Postpartum Anxiety

What is postpartum anxiety?

Postpartum anxiety is when a person experiences severe anxiety after having a baby or becoming a parent (the postpartum period). These anxious feelings are often out of control and take over your thoughts. Some level of worry is expected after welcoming a new baby to your family. But, if you have postpartum anxiety, the worry can be all-consuming or make you feel worried all day and all night. It often causes you to have irrational fears or excessive worries about events that are unlikely to happen. Sometimes the anxiety is related to a specific incident from your past, but other times the worry is general and vague. For example, you may feel a constant sense of danger but be unable to put your finger on the cause.

Postpartum anxiety can occur along with postpartum depression. The conditions are different despite sharing many of the same symptoms.

How common is postpartum anxiety?

Studies have shown that postpartum anxiety affects between 11% and 21% of new mothers. Healthcare providers don't have a specific screening to diagnose postpartum anxiety, so it's hard to determine exactly how many people suffer from the condition. It's often identified during an assessment for postpartum depression (which researchers know more about).

What is the difference between postpartum anxiety and postpartum depression?

If you have postpartum depression, you may experience excessive sadness, frequent crying or feel like you can't take care of yourself or your baby. You may have trouble finding joy in your baby or feel like you aren't capable of being a parent. Postpartum anxiety is associated with excessive worrying, not with sadness. If you feel panicked or overwhelmed with fearful thoughts, you may be suffering from postpartum anxiety.

Many of the signs of postpartum depression overlap with postpartum anxiety like disrupted sleep, heart palpitations or feeling afraid. It's common for people with postpartum depression to experience signs of postpartum anxiety. However, not everyone with postpartum anxiety is also depressed.

It's important to discuss all of your symptoms and feelings with your healthcare provider so they can help you.

How do I know it's postpartum anxiety and not just worrying?

Having a baby or becoming a parent and worrying go hand in hand. Postpartum anxiety is an excessive or extreme worry that feels like it never stops. If your worrying interferes with your ability to calm down and feels like it lasts all day, you may have postpartum anxiety. Postpartum anxiety is also associated with irrational fears or constantly feeling on edge.

Some examples of postpartum anxiety could be:

• Staying awake all night because you are afraid your baby will stop breathing in their sleep.
• Being terrified to leave your baby alone for a few minutes with an adult you trust (or your spouse).
• Being so afraid someone will hurt you or your child that the thought of leaving your house makes your heart race.

What are the symptoms of postpartum anxiety?

Anxiety is your body's way of responding to danger or threats. If you have postpartum anxiety, you may feel like you or your baby is in constant danger. The symptoms you feel are your body's way of reacting to this constant sense of worry or fear.

Common signs of postpartum anxiety are:

Physical symptoms

• Disrupted sleep.
• Increased heart rate or heart palpitations.
• Nausea or stomach aches.
• Being unable to breathe or feeling short of breath.
• Loss of appetite.
• Trouble sitting still.
• Muscle tension.

Emotional symptoms

• Inability to relax or keep calm.
• Racing thoughts, especially about worse-case scenarios.
• Obsessing over irrational fears or things that are unlikely to happen.
• Difficulty focusing or forgetfulness.
• Irritability.
• Feeling on edge or fearful.

Behavioral symptoms

• Avoiding certain activities, people or places.
• Being overly cautious about situations that aren't dangerous.
• Checking things over and over again.
• Being controlling.

There are certain conditions like obsessive-compulsive disorder (OCD) or panic disorders that can affect you during the postpartum period. If you are suffering from either of these conditions, you may have panic attacks or obsessive thoughts.

Be honest with your healthcare providers about all the symptoms you feel. They are there to support you and recommend treatments to help.

What are the main causes of postpartum anxiety?

There is no one cause for postpartum anxiety. Healthcare providers think several factors can cause it:

• Change in hormones: The sharp decrease in hormones after delivery can cause changes in mood or cause you to overreact to stress.
• Lack of sleep: Caring for newborns can be a 24-hour job and cause sleep deprivation.
• Feelings of responsibility: You may be overcome with feelings of needing to protect and care for your new baby.
• Stressful events: Certain milestones or events in your baby's life could trigger anxiety. For example, issues with breastfeeding, a difficult pregnancy or stressful delivery.
• Risk factors that increase your chances of postpartum anxiety: Health conditions and past experiences may put you at a higher risk for developing anxiety.

What are some risk factors for getting postpartum anxiety?

• Personal or family history of depression or anxiety.
• Previous pregnancy loss or loss of a child.
• Having a baby or child with health conditions.
• History of eating disorders.
• Caring for multiple children.
• Personality type (being a natural worrier).
• Not having a supportive partner or a support network after childbirth.

When does postpartum anxiety start?

It depends on the individual. It can start as early as right after birth or not begin until your baby is several months old. Anxiety can even begin during pregnancy.

How is it diagnosed?

Unlike other medical conditions, there isn't a clear diagnostic tool for postpartum anxiety. There are postpartum anxiety questionnaires that your provider may ask at your appointment. You should not feel ashamed or uncomfortable sharing your symptoms. Having an open and honest conversation about your anxiety is often the best tool providers have to diagnose postpartum anxiety. They may ask you questions or use other screening tools to diagnose postpartum anxiety and determine the severity of symptoms.

How is postpartum anxiety treated?

Your healthcare provider will recommend treatment based on your symptoms, health history or if you are breastfeeding. In mild cases, changes to daily activities or speaking with a counselor can help reduce symptoms. If your anxiety worsens or is interfering with your life, medication may be an option.

Cognitive behavioral therapy (CBT) for postpartum anxiety

CBT is a technique used by therapists or psychologists to help identify your emotions and change your thought patterns. Through CBT, you can unlearn negative thoughts and behaviors and adopt healthier thinking patterns and habits. CBT typically takes place over several one-on-one sessions. Using a question-and-answer format in your sessions, your therapist or counselor helps you learn to respond better to stress and anxiety. In some cases, your therapist may specialize in the emotions and behaviors of the postpartum period.

Non-medicated treatments for postpartum anxiety

Medication is not always needed to treat postpartum anxiety. Some ways to treat postpartum anxiety without medication are:

• Find a support group for new parents (some are 100% online) where you can share your feelings with people in a similar situation.
• Ask for help from family or friends. For example, having someone help with chores or babysitting can take some pressure off of you.
• Try to take a walk or get exercise every day. Practicing yoga can also help with relaxation.
• Take care of yourself by eating a healthy diet and sleeping as much as you can.

You may feel like you are being pulled in 100 different directions. Taking care of a baby (and yourself) and being a parent is a difficult job. Don't be afraid to ask for help.

What medications are used for postpartum anxiety?

SSRIs (selective serotonin reuptake inhibitors) are the most widely used and most researched medication for postpartum anxiety and postpartum depression. SSRIs work by increasing the level of serotonin in the brain. After carrying a message between cells, serotonin is reabsorbed by the nerve cells. SSRIs work by blocking reabsorption. This means more serotonin is available to pass messages between nerve cells.

Serotonin-norepinephrine reuptake inhibitors (SNRIs) work similarly to SSRIs by increasing certain chemicals in your brain.

Other medications like tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs) and norepinephrine and dopamine reuptake inhibitors (NDRIs) can be used to treat anxiety. However, SSRIs are the preferred medication because of their low side effects.

All medications come with possible side effects. Before taking medication to treat your anxiety, weigh the risks and benefits with your healthcare provider. If you are breastfeeding or plan to breastfeed, let your provider know so they can provide a breastfeeding-friendly treatment.

Can I breastfeed if I am on anti-anxiety medication?

If you are breastfeeding, it's best to discuss the risks and benefits of medication with your healthcare provider. Medications are passed to your baby through your bloodstream and breastmilk. Certain medications are safe to use during pregnancy and while breastfeeding, but others are not.

How long does postpartum anxiety last?

It varies depending on the person. Postpartum anxiety doesn't last forever but also doesn't typically go away on its own. Getting prompt treatment from your healthcare provider is the best way to recover from postpartum anxiety. Do not be afraid of the stigma associated with anxiety or let it prevent you from seeking help.

Can postpartum anxiety come back?

Yes, it can. Unfortunately, excessive anxiety can strike at any time. It may not be labeled as postpartum anxiety if it occurs 12 months after your baby is born, but anxious feelings related to your children can develop at any time. It's important to talk with your healthcare provider if extreme worry interferes with your life, no matter your child's age.

How do I cope with postpartum anxiety?

First, know that you're not alone and that caring for a new baby is hard work. Your feelings are valid, and there is nothing you did to cause postpartum anxiety. The best thing you can do for yourself is to seek help from your healthcare provider. They will be able to help you find the support you need or recommend medication, if necessary. Finding a group of trusted friends or family members to talk to or share responsibilities with may help. Finally, try to set aside time for activities that bring you happiness. Sometimes parents forget about themselves. Taking a few minutes to enjoy a hobby can help take your mind off your worries.

How can I reduce my risk for postpartum anxiety?

Sometimes there isn't anything you can do to prevent postpartum anxiety. It's not your fault and not caused by anything you did or didn't do. If you know of specific triggers from your past or have a history of anxiety or depression, talk to someone during your pregnancy. Talking with a counselor and learning coping tools before your baby is born can reduce the intensity of your anxious thoughts during the postpartum period.

When should I call my doctor?

Contact your healthcare provider if you have any symptoms of postpartum anxiety. Some specific signs to watch for are:

• Feeling like you aren't bonding with your baby.
• Feeling like you are worrying all day, every day.
• Signs of postpartum depression.
• Feeling overwhelmed with day-to-day life.
• Feeling like your anxious thoughts are worsening.

If you need immediate help or have thoughts of hurting yourself or your baby, contact the National Suicide Prevention Hotline at 1-800-273-8255.

Can my spouse get postpartum anxiety?

Yes, your spouse can have postpartum anxiety. Anxiety doesn't just affect the parent who gave birth. Adoptive parents and nonbiological parents can also suffer from excessive worry after having a baby.

How can I help my friend with postpartum anxiety?

The best thing you can do for your friend with postpartum anxiety is to be a supportive listener. Allow your friend to talk through their thoughts and feelings. They are likely feeling overwhelmed, so offering to help with household chores (like cleaning or laundry) or other errands (like grocery shopping) could be beneficial.