, anxiety, or postpartum depression
  • Premenstrual dysphoric disorder (PMDD or PMS)
  • Inadequate support in caring for the baby
  • Financial stress
  • Marital stress
  • Complications in pregnancy, birth or breastfeeding
  • A major recent life event: loss, house move, job loss
  • Mothers of multiples
  • Mothers whose infants are in Neonatal Intensive Care (NICU)
  • Mothers who’ve gone through infertility treatments
  • Women with a thyroid imbalance
  • Women with any form of diabetes (type 1, type 2 or gestational)

Postpartum and antepartum depression are temporary and treatable with professional help. If you feel you may be suffering from one of these illnesses, know that it is not your fault and you are not to blame. 


Anxiety During Pregnancy & Postpartum

Approximately 6% of pregnant women and 10% of postpartum women develop anxiety. Sometimes they experience anxiety alone, and sometimes they experience it in addition to depression.


  • Constant worry

  • Feeling that something bad is going to happen
  • Racing thoughts
  • Disturbances of sleep and appetite
  • Inability to sit still
  • Physical symptoms like dizziness, hot flashes, and nausea

Risk Factors

Risk factors for perinatal anxiety and panic include a personal or family history of anxiety, previous perinatal depression or anxiety, or thyroid imbalance.

In addition to generalized anxiety, there are some specific forms of anxiety that you should know about. One is Postpartum Panic Disorder. This is a form of anxiety with which the sufferer feels very nervous and has recurring panic attacks. During a panic attack, she may experience shortness of breath, chest pain, claustrophobia, dizziness, heart palpitations, and numbness and tingling in the extremities. Panic attacks seem to go in waves, but it is important to know that they will pass and will not hurt you.

Another form of anxiety is Postpartum Obsessive Compulsive Disorder.

Postpartum and antepartum anxiety are temporary and treatable with professional help. If you feel you may be suffering from one of these illnesses, know that it is not your fault and you are not to blame.


Postpartum Obsessive-Compulsive Disorder

Postpartum Obsessive-Compulsive Disorder (OCD) is the most misunderstood and misdiagnosed of the perinatal disorders. You do not have to be diagnosed with OCD to experience these common symptoms of perinatal anxiety. It is estimated that as many as 3-5% of new mothers and some new fathers will experience these symptoms. The repetitive, intrusive images and thoughts are very frightening and can feel like they come “out of the blue.” Research has shown that these images are anxious in nature, not delusional, and have very low risk of being acted upon. It is far more likely that the parent with this symptom takes steps to avoid triggers and avoid what they fear is potential harm to the baby.


  • Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images related to the baby. These thoughts are very upsetting and not something the woman has ever experienced before.
  • Compulsions, where the mom may do certain things over and over again to reduce her fears and obsessions. This may include things like needing to clean constantly, check things many times, count or reorder things.
  • A sense of horror about the obsessions
  • Fear of being left alone with the infant
  • Hypervigilance in protecting the infant
  • Moms with postpartum OCD know that their thoughts are bizarre and are very unlikely to ever act on them.

Risk Factors

Risk factors for postpartum OCD include a personal or family history of anxiety or OCD.

Postpartum OCD is temporary and treatable with professional help. If you feel you may be suffering from one of these illnesses, know that it is not your fault and you are not to blame.


Postpartum Post-Traumatic Stress Disorder

Approximately 9% of women experience postpartum post-traumatic stress disorder (PTSD) following childbirth. Most often, this illness is caused by a real or perceived trauma during delivery or postpartum. These traumas could include:

  • Prolapsed cord
  • Unplanned C-section
  • Use of vacuum extractor or forceps to deliver the baby
  • Baby going to NICU
  • Feelings of powerlessness, poor communication and/or lack of support and reassurance during the delivery
  • Women who have experienced a previous trauma, such as rape or sexual abuse, are also at a higher risk for experiencing postpartum PTSD.
  • Women who have experienced a severe physical complication or injury related to pregnancy or childbirth, such as severe postpartum hemorrhage, unexpected hysterectomy, severe preeclampsia/eclampsia, perineal trauma (3rd or 4th degree tear), or cardiac disease.


  • Intrusive re-experiencing of a past traumatic event (which in this case may have been the childbirth itself)
  • Flashbacks or nightmares
  • Avoidance of stimuli associated with the event, including thoughts, feelings, people, places and details of the event
  • Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response)
  • Anxiety and panic attacks
  • Feeling a sense of unreality and detachment

Postpartum Post-Traumatic Stress Disorder is temporary and treatable with professional help. If you feel you may be suffering from one of these illnesses, know that it is not your fault and you are not to blame.


Bipolar I and Bipolar II Perinatal Mood Disorders

There are two phases of a bipolar mood disorder: the lows and the highs. The low time is clinically called depression, and the high is called mania or hypomania. Many women are diagnosed for the first time with bipolar depression or mania during pregnancy or postpartum. In Bipolar 2, the manic episode is less apparent; the highs and lows are not as extreme, and sometimes it is more apparent to friends and families than to the individual going through the phases.

The criteria for a diagnosis of a bipolar mood disorder is that the symptoms last longer than four days and interfere with functioning and relationships. Sometimes the ups and downs seem to happen at almost the same time; this confusing state is called a mixed episode. These cycles and emotional states are more than the moodiness of pregnancy or postpartum. For many women, pregnancy or postpartum might be the first time she realizes that she has bipolar mood cycles.

Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. These symptoms present a high risk and must be treated immediately. In an emergency, click here for information.

Bipolar disorder can look like a severe depression or anxiety.

In pregnant and postpartum women, a bipolar depression can look just like a very severe depression, or might be experienced as anxiety. It is very important that your mood history is reviewed to assess whether you have had times of a persistently elevated mood, decreased need for sleep, and periods of over-average productivity. There is a very high risk of increased severity if you are treated only for depression, but have the potential to move into a manic or hypomanic part of your cycle.


Bipolar I Mood Disorder

  • Periods of severely depressed mood and irritability
  • Mood much better than normal
  • Rapid speech
  • Little need for sleep
  • Racing thoughts, trouble concentrating
  • Continuous high energy
  • Overconfidence
  • Delusions (often grandiose, but including paranoid)
  • Impulsiveness, poor judgment, distractibility
  • Grandiose thoughts, inflated sense of self-importance
  • In the most severe cases, delusions and hallucinations

Bipolar II Mood Disorder

  • Periods of severe depression
  • Periods when mood much better than normal
  • Rapid speech
  • Little need for sleep
  • Racing thoughts, trouble concentrating
  • Anxiety
  • Irritability
  • Continuous high energy
  • Overconfidence

It is essential to consult an informed professional with experience and training in mental health assessment and treatment during pregnancy and postpartum. Each woman’s situation is different, but it is best practice to consult before pregnancy and to have a treatment plan in place. There is a growing body of research that explores the risk-benefit balance of using mood stabilizers during pregnancy and breastfeeding.

Please visit Postpartum Support international’s page listing perinatal medication resources for more information.

Risk Factors

Risk Factors for Bipolar Mood Disorder are family or personal history of bipolar mood disorder (also called manic-depression).



Postpartum Psychosis is a rare illness, compared to the rates of postpartum depression or anxiety. It occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately .1 -.2% of births. The onset is usually sudden, most often within the first 2 weeks postpartum.


Symptoms of postpartum psychosis can include:

  • Delusions or strange beliefs
  • Hallucinations (seeing or hearing things that aren’t there)
  • Feeling very irritated
  • Hyperactivity
  • Decreased need for or inability to sleep
  • Paranoia and suspiciousness
  • Rapid mood swings
  • Difficulty communicating at times

The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode.

Of the women who develop a postpartum psychosis, research has suggested that there is approximately a 5% suicide rate and a 4% infanticide rate associated with the illness. This is because the woman experiencing psychosis is experiencing a break from reality. In her psychotic state, the delusions and beliefs make sense to her; they feel very real to her and are often religious. Immediate treatment for a woman going through psychosis is imperative.

It is also important to know that many survivors of postpartum psychosis never had delusions containing violent commands. Delusions take many forms, and not all of them are destructive. Most women who experience postpartum psychosis do not harm themselves or anyone else. However, there is always the risk of danger because psychosis includes delusional thinking and irrational judgment, and this is why women with this illness must be quickly assessed, treated, and carefully monitored by a trained healthcare perinatal mental health professional.

Postpartum psychosis is temporary and treatable with professional help, but it is an emergency and it is essential that you receive immediate help. If you feel you or someone you know may be suffering from this illness, know that it is not your fault and you are not to blame. Call your doctor or an emergency crisis hotline right away so that you can get the help you need.


Suicide Prevention

Emergency Hotlines are available all the time. It is very important that you reach out right now and find the support and information you need to be safe.

Reliable resources to contact in a crisis:

SLO Hotline | 800-783-0607

  • A confidential mental health support, crisis and suicide prevention telephone line which also provides mental health resource information.

National Suicide Prevention Hotline | 800-273-8255

  • Call for yourself or someone you care about; free and confidential; network of more than 140 crisis centers nationwide; available 24/7


Paternal Depression and Anxiety

Recent studies have shown that up to 10% of fathers and partners experience paternal depression or anxiety.

PMAD in mothers has been linked to traumatic birth experiences, hormonal changes, thyroid problems, vitamin D deficiencies, previous history of mental illness and many other factors.

So why are men and partners affected?

While men and partners may not experience the full spectrum of biological and hormonal changes or other factors impacting mothers, they are experiencing a change in their role and a major life change. The pressure and desire to be a good parent and the dramatic life change can bring on paternal postnatal depression (PPND). Plus, dads and partners also experience the lack of sleep, the frustration of trying to soothe a fussy baby and the fear of making a mistake.

Other factors of the partner experience can contribute to paternal depression and anxiety, including the change of family dynamics that lead to feelings of exclusion from the parenting role, additional financial stress and family responsibilities, unmet expectations for resumption of the sexual relationship, the impact of changing social roles for fathers and partners in the family and, for men specifically, reduced likelihood of talking about feelings due to socialized ideas about masculinity. If a mother is experiencing a PMAD, her partner’s risk to develop one also is twice as high.

While much is to be learned about paternal depression, one thing is sure: It is important to get help. Studies have shown untreated paternal depression leads to marital and relationship problems, increased conflict in the home and decreased bonding with the baby.


  • Being easily stressed
  • Fatigue
  • Feeling discouraged, depressed
  • Impulsiveness and reckless behavior
  • Increased alcohol consumption
  • Increased anger and conflict
  • Irritability
  • Isolating from family and friends
  • Loss of interest in work, hobbies or sex
  • Misuse of prescription medication
  • Physical complaints like headaches, stomach problems
  • Problems with concentration and motivation
  • Suicidal thoughts
  • Violent behavior
  • Weight loss without dieting
  • Working constantly


Guidance For Family and Friends

You may be worried that someone you care about is suffering from a Perinatal Mood or Anxiety Disorder (PMAD). PMAD can threaten the mother’s and her partner’s health, relationship, friendships and careers, as well as the baby’s welfare. Thankfully, PMAD can be temporary and are treatable with professional help and support from loved ones.

Please know that the person with depression or anxiety is not to blame for this illness and that she or he is just as surprised by what is happening to them as you are. Pregnancy and the months following childbirth are a stressful time of life, but friends and family can offer practical support. Be there, be involved.

Ways that you can help and feel useful, needed, and involved:

  • Allow mom and her partner to openly express their feelings. Appreciate that her partner may also be emotionally affected by the demands and challenges of new parenthood.

  • Accept their need to cry.
  • Ask mom and her partner how you can help in the best way, or provide some of the following suggestions:
    • Providing meals, doing laundry and housework, running errands and babysitting so that they can have a break.
  • Encourage mom and her partner to find a compassionate health professional to talk to.
  • Offer to drive or go with them to an appointment for added support.
  • Support her/him in seeking and pursuing treatment (therapy, medication, support group, exercise, eating well, etc.)
  • Educate yourself about perinatal depression & anxiety.
  • Be patient. You may need to talk to someone for support.
  • Encourage activity. Suggest going for a walk together, out to dinner, watching a movie, etc.
  • Assure the parent that she/he is doing their best and point out ways you see she/he is doing a good job. (Be specific, like: “I love how you smile at the baby.”
  • Tell the parent their situation isn’t her/his fault and not to place blame.

What does not help:

  • Criticizing or judging. These actions make mom feel guilty and ashamed. It’s not her fault.

  • Denying the problem. Saying things like, “You should be happy to have this baby” will not make her/his feelings go away, it will only make mom and her partner feel worse about the situation.
  • Telling mom or her partner to “snap out of it”. This will make them feel as if they have control over their situation, which is not the case. If they could “snap out of it”, they definitely would. Perinatal depression & anxiety are not due to lack of mental strength.
  • Withdrawing your support. This action will only make mom or her partner feel rejected, and they need to know that you accept her or him, no matter what happens.
  • Telling mom or her partner what to feel and what not to feel. They need you to accept and validate their feelings, whatever they are.


Talk with Someone Who Understands

Local help from Pregnancy & Parenting Support of San Luis Obispo is here to listen and put you in touch with nearby professionals who can help. Services are free and available in English and Spanish.

Note that this is not an emergency or hotline service. If you or someone you know needs emergency attention, please contact one of the crisis hotlines below or visit your nearest emergency room. All phone calls, messages and emails will be answered within 24 hours. Also note that PSI volunteers are not clinicians or physicians, and cannot diagnose.

Call or text | 805-541-3367
Email | [email protected]


Crisis Hotlines: For Immediate Help


Help for Parents & Families

Use this directory of SLO County perinatal resources below to find the help you need. Please be sure to reach out ahead to confirm details before going to any in-person classes or events.

Please note: Listings do not constitute or imply an endorsement by the Public Health Department.

Pregnancy and Parenting Support of San Luis Obispo County | 805-541-3367 | [email protected] 

  • Services are free and available in English and Spanish. PPS provides emotional support, practical assistance (e.g. maternity and baby clothes, prenatal vitamins, diapers, wipes, formula and baby food, baby equipment, car seats and installation) and loving connections to community resources. PPS also accepts donations of gently used baby items to be repurposed and gifted to local families in need. 

Parent Connection, Center for Family Strengthening  

  • Parent Coaching and a variety of parent education classes and support groups designed to meet the unique needs of each community.  
    • 805-543-3700 (Coordinator & Parent Coach Line)  
    • 805-462-7135 SLO & South County Parent Coach (Habla Español)  
    • 805-904-1411 North County Parent Coach  
    • 805-712-5038 North County Parent Coach (Habla Español) 

The Link Family Resource Center  

  • Community centers in Atascadero and Paso Robles that link families to family advocates, parent coaches, classes and other services, including for Spanish speakers. (Habla Español)  
    • 805-466-5404 (Atascadero Family Resource Center)  
    • 805-238-2775 (Paso Robles Family Resource Center) 

Parent Participation Program (SLO and North Coast) | 805-549-1222  

  • Parent-child playtime provided for a fee by the San Luis Coastal Unified School District Adult School. Addresses multiple issues related to parenting in a fun and safe atmosphere. Ages 0-5. (San Luis Obispo, Los Osos, Morro Bay)

Parent Participation Program (Southern SLO County) | 805-474-3900  

  • Children and their parents enjoy songs, creative movement, fingerplays, art experiences, painting, exploring new environments, outside play and field trips. Facts, fun and family are the goals of this course. Ages 0-5. (Five Cities)

Preparing for Childbirth Education for Life | Bishop’s Peak Women’s Health Center | 805-548-0606 

  • Call to sign up for prenatal and postpartum group classes with a childbirth educator, labor and birth doula, and lactation educator.

Group Prenatal | Santa Lucia Birth Center | 805-548-0606 

  • Call to sign up for class. Topics include nutrition, stress management, exercise, baby basics, and breastfeeding. 

Community Counseling Center | 805-543-7969  

  • The CCC provides a sliding scale payment structure, based on the client’s income. All prenatal and postpartum mood disorder clients work with a PSI-trained clinician. 

Postpartum Support International offers an extended array of free online support groups for mood support. 

The Mommy Hour: Emotional Health Support During Pregnancy and Postpartum | French Hospital | 805-541-2229 | [email protected] 

Moms FIRST - Virtual | 805-574-4244 | [email protected]   

  • Welcoming support group is here for you whether you are looking for resources, seeking support,   struggling with anxiety and/or depression. Contact via email for meeting details. 

Moms Club of Atascadero | [email protected] 

Navigating Motherhood Support Group: Birth & Beyond | Twin Cities Hospital | 805-434-4644  

  • Interactive support group for mothers dealing with pregnancy and postpartum depression and anxiety issues. Register on Twin Cities Hospital website. 



Information for Health Care and Service Providers

Postpartum depression is the most under-diagnosed obstetric complication in the U.S. (Earls, 2010)

Whether you’re an obstetrician, pediatrician, therapist, counselor, psychiatrist, general practitioner, social worker, lactation consultant, labor and delivery nurse, community leader or any professional who interfaces with new and expecting parents, it is imperative to know the symptoms and treatment options of perinatal mood and anxiety disorder (PMAD). Over 15 percent of births in San Luis Obispo County are associated with prenatal and postpartum mood disorders. That means, of the mothers a SLO County professional treats, one in seven suffers.


Screening Recommendations

PMAD SLO and the San Luis Obispo Department of Public Health, Maternal Child & Adolescent Health (MCAH) recommend universal screening for the presence of prenatal or postpartum mood and anxiety disorders, using an evidence-based tool.


Screening Tools

Tools like the Edinburgh Postnatal Depression Screen (EPDS) or Patient Health Questionnaire (PHQ-9) are validated, free to use, available in multiple languages, and screen for anxiety in addition to depression symptoms and suicidal thoughts. The recommended cut-off score for a positive screen using either tool is 10. The EPDS is a reliable and valid measure of mood in fathers. Screening for depression or anxiety disorders in fathers requires a two-point lower cut-off than screening for depression or anxiety in mothers, and we recommend this cut-off to be 5/6. (Matthey, 2001)



Ideal practices include screening at:

  • First prenatal visit

  • At least once in second trimester
  • At least once in third trimester
  • Six-week postpartum obstetrical visit (or at first postpartum visit)
  • Repeated screening at 6 and/or 12 months in OB and primary care settings
  • 1, 2, 4 and 6-month pediatric visits



Postpartum Support international recommends universal screening in prenatal, postnatal, and pediatric settings. Settings for maternal mental health screening may include but are not limited to: health care providers (primary care, OB, midwifery, and pediatric), public health, addictions and mental health, community social services, and early childhood programs.



Screening must exist in a system of care that includes educated providers, social support for families, and a protocol to follow up with those who have screened above the cut-off score (10) on an evidence-based screening tool, aligned with the ACOG and USPSTF recommendations.

Please contact us for help on how to build your practice into an integrated system of care that can follow up with patients and clients who screen over 10 on the EPDS or PHQ self-assessment tools


Certifications & Training

Multiple certifications and training opportunities exist for clinicians and professionals who serve those suffering with perinatal mood and anxiety disorders. Find additional options, including advanced psychotherapy and psychopharmacology, on the Postpartum Support International website


Perinatal Mental Health Training for Frontline Providers (see website for requirements)

  • Obstetricians/gynecologists, family practice physicians, internists, nurse practitioners, midwives, physician’s assistants, nurses are the first, and often the only, provider to which new moms turn. Are you ready to respond with effective and well-researched treatment options to help them get better?
  • Designed to equip frontline healthcare providers with the skills necessary to assess patients for perinatal mental health complications and, as appropriate, provide treatment with medication(s) or connect individuals with additional resources and care. Discounts for group registration. One-day online or in-person training.

Certification in Perinatal Mental Health (see website for schedule)

  • Postpartum Support International’s Perinatal Mental Health Certification Program creates a structure for professional education and evaluation, and a standardization of training and experience to inform families and payers of perinatal mental health specialists. The certification curriculum requirements build on existing evidence-based perinatal mental health certificate trainings, adding an advanced-training component.

PSI 2-day Perinatal Mood Disorders: Components of Care Course (see website for schedule)

  • PSI has developed an internationally recognized unique evidence-based training program for health providers and social support networks. The 2-day PSI Certificate of Completion Course, taught by experienced and engaging faculty, is a thorough and evidence-based curriculum designed for nurses, physicians, social workers, mental health providers, childbirth professionals, social support providers, or anyone interested in learning skills and knowledge for assessment and treatment of perinatal mood disorders. Registration includes training binder, handouts, breakfast and lunch, and continuing education credits. Approved for CMEs, CNEs, and CEs.

Maternal Mental Health Webinar Certificate Course by PSI and 2020 Mom

  • PSI and 2020 Mom present a Maternal Mental Health Certificate Training for Mental Health and Clinical Professionals. This online webinar series includes eight live sessions, small group discussions, supplemental reading materials, 16 continuing education credits (where applicable), and a certificate of completion.


Consult Lines

The PSI Perinatal Psychiatric Consultation Line is staffed by reproductive psychiatrists who are members of Postpartum Support International and specialists in the treatment of perinatal mental health disorders. The consultation line is available only to medical professionals who have questions about the mental health care related to pregnant and postpartum patients and pre-conception planning.

This service is free and available by appointment.

To schedule a phone conversation with a reproductive psychiatrist, please complete this form, and a PSI scheduler will be in touch to set the appointment.


Medication Interaction

The following provide information and research on drug safety during pregnancy and lactation.

Mother to Baby |  866-626-6847

  • MotherToBaby, a service of the non-profit Organization of Teratology Information Specialists, is dedicated to providing evidence-based information to mothers, health care professionals, and the general public about medications and other exposures during pregnancy and while breastfeeding. MotherToBaby affiliates support and contribute to worldwide initiatives for teratology education and research.

Infant Risk Center | 806-352-2519

  • The InfantRisk Center at Texas Tech University Health Sciences Center is a call center based solely on evidence-based medicine and research. We are dedicated to providing current and accurate information to pregnant and breastfeeding mothers and healthcare professionals. We are a training center for medical and pharmacy students and medical residents in the use of drugs in pregnant and breastfeeding mothers.

Massachusetts General Hospital (MGH) Women’s Mental Health

  • The MGH Library on Women’s Mental Health is a repository of useful information and frequently referenced articles compiled into different specialty areas, including psychiatric disorders during pregnancy and postpartum.


Multi-Language Resources for Professionals

Spanish: PSI Links and Materials

French: Societe Marce Francophone

German: Marce Gesellschaft


Medline Plus Postpartum Depression Resources (Postpartum Depression Information in 15 languages, included Arabic, Japanese, Korean, Chinese, Vietnamese, Russian and Somali)

Maternal & Child Health Library, Non-English Language Resources

University of California, San Francisco, Depression Prevention Course (Muñoz) (Workbooks available in Spanish, Japanese, Chinese, English)

Here to Help (British Columbia Partners for Mental Health and Addictions Information. Publications available in Arabic, Chinese, English, Farsi, French, Korean, Punjabi, Russian, Spanish, Japanese, Vietnamese)


Contact Us

County of San Luis Obispo Public Health Department
Maternal & Child Health (MCH) team

Contact us online or call 805-781-5500. 


After having a baby, most women experience changes in their mood. One minute you feel happy, the next minute you may start to cry. You may feel sad, have a hard time concentrating, lose your appetite or find that you can’t sleep well even when the baby is asleep. These symptoms usually start about 3 to 4 days after delivery and may last several days.

New mothers who are experiencing these symptoms have what are called the “baby blues”. The baby blues are considered a normal part of early motherhood and usually go away within a couple weeks after delivery.

However, some women have more severe symptoms or symptoms that last longer than a few days. This is called postpartum depression.

Support groups can be helpful places where you can talk with others who understand what you are experiencing, and meet people who have recovered. Groups associated with PSI are led by facilitators who encourage members to share non-judgmental support and suggestions for recovery, if requested. You will have the option of sharing or simply listening to others. Support groups are not a substitute for professional care; they are places to connect with others who understand and give encouragement.

Online therapy or therapy over the phone are options for treatment. As with all therapists, remember that you have the right and responsibility of asking about the therapist’s qualifications, training, approach to treatment, and confidentiality policies.

Work with an informed provider who prescribes medication to weigh the benefits and risks of the medications versus your symptoms of depression and anxiety.

Use our resource directory to find informed health care professionals in your area. You can also ask your doctor.

Most new mothers – experts estimate about 80% — experience mood swings and weepiness during the first 2-3 weeks after giving birth. Sometimes called “the baby blues”, this is a normal adjustment period and resolves without any medical assistance.

It varies for each woman. Some women feel better within a few weeks, but others feel depressed or “not themselves” for many months. The important thing is that postpartum depression is treatable. The sooner a woman begins treatment the sooner she will begin to feel better.

Remember, help is available and with treatment, you can feel better.

Unlike chicken pox or measles, perinatal mood and anxiety disorders have no defined time frame. It is different for every woman and it depends on many things, including access to support and informed health care professionals. Every perinatal mood disorder, no matter how strong the symptoms are, is temporary and treatable.

Yes it is related. PPD is a term that most people use to describe postpartum emotional distress, but many pregnant and postpartum moms have mostly anxiety-related symptoms – feeling irritable, agitated, or overwhelmed — without primary depression. Perinatal anxiety might include insomnia, low appetite, fears and worries, restlessness, and physical symptoms such as dizziness, rapid heartbeat, or aches and pains. Anxiety is a real condition, and it is completely treatable.

The best medication to treat your symptoms should be decided during a conversation with your informed medical caregiver. Medications work individually with each person, so what works well for one may not work as well for another.

If you have any questions about your reaction to medication, you should contact your provider and ask about it.

You might experience side-effects, especially when your body is adjusting to the medication in the first few weeks, but you should not feel worse on medication. Experts say that if you have previously had a successful experience with medication, you might consider starting with that one. The best medication is the one that works for you and your individual situation.

Women do breastfeed and take medication. It is a decision best made between the mother and a provider who is informed on the latest research about using medication during pregnancy and breastfeeding.

If your company has a Human Resources department, you can let them know of your situation with a doctor’s note. If you are fortunate you might also find support there. It is not a requirement to tell your boss or anyone at work. You can tell them that every perinatal mood disorder is treatable and you are getting help. If you need it, you or a partner might be able to use Family Medical Leave so that you can focus on recovery.

Exercise, massage, meditation or other techniques designed to relieve tension and stress can bring relief and be part of your wellness plan. Good nutrition and adequate rest will also be helpful. If you are using complementary and traditional medicines, you should make sure that all of your providers know about any medicines or remedies you are taking. You need to work with them to make sure that different treatments will work well together.

Deciding if you need medication is a decision best made between you and your medical professional. Several medications are available to treat the symptoms of perinatal depression and anxiety. Some women take medication during pregnancy and while breastfeeding.

Postpartum depression or PPD are most commonly used to describe mood changes after a woman has a baby. However, postpartum depression is not the only disorder that women experience during the perinatal period. There are other disorders such as postpartum anxiety and OCD that can also occur during this time. The term ‘perinatal mood disorders’ includes all of these illnesses. 

There is no one cause for perinatal mood and anxiety disorders. Women who develop depression or anxiety around childbearing have symptoms that are caused by a combination of psychological, social, and biological stressors. Hormonal fluctuations cause reactions in sensitive women. Risk factors do include a personal or family history of mood or anxiety disorders such as depression, anxiety, bipolar disorder (manic-depressive), and sensitivity to hormonal changes. Developing a perinatal mood and anxiety disorder is not your fault. You did not do anything to “get” this.

You might look like you’re doing better than you feel, and you can explain that to friends and family. You can explain that some people call postpartum depression “the smiling depression” because moms often try to put on a happy face even when they feel depressed.

You don’t need to tell anyone about your illness unless you are comfortable doing so. If you feel comfortable opening up, you may start out with saying things are more difficult than expected; that even though you don’t have any outward signs to point to like a broken leg, you aren’t feeling like yourself and do appreciate their support.

Perinatal means the period “all around” birth. We use it to mean the period of time all throughout pregnancy as well as the baby’s first year.

Many therapists and psychiatrists offer a sliding scale for self-pay patients without insurance. Some may also be willing to work out a payment plan. Don’t be afraid to ask about adjusting the fee. Many medications are available in an affordable generic form. There may also be cost-participation clinics in your area through which you may qualify for free treatment. Contact the SLO Hotline for help in locating these resources near you.

Yes, during pregnancy or postpartum, approximately 1 out of every 7 women experiences significant depression, anxiety, intrusive repetitive thoughts, panic, or post-traumatic stress. Some women experience symptoms of a bipolar depression, which is a cyclical, deep depression with periods of very high energy, decreased need for sleep, and changing moods (mania). These reactions can also occur with miscarriage, abortion, stillbirth or infant loss. The least common reaction is postpartum psychosis, which occurs after 1 or 2 per thousand births. In the news and on TV, postpartum psychosis is often called depression, but it is a separate and unique illness.

Telephone support is receiving support and information, being listened to, validated, and understood. It’s not meant to be a substitute for professional care; it is a way to connect with someone who understands and gives encouragement. A warm-line is set up so that you can leave a message and a trained volunteer or staff person will call you back. Many states have organizations with warm-lines, and most have the goal of returning calls within 24 hours.

Treatment plans are different for each woman, but might include increased self-care, social support, talk therapy or counseling, and treatment of symptoms, with medication when necessary.

  • Self-care includes proper rest, good nutrition, assistance with baby and other children, and caring for personal needs such as exercise, relaxation, or time with a partner/spouse.
  • Social support includes talking with others — either on the telephone, online, or at a support group — who understand and provide encouragement.
  • Talking with a counselor or therapist who understands perinatal mood and anxiety disorders can be extremely beneficial.
  • Finally, medications are available to address both anxiety and depression.

Some women treat depression and anxiety with medication, some with natural remedies, some with diet and exercise, some with counseling, support groups, or spiritual practice and support. Many use all of them. Find what works best for you, make a plan of self-care, and stick to it. Learn about how to cope with depression and anxiety, and reach out to informed providers until you find the help you need.

She should reach out as soon as she can, and talk to supportive and informed people. She should start by talking to her care provider. Admitting there may be a problem is the most important step a mother can take for herself and her family. Some mothers find it helpful to write down symptoms and feelings prior to an appointment with their care provider. It may also be helpful to take a supportive person with her to the appointment.

If you need immediate help, please contact one of the national emergency services listed below. They are available all the time. It is very important that you reach out right now and find the support and information you need to be safe. Call for yourself or someone you care about; free and confidential; network of more than 140 crisis centers nationwide; available 24/7:

National Suicide Prevention & Crisis Lifeline

Call or Text: 988

It is hard to recognize or identify perinatal depression or anxiety for several reasons:

  • First, a new mother might not recognize depression or anxiety because she is tired, overwhelmed, or simply adjusting to life with a baby. Perhaps she thinks that this is just part of being a new mother. It’s hard for new moms and families to know what normal mom stuff is and what is a symptom of depression or anxiety. We are afraid of being seen as complaining or not able to handle motherhood. We didn’t think it could happen to us. We tend to blame ourselves for not being able to handle things instead of realizing that it is a medical condition and not a sign of failure.
  • Second, moms and their families might feel ashamed or embarrassed. When the expected glow of pregnancy or postpartum does not arrive, mothers tend to blame themselves and feel embarrassed. They fear admitting to negative feelings during the perinatal period may lead to their children being taken away or they will be labeled as bad mothers.
  • Third, each woman experiences a unique situation and unique symptoms. Some new mothers are sad and teary; some feel overwhelmed and irritable; some bond well with their babies while others feel distant; some sleep all the time while others have insomnia. The up-and-down nature of symptoms also makes it difficult to recognize or admit perinatal depression or anxiety.