We Need To Talk About Postpartum Anxiety

Welcoming a new baby can cause various emotions and it can also impact a parent's mental health. Postpartum depression (PPD) has thankfully gained a lot of attention in recent years, but there's another mental health condition that is just as critical to speak about: postpartum anxiety (PPA).

PPA typically presents as excessive worrying, racing thoughts, and feelings of dread. A 2018 study found around 20% of postpartum people who had given birth experienced clinical anxiety. It can impact birthing parents, as well as those who have adopted.

Read on to learn more about postpartum anxiety symptoms, causes, treatment options, and how long it lasts.

The Difference Between Postpartum Anxiety and Worry

Worrying when having a newborn is normal. "Some worry is adaptive. Anxiety is a natural response to protect one's baby, and often that's expressed with hyper-alertness and hyper-vigilance," says Margaret Howard, PhD, director of postpartum depression at Day Hospital at Women & Infants in Providence, Rhode Island. That's why most new parents find their minds racing: What if the baby suffocates? Or slips under the water during a bath? What if someone breaks into the house and snatches them?

"For most parents, this is just mental noise," says Jonathan Abramowitz, PhD, associate chairman of psychology and director of the Anxiety and Stress Disorders Clinic at the University of North Carolina at Chapel Hill. "They learn to dismiss it, so the thoughts stop cropping up."

On the other hand, if your worries will not stop cropping up or are irrational (say, you have an intense fear that your baby will get hurt if you're not holding them), your worry may be a result postpartum anxiety. These symptoms become a problem when they affect everyday life or they interfere with your ability to function. "Anxiety is a problem when it overshoots reality," Dr. Howard says.

Postpartum Depression vs. Postpartum Anxiety

Unlike postpartum depression, which can cause postpartum parents to experience extreme sadness or even disinterest in their newborn, postpartum anxiety symptoms mainly manifest in the form of worry. "You constantly feel worried and on edge," says Sara Gottfried, MD, author of The Hormone Cure. "I think of postpartum anxiety as the loss of the normal sense of balance and calm and postpartum depression as a loss of heart."

Postpartum depression is the disorder that's talked about most, so many parents aren't sure what to think once they start experiencing intense worry. "We call postpartum anxiety 'the hidden disorder' because so few moms recognize it and it goes undiagnosed," says Dr. Abramowitz. "It hasn't been discussed or studied much, even though it's likely more common than postpartum depression."

It's also important to note that PPD and PPA often go hand in hand—about half of people who have postpartum depression also have anxiety. "If you're anxious and it's getting in the way of your life, you may begin to feel depressed about that and vice versa," Dr. Abramowitz says.

Postpartum Anxiety Symptoms

Like postpartum depression, which can make postpartum parents feel tired all the time, postpartum anxiety might also involve physical symptoms. Here are some common signs of postpartum anxiety:

• Excessive worry
• Changes in eating and sleeping patterns
• Dizziness
• Feelings of dread
• Hot flashes
• Lack of concentration
• Nausea
• Racing thoughts
• Rapid heartbeat

For the majority of people who will experience them, postpartum anxiety symptoms kick in sometime between birth and your baby's first birthday—but in some cases, they begin much earlier. "Twenty-five to 35% of postpartum anxiety cases begin during pregnancy," says Ann Smith, CNM, president of Postpartum Support International.

Smith also notes that, while most people with PPA will start feeling on edge shortly after giving birth, a particularly stressful life event—or even weaning from breastfeeding—can trigger PPA months later.

Postpartum Anxiety Causes

Postpartum anxiety can result from a variety of triggers, experts say. For starters, "there's a huge hormonal shift—estrogen and progesterone levels increase 10- to 100-fold during pregnancy, then fall to essentially zero within 24 hours of delivery," explains Elizabeth Fitelson, MD, director of the Women's Program at the Columbia University Department of Psychiatry.

In the days that follow, you're dealing with sleep deprivation, changes to your relationship, and new schedules and responsibilities, including around-the-clock care of a newborn. Add to that society's expectation that this should be one of the happiest times in your life, and it's no wonder so many postpartum parents start to come unglued.

Postpartum Anxiety Risk Factors

While any new parent can develop postpartum anxiety, there are some factors that might increase your risk. These include:

• A personal or family history of anxiety
• Certain symptoms of PMS (such as feeling weepy or agitated)
• Eating disorders
• Obsessive-compulsive disorder (OCD)
• Previous experience with depression

What's more, anyone who has had a miscarriage or stillbirth may be more susceptible to postpartum anxiety and depression with a subsequent healthy delivery because they're so worried that something else might go wrong.

Personality may also come into play: "Parents with postpartum anxiety often describe themselves as Type A, sensitive, or easily worried," says Sherry Duson, a family therapist in Houston who specializes in treating those with pregnancy and postpartum mood and anxiety issues.

How Long Does Postpartum Anxiety Last?

Unlike the baby blues, which last about two weeks, postpartum anxiety typically doesn't always go away on its own. It's crucial to seek help if anxiety is disrupting your sleep or you're constantly preoccupied with worries. "In moderate to severe untreated cases, postpartum anxiety can last indefinitely," Smith says. "Perinatal mood disorders don't always disappear on their own. In fact, in some cases, if left untreated, they can set people up for a lifelong bout with mental illness."

Fortunately, there are a number of postpartum anxiety treatments, but the burden often falls on you to bring it to a doctor's attention. When researchers at Massachusetts General Hospital in Boston screened 491 mothers for postpartum anxiety or depression six weeks after they gave birth, 17% had one or the other—yet the majority of them had not been diagnosed.

Postpartum Anxiety Treatment

If you're feeling overwhelmed with worry, tell your health care provider or pediatrician. "In mild cases of any perinatal disorder, the first thing that should be tried is a combination of support and therapy," Smith notes. "Sometimes just having someone to talk to or give you a break from baby duties makes a big difference."

You should also ask your health care provider for a referral to a therapist who has experience with perinatal mood disorders or a psychologist who specializes in cognitive behavioral therapy (CBT).

"CBT gives you the skills to change the thinking and behavior patterns that lead to anxiety," Dr. Abramowitz explains. For instance, if you tend to think the baby has a serious illness at the first sign of a sniffle, CBT can help you develop a more realistic outlook (could be a cold!). "This isn't about positive thinking," says Dr. Abramowitz. "It's about being rational."

An expert can also teach you relaxation techniques, such as meditation, progressive muscle relaxation, and mindfulness training. When completed before bedtime, these exercises can set you up for a good night's sleep.

Exercise can also relieve anxiety by helping you feel more empowered, Dr. Howard says. Six weeks of resistance training or aerobic exercise led to a remission rate of 60% and 40%, respectively, among females ages 18 to 37 with generalized anxiety disorder.

Do I Need Postpartum Anxiety Medication?

For more severe cases of postpartum anxiety, your health care provider may recommend therapy, support, and medication, even if you're nursing. "The use of medications needs to be determined on a case-by-case basis," Dr. Fitelson says. "Your mental health—and your ability to take care of and bond with your child—are so important. At some point, they take precedence over the low or theoretical risk to your baby of taking an antidepressant."

If you've taken an antidepressant or anti-anxiety medication in the past and it worked, you might consider starting it again. "Don't try to reinvent the wheel," Smith says. Always talk to your health care provider about how a particular medication may affect your baby.

And remember: Regardless of whether your postpartum anxiety symptoms fall on the moderate or more severe end of the spectrum, it's better to seek help sooner than later. Think of it this way, Dr. Fitelson says: "Taking care of yourself is taking care of your baby."