Navigating PMADs and Medication During the Perinatal Period: What Black Women Should Know

Pregnancy and motherhood are often portrayed as times of joy and fulfillment. But for many women, these life transitions come with emotional challenges. Perinatal mood and anxiety disorders (PMADs) affect many new and expectant mothers, yet they remain misunderstood—especially in Black communities, where stigma and systemic barriers can make seeking help even harder.

If you’re feeling overwhelmed, know that you’re not alone, and support is available.

Tiirini Hill, MSN, PMHNP-BC, a psychiatric nurse practitioner specializing in perinatal mental health

This month, Tiirini Hill, MSN, PMHNP-BC, a psychiatric nurse practitioner specializing in perinatal mental health, is sharing insights from her work with Black mothers navigating pregnancy, postpartum, and reproductive transitions. With expertise in traditional psychiatric care and integrative approaches, she helps individuals understand how medication, therapy, and lifestyle changes can work together to improve mental health. She also addresses some of the most common concerns she hears from Black mothers about PMADs and medication.

Recognizing When It’s More Than the Baby Blues

The baby blues are a normal adjustment period after childbirth, often lasting up to two weeks. Symptoms like mood swings, crying spells, and fatigue typically resolve on their own. However, if these feelings persist or intensify, it may be a sign of a PMAD, such as postpartum depression or anxiety.

Therapy is often a great first step, but for some, medication is also a necessary tool. Providers may use a depression screening tool like the PHQ-9, and if a score falls in the moderate to severe range, a combination of therapy and medication may be the most effective approach.

Medication’s Role in Healing After Loss or Infertility Challenges

Pregnancy loss, stillbirth, or infertility challenges bring deep grief, anxiety, and depression. Medication doesn’t erase these emotions but can reduce the intensity of overwhelming distress, making it easier to process and heal in a healthy way. Healing is not about getting over loss—it’s about finding support and tools to move forward at your own pace.

Coping With Intrusive Thoughts or Severe Anxiety

Intrusive thoughts, panic attacks, and severe anxiety are some of the most distressing symptoms of PMADs. Experiencing these thoughts does not reflect someone’s ability to be a good mother, and seeking support is an important step toward healing.

Resources like the 988 Mental Health Crisis Hotline and Postpartum Support International can connect people to providers who understand perinatal mental health.

Medication and Breastfeeding: What You Need to Know

Many mothers worry about the safety of antidepressants during pregnancy or breastfeeding. Most SSRIs (selective serotonin reuptake inhibitors) are considered safe, with no evidence of harm to babies, though some medications transfer slightly into breast milk. Working with a provider specializing in PMADs is key to ensuring up-to-date, research-based guidance on the safest options for both mother and baby.

Advocating for Yourself: Preparing for Appointments

Being prepared can help make the process of seeking medication treatment less overwhelming. Before an appointment, it helps to:

• List current medications and supplements

• Write down symptoms and concerns

• Prepare questions, such as:

• What side effects should I expect?

• How long will it take for the medication to work?

• Are there alternative treatments available?

Advocating for treatment doesn’t stop after the first appointment. If medication doesn’t seem effective or causes side effects that are difficult to manage, it’s important to communicate with a provider to explore adjustments.

Thinking About Stopping Medication?

If someone wants to stop taking medication, it’s best to do so under medical supervision. Stopping suddenly can lead to withdrawal symptoms or a relapse of depression or anxiety. Tapering off with a provider’s guidance is the safest option. If stopping medication doesn’t feel right, restarting is always an option.

Maternal Mental Health and Life Transitions

Trauma and Medication

A NICU stay, a traumatic birth, or medical complications can leave lasting emotional scars. If anxiety or depression lingers beyond two weeks postpartum, reaching out for professional support can help with regaining balance. Tools like the PHQ-9 or the Edinburgh Postnatal Depression Scale can help assess whether treatment, including medication, might be beneficial.

New Advances in PMAD Treatment

Most antidepressants take four to six weeks to reach full effect, but new treatment options are emerging. The FDA recently approved Zurzuvae, a medication that offers relief for postpartum depression in just days, with some women reporting improvement as early as day one or two.

Perimenopause and Mental Health

Many Black women experience more severe perimenopausal symptoms due to systemic health disparities. Mood swings, anxiety, and depression can intensify during this time. While lifestyle changes are a great first step, antidepressants or hormone replacement therapy (HRT) can also provide relief when needed.

Reproductive Challenges and Medication

For those navigating infertility, miscarriage, or infant loss, mental health care should be as individualized as medical treatment. Working with a provider who understands both integrative and traditional approaches can help create a care plan that supports emotional and physical well-being.

You Deserve Support

Black women are often expected to be strong, but true strength includes seeking help when needed. Mental health care is not a luxury—it’s a necessity. Whether through therapy, medication, or both, support is available.

You don’t have to suffer in silence. Reach out, advocate for yourself, and remember that you are never alone on this journey.

To take the next step in your mental health journey, schedule a consultation with Tiirini Hill, MSN, PMHNP-BC.

Schedule an appointment here