Postpartum Anxiety

Postpartum anxiety is when you have severe anxiety after having a baby or becoming a parent. These overwhelming thoughts are often out of control and hard to manage. You may feel a constant sense of danger but be unable to put your finger on a cause or calm your thoughts.

Having a new baby is likely to bring worry into your life. But if you have postpartum anxiety, the worry can be all-consuming and nonstop. It often causes you to have irrational fears or excessive concerns about events that are unlikely to happen. Sometimes, the anxiety is related to a specific incident from your past. Other times, it’s general and vague.

Here are some examples of what postpartum anxiety may feel like:

• Avoiding public places because you’re afraid something or someone will hurt you or your baby
• Staying up all night because you’re afraid your baby will stop breathing in their sleep
• Being terrified of leaving your baby with an adult you trust, even if it’s for a few minutes
• Experiencing unwanted, scary thoughts of harming your infant or your infant being harmed

Studies have shown that postpartum anxiety affects about 1 in 5 women. But it’s hard to determine the exact number because many don’t talk about their symptoms.

Postpartum anxiety often occurs with postpartum depression. The conditions are different despite having many of the same symptoms.

Symptoms of postpartum anxiety

Anxiety is your body’s way of responding to danger or threats. The symptoms you feel are your body’s reactions to this constant sense of worry or fear. Signs of postpartum anxiety can be physical, emotional and behavioral. Typically, these symptoms interfere with your ability to function.

Physical symptoms

The physical symptoms of postpartum anxiety include:

• Being unable to breathe or feeling short of breath
• Disrupted sleep
• Feeling tense
• Increased heart rate or heart palpitations
• Loss of appetite
• Nausea or stomach aches
• Trouble sitting still (restlessness)

Emotional symptoms

The emotional symptoms of postpartum anxiety include:

• Difficulty focusing
• Feeling on edge
• Inability to relax or calm down
• Irritability
• Obsessing over irrational fears
• Thinking about worst-case scenarios
• Panic attacks
• Generalized anxiety
• Tearfulness

Behavioral symptoms

The behavioral symptoms of postpartum anxiety include:

• Avoiding certain activities, people or places
• Being overly cautious about situations that aren’t dangerous
• Checking things repeatedly (like how long ago your baby ate or that objects that could hurt your baby are put away)

It’s important to be open with your healthcare providers about everything you’re feeling. They’re there to listen without judgment and help find the best ways to help you feel better.

When does postpartum anxiety start?

It depends. It can start as early as during pregnancy or, more typically, right after birth. Symptoms may even begin when your baby is several months old.

Postpartum anxiety causes

There isn’t 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 make it harder to manage stress.
• Lack of sleep: Caring for newborns can be a 24-hour job and cause sleep deprivation.
• Feelings of responsibility: You may be overwhelmed with feelings of needing to protect and care for your new baby.
• Stressful events: Certain events in your baby’s life could trigger anxiety. For example, issues with breastfeeding or a stressful delivery. Past traumatic experiences in your own life can put you at a higher risk, too.

Risk factors

The following factors can increase your risk:

• Personal or family history of depression or anxiety
• Previous miscarriage 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

Sometimes, there isn’t anything you can do to prevent postpartum anxiety. It’s not your fault and it’s not because of anything you did or didn’t do.

If you know specific triggers from your past or have a history of anxiety or depression, talk to someone during your pregnancy. Meeting with a counselor and learning coping strategies before your baby is born could help.

How doctors diagnose postpartum anxiety disorder

There isn’t a clear diagnostic tool for postpartum anxiety. There are postpartum anxiety questions that your provider may ask at your postpartum appointment, though. They use your response to gauge whether you may need additional support to feel like yourself again.

Don’t feel embarrassed or uncomfortable sharing your symptoms. There are many other people in your situation who have the same feelings. An open and honest conversation about your anxiety is often the best tool your provider has to help you.

How is postpartum anxiety treated?

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

Lifestyle treatments

Some ways to treat postpartum anxiety without medication are:

• Finding a support group for new parents (some are 100% online) where you can share your feelings with people in a similar situation (for example, Postpartum Support International offers free online support groups)
• Asking for help from family or friends (having someone help with chores or babysitting can take some pressure off you)
• Trying to take a walk, stay active or get exercise every day (practicing yoga can also help with relaxation)
• Taking care of yourself by eating healthy meals and sleeping as much as you can

You may feel like you’re 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.

Cognitive behavioral therapy (CBT)

CBT is a technique therapists or psychologists use to help identify your emotions and change your thought patterns. It can help you unlearn negative thoughts and behaviors and adopt healthier thinking patterns and habits. Using a question-and-answer format in your sessions, your therapist or counselor helps you learn to respond better to stress and anxiety.

Medications

SSRIs (selective serotonin reuptake inhibitors) are the most common and most researched medications for postpartum anxiety and postpartum depression. SSRIs work by increasing the level of serotonin in your brain. Serotonin plays a key role in regulating your mood and boosting feelings of happiness and well-being. SSRIs also don’t have many side effects.

Serotonin-norepinephrine reuptake inhibitors (SNRIs) work similarly to SSRIs by increasing serotonin and norepinephrine in your brain. Norepinephrine plays an important role in your body’s “fight-or-flight” response.

Other medications like tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs) and norepinephrine and dopamine reuptake inhibitors (NDRIs) can treat anxiety.

For those with both anxiety and postpartum depression, a new medication called zuranolone (Zurzuvae®) can be helpful. Zuranolone is a neurosteroid and has a unique way of working when compared to standard antidepressant treatments. It acts quickly, and you only have to take this medication for 14 days. It offers help with depression, anxiety and insomnia symptoms.

The combination of therapy and medication appears to be more effective than therapy or medication alone.

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’re breastfeeding or plan to breastfeed, let your provider know.

When should I see my healthcare provider?

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

• Feeling like you’re worrying all day, every day
• Feeling overwhelmed with day-to-day life
• Feeling like you aren’t bonding with your baby
• Feeling like your anxious thoughts are worsening

You should also watch for signs of postpartum depression, like feeling sad most of the time and losing interest in things you enjoy.

If you need immediate help or have thoughts of hurting yourself or your baby, contact the 988 Suicide & Crisis Lifeline by texting or calling 988 (in the U.S.). Other countries have similar helplines for support.

What can I expect if I have 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’s nothing you did to cause postpartum anxiety.

The best thing you can do for yourself is to seek help from your healthcare provider. They’ll be able to help you find the support you need or recommend medication, if necessary. They’ve had many people talk to them about their anxious thoughts (probably a few every day) and know what to do to help you.

Finding a group of trusted friends or family members to talk to or share responsibilities with may help. You may not want to ask for help or feel like you’re burdening someone. But this usually isn’t the case at all. Talk to someone you trust and see if they can help you.

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 long does postpartum anxiety last?

Postpartum anxiety doesn’t last forever, but it also doesn’t typically go away on its own. Getting treatment from your healthcare provider is the best way to recover from postpartum anxiety. Don’t be afraid of the stigma of anxiety or let it prevent you from seeking help. There are many people in the same situation as you.

Can it come back?

Yes, it can. Anxiety can happen at any time, even after your baby’s first birthday. It may not be called postpartum anxiety, but worries about your child can still affect you. If intense anxiety is disrupting your life, talk to your healthcare provider — no matter how old your child is.

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’re likely feeling overwhelmed, so offering to help with household chores (like cleaning or laundry) or other errands (like grocery shopping) could help.