Amanda Farmer thought she was ready for anything that could come after giving birth. She’d read everything she could find on postpartum anxiety (PPA) and postpartum depression (PPD). She’d coached her husband on the signs and symptoms. “I thought I had this in the bag. If I was going to develop PPD or PPA, I was going to be on top of it, and I’d ask for help the second I started feeling the baby blues,” the mom of one and writer tells HealthyWay. Seven months after giving birth, on the day before her 35th birthday, Farmer says she fell apart. “I hit rock bottom. I couldn’t get out of bed. I cried—sobbed, really—told my husband that he should take [our daughter] and move home with his parents because together they would be able to provide a better family for [her] than I could,” Farmer recalls. “I didn’t eat. I’d cry until my body was so exhausted that I’d sleep. My husband would wake me up to check on me, and then I’d cry until passing out again. I was a shell of who I once was. I didn’t feel like me. I felt like an imposter—an actor trying to portray a role that she wasn’t suited for.” That was a Saturday. That Monday, Farmer went to see her OB-GYN, who quickly helped her get an appointment with an on-site psychologist. The diagnosis was immediate: Farmer had postpartum anxiety. “She prescribed me meds, gave me hug, told me that I wasn’t alone. She made me feel normal,” Farmer recalls. Farmer is far from alone. Although discussions of PPD tend to outweigh those of PPA in new mom Facebook groups and parenting books, some researchers have posited that rates of postpartum anxiety may actually be higher than those of postpartum depression. A 2016 study performed by researchers at the University of British Columbia estimated that as many as three to four times more new moms could be suffering from PPA than PPD. To put that in perspective, it’s estimated that postpartum depression affects one in seven women. That’s a huge number in and of itself. Now multiply it by four. That’s how many women might be suffering from postpartum anxiety.
What is postpartum anxiety?
Because they’re both mental health concerns and society tends to lump depression and anxiety together, postpartum anxiety is often confused with postpartum depression. But the two have different roots, says Mayra Mendez, PhD, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center in Santa Monica, California. “Anxiety is informed by fear and worry, while depression is informed by sadness, low mood, discontent,” Mendez explains. So why don’t you hear about postpartum anxiety as much as you do postpartum depression? In part it’s because postpartum anxiety is not technically a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (commonly known as the DSM-V). That’s the “bible of diagnostic criteria for psychologists,” according to Hayley Hirschmann, PhD, a clinical psychologist in private practice with the Morris Psychological Group in Parsippany, New Jersey. “Postpartum depression is not really a diagnosis there either, but someone can be diagnosed with major depression with a specifier of postpartum or peripartum onset,” she explains. “This means the symptoms began during pregnancy or in the four weeks after delivery.” But just because it’s not in the DSM-V doesn’t mean postpartum anxiety isn’t real or that it’s all in a mom’s head. “You can be a postpartum parent who is suffering from a specific anxiety disorder, e.g. panic disorder, generalized anxiety disorder, [et cetera],” Hirschmann says. That there’s no official diagnosis for postpartum anxiety comes down largely to semantics, she says. If you’re presenting in her office with anxiety symptoms, and they’re spurred by the recent birth of your baby, it’s fairly easy for a clinician to put two and two together. What’s more difficult is to break down societal myths about anxiety and depression. “People use the words anxious or depressed all the time,” Hirschmann points out. “We say ‘Oh, I’m so anxious about that test,’ but it’s not the same as having anxiety. Even having some anxiety about a new baby is not the same.” So what are the signs of postpartum anxiety, and how do clinicians differentiate between postpartum anxiety and postpartum depression?
Postpartum Anxiety Symptoms
There’s a certain amount of overlap in symptoms between postpartum depression and postpartum anxiety and that can make sussing out which a mom is facing hard for those who aren’t trained clinicians. It’s also possible for a new mom to be suffering from both, Hirschmann says, which makes it all the more important to talk to your doctor. That said, here’s a look at the symptoms most commonly associated with anxiety disorders, according to the National Institutes of Health:
- Restlessness or feeling wound-up or on edge
- Being easily fatigued
- Difficulty concentrating or having your mind go blank
- Muscle tension
- Difficulty controlling your worry
- Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)
By contrast, postpartum depression (again from the National Institutes of Health) is typically characterized by:
- Feeling sad, hopeless, empty, or overwhelmed
- Crying more often than usual or for no apparent reason
- Worrying or feeling overly anxious
- Feeling moody, irritable, or restless
- Oversleeping or being unable to sleep even when your baby is asleep
- Having trouble concentrating, remembering details, and making decisions
- Experiencing anger or rage
- Losing interest in activities that are usually enjoyable
- Suffering from physical aches and pains, including frequent headaches, stomach problems, and muscle pain
- Eating too little or too much
- Withdrawing from or avoiding friends and family
- Having trouble bonding or forming an emotional attachment with the baby
- Persistently doubting your ability to care for your baby
Notice an overlap? That’s what makes postpartum anxiety particularly confusing for new moms and their partners—and the differences can make it harder for some to seek treatment. That’s what happened to Kimberly Rae Miller. The writer and mom of a now-2-year-old son says she had read up on postpartum depression and even had a feeling it might crop up after giving birth, but when it didn’t, the feelings that swam to the surface put her off keel. “I was so consumed by how perfect my son was when he was born that I felt that there had to be a shoe that was about to drop,” Miller recalls. “I was petrified of everything. When he was born we lived in a third-floor walk-up in Manhattan. I constantly had images of tripping down the stairs while holding him, or tripping and him falling over the side of the banister. I wouldn’t leave the house, and when I did I always carried him in a baby carrier while I walked down the stairs very slowly, even if I was going to use a stroller while we were out.” Miller and her partner moved to the suburbs just before her son turned 1, and she recalls panicking because the car gifted to them by her parents didn’t have a LATCH system in the middle seat for his car seat. She’d read that the middle was the safest spot, and the fear kept her up at night. “I kept having images of us being in an accident on the side of the car his seat was on,” she says. “At one point I described my anxiety and how I hardly ever left the house with a mom’s group I was in and someone recommended I talk to someone at Seleni Institute in New York about what they said sounded an awful lot like postpartum anxiety.” Like Farmer, Miller was eventually diagnosed with postpartum anxiety, but it’s a diagnosis she didn’t expect, in part because information about PPD was available everywhere she turned, but there was little to none on postpartum anxiety. Adding to the confusion for moms are the “baby blues,” a normal (aka just about every mom has them) period after the birth when you just don’t know which way is up: You’re tired. The baby is screaming. You have no idea how to do this. The baby blues may last up to two weeks, and it’s pretty typical to feel out of sorts during this time, Hirschmann says. After all, your body just went through a major trauma, and your sleep schedule (we use that term loosely) is likely out of whack, with baby waking up at odd hours demanding to be fed or changed. As many as 80 percent of moms will go through this period of change with at least some issues. It’s when the so-called baby blues last beyond that two-week period that it starts to become a concern. If you’re feeling the same or worse at three weeks postpartum, call your doctor, Hirschmann says. And if you’ve gone past that three-week point, but you’re still struggling, make the call. During your appointment, your provider will look at “intensity” of worry and anxiety, Hirschmann says. They may also ask you to answer the questions on the Edinburgh Postnatal Depression Scale, an assessment tool commonly used to suss out postpartum mental health issues. “I’ll focus a lot in the clinical intake interview on the frequency, intensity, and duration of whatever symptoms they are reporting, which can vary a lot from individual to individual,” Hirschmann explains. “I’ll also try to get a good sense of how much of a change these symptoms are from prior functioning. A mom suffering from a generalized anxiety disorder is going to look very different from one suffering from a panic disorder. One is going to have excessive, ongoing, uncontrollable worry about lots of things they never worried about before.”
Who’s at risk of postpartum anxiety?
Moms don’t bring postpartum anxiety on themselves. There’s nothing that a mom does “wrong” that makes her wake up in the morning clutching at her throat and worrying that she or her baby won’t make it through the day. But there are risk factors at play that make some moms more likely to progress from baby blues to diagnosable anxiety—risk factors that typically come down to things moms can’t control. “The postpartum period adds a hormonal variable to the dysregulation of mood and emotions,” Mendez says. “Some women are at greater risk of experiencing postpartum anxiety and/or depression because of the hormonal changes in their bodies, but also because of life changes and demands.” Also on the list of risk factors? Any prior history of anxiety and or depression. Even a battle with mental health issues in your teenage years that you thought you licked can come roaring back in the days or months after giving birth. That’s not a flaw, Hirschmann says, it’s just life.
Treatment for Postpartum Anxiety
Treatment for postpartum anxiety is not one-size-fits-all, and some doctors may recommend therapy alone or medication alone, while others may recommend therapy plus medication. “The most effective anxiety treatments focus on teaching coping skills to manage fears and worry and promote shifting of negative thinking patterns,” Mendez says. While postpartum anxiety can last anywhere from a few months to a few years depending on a mom’s circumstances, the real key to finding your way out seems to be finding help. “The sooner you get treatment, the sooner you start feeling better,” Hirschmann says. For Farmer, treatment made all the difference, but even being acknowledged helped get that ball rolling. “Within 48 hours of being diagnosed with postpartum anxiety and starting medication, I felt different. I could breathe,” she recalls. That’s a common reaction, although truly moving on toward “normal” can take awhile. Because medications can take as much as four to eight weeks to be effective, typically talk therapy is helpful in the early days or weeks after diagnosis, Hirschmann notes. Some moms may eschew medication entirely because they’re breastfeeding, although a number of selective serotonin reuptake inhibitors (SSRIs) get the nod from clinicians for being okay while nursing. That’s information Miller wishes she’d known when she was diagnosed with postpartum anxiety, and she encourages other moms to look to the medical studies on anti-anxiety medications when they’re struggling with postpartum anxiety. “My doctor … told me that he didn’t feel like there was enough research into breastfeeding and anti-anxiety meds and wouldn’t prescribe for me until I stopped breastfeeding,” she says. “I didn’t mind supplementing, but my son found huge comfort in breastfeeding, and I didn’t feel like it was fair for me to take that away from him, so I felt like I had to make the choice between his happiness and mine. I chose his and forwent medication. Looking back, I wish I’d gotten a second opinion.” The fact is, Mendez says, “Symptoms of anxiety and/or depression can be managed effectively with treatment.” If your doctor says you do have postpartum anxiety but isn’t supportive of the treatment options you want to pursue, don’t be afraid to find a second opinion.