Understanding Postnatal Depression and Anxiety

Whether it’s your first or your fourth delivery, having a baby will mean significant changes for any woman. You’re making adjustments to your living arrangements to accommodate a new member of the family, your daily schedule drastically detours from your pre-pregnancy norm, and the physical differences in your postpartum body bring on an entirely new set of challenges.

However, perhaps the most significant changes women experience after giving birth are mental or emotional. “Pregnancy brain” or “momnesia” — the tendency to be forgetful while pregnant — can continue to occur after the baby arrives. Skyrocketing hormone levels, sleep deprivation, and multitasking to prioritize baby-related activities contribute to mild short-term memory loss and leave moms feeling less mentally sharp than before pregnancy and childbirth. This is a common condition that usually subsides when mothers can get adequate sleep.

Perfectly normal post-pregnancy emotions

Once the baby arrives, mothers will usually experience a flood of new feelings on top of the short-term memory issues to which they’ve become accustomed. These feelings can vary from mother to mother, but Parents magazine cites joy, jitters, fear, sadness, anger, doubt, and hypersensitivity as some of the most common and perfectly normal emotions that most new moms experience. 

Overwhelming joy can cause you to laugh or cry at otherwise seemingly insignificant moments, like when your baby yawns, hiccups, or clenches your finger in their tiny hand. Continued lack of sleep coupled with a natural nervousness around this new little life can give you the jitters or slight, temporary feelings of anxiety. Fear happens when you become afraid that you’re not doing everything right, whether that’s feeding them the correct amount at the appropriate time or holding them too tight.

Feeling sad is normal after giving birth. Many moms find themselves crying when they realize their baby is already six days old (where has the time gone?) or has already outgrown zero-to-three-month outfits. You can feel sad that you’ve lost your pre-child lifestyle or that your baby is now outside your womb and no longer protected and growing inside of you. 

It’s also okay to feel angry. This is especially common among women who think they’re not living up to their standards of perfectionism. This is similar to doubting your abilities to be a “good” parent, even though there’s never been any rulebook on what this entails.

Being overly sensitive to anything and everything around you, whether that means taking your mother-in-law’s compliments as back-handed slights or extravagantly mourning the bug you accidentally squished with your shoe, can usually be chalked up to that explosion of hormones coursing through your body.

Is it just the baby blues?

The Mayo Clinic refers to this collection of postpartum moods and emotions as the “baby blues.” Feeling anxious, irritable, or overwhelmed, or experiencing reduced concentration, appetite problems, or trouble sleeping are all symptoms of this condition, which typically last only a few days to a week or two after your baby is born. According to WebMD, more than 80 percent of new moms suffer from the baby blues during their child’s first few weeks of life. 

These and other emotions, like mental exhaustion, frustration, or a quick temper, are common among new mothers, and they’re usually temporary too. If you’re experiencing moods that quickly swing from happy to sad, or content to overwhelmed, or confident to doubtful, it’s most likely the baby blues. You may also find that you forget to eat or take care of yourself because you’re focused on the baby and are utterly exhausted, which will intensify your emotions. 

You can alleviate the baby blues by trying to give your body what it needs. This includes sleep, healthy food, and exercise. Accept help from others when it’s offered, whether that’s your neighbor’s insistence on bringing over her special casserole or your mother urging you to take a nap while she watches the baby. Let household chores slide for a few days. No one expects a new mom’s house to be spic-and-span after bringing home a newborn. Rest while your baby naps, and take them for a stroll so that both of you can enjoy the fresh air and sunshine. You should start to feel better naturally within a few weeks as your body, mind, and routines adjust to your new post-baby normal.

Is it something more serious?

When negative feelings like sadness or anxiety last longer than two weeks or become worse instead of better, you might be suffering from a more severe postnatal mental health condition. Postpartum Support International has identified several perinatal mood and anxiety disorders. These include postpartum depression, postpartum anxiety, postpartum obsessive-compulsive disorder (OCD), postpartum post-traumatic stress disorder (PTSD), bipolar mood disorder, and postpartum psychosis. 

The last four conditions are less commonly seen among new mothers. About three to five percent of new moms (as well as some new dads) will experience postpartum OCD. Symptoms include persistent, repetitive, and upsetting thoughts or mental images related to the baby, compulsions like constant cleaning or repetitive checking or counting, or the fear of being left alone with your infant. Fortunately, new mothers with OCD are most often aware that their thoughts are bizarre and are unlikely to act on them in a way that will be dangerous to them or the baby.

Women who undergo real or perceived trauma during or after childbirth may experience postpartum PTSD. It’s a condition that affects nine percent of new mothers. Traumas could include an unplanned C-section, a baby who is admitted to the newborn intensive care unit (NICU) for round-the-clock care, severe postpartum hemorrhage or an unexpected hysterectomy, or even the lack of communication or support during the delivery. Moms who have postpartum PTSD could have flashbacks, nightmares, re-experiences of a traumatic event, anxiety, and panic attacks.

Bipolar mood disorder (Bipolar 1 and Bipolar 2) is often diagnosed in women for the first time during pregnancy or after the birth of a child. However, these women may have suffered from this condition before pregnancy to some degree. Women with a family or personal history of bipolar disorder — sometimes called manic depression — are more likely to be at risk during and after pregnancy. Although it sometimes looks like severe depression or anxiety, bipolar disorder is characterized by “times of a persistently elevated mood, decreased need for sleep, and periods of over-average productivity,” according to Postpartum Support International.

Postpartum psychosis is extremely rare, only occurring in about one or two out of every 1,000 births. This condition can lead to delusions and hallucinations — some of which can result in violence toward one’s self or the child. Women without any previous mental health issues may experience postpartum psychosis after the birth of a child, but those with a history of conditions like bipolar disorder are at a much higher risk. Postpartum psychosis is a severe condition that should always be treated as a medical emergency. 

Each of these conditions is treatable with the help of a mental health professional, and most women will never experience such severe postpartum mental health issues. However, postpartum depression and postpartum anxiety are much more common. Up to 20 percent of new mothers will experience significant depression or anxiety following the birth of a child.

Postpartum depression symptoms, causes, and risks

The symptoms of postpartum depression are similar to those experienced during the baby blues. However, when a woman suffers from postpartum depression, these feelings of sadness, emptiness, or hopelessness will persist past the usual two-week duration of the baby blues and can be more severe. The U.S. Department of Health & Human Services Office on Women’s Health recommends seeking help from a doctor, nurse, or mental health professional if any of the following symptoms last more than two weeks:

• Feeling restless or moody
• Feeling sad, hopeless, or overwhelmed
• Crying a lot
• Having thoughts of hurting the baby
• Having thoughts of hurting yourself
• Not having any interest in the baby, not feeling connected to the baby, or feeling as if your baby is someone else’s baby
• Having no energy or motivation
• Eating too little or too much
• Sleeping too little or too much
• Having trouble focusing or making decisions
• Having memory problems
• Feeling worthless, guilty, or like a bad mother
• Losing interest or pleasure in activities you used to enjoy
• Withdrawing from friends and family
• Having headaches, aches, and pains, or stomach problems that don’t go away

Postpartum depression isn’t exclusive to first-time moms, particular ethnic groups, or any income or education level. It can affect any new mother, no matter what her background. However, some moms may be at a higher risk for postpartum depression, including women who:

• Have a personal or family history of depression or bipolar disorders
• Are younger than 20 years old
• Have relationship or money problems
• Lack of support from friends and family
• Have had issues with previous pregnancies or births
• Use or abuse alcohol or drugs
• Had an unplanned or unwanted pregnancy

Although it has not been scientifically proven, many researchers hypothesize that postpartum depression could also be caused by hormonal changes. During pregnancy, levels of estrogen and progesterone increase to exceedingly high levels. These hormone levels quickly drop back to normal within 24 hours of childbirth, and this rapid change is what is suspected to lead to depression. Other conditions, such as a thyroid imbalance, previous infertility treatments, and any form of diabetes could also contribute to a higher risk of postpartum depression.

Sometimes new mothers don’t realize they’re suffering from postpartum depression. Friends and family may recognize symptoms before the mother understands what’s happening. Regardless of who first understands that a mother’s baby blues are more severe or last longer than average, immediate help from a mental health professional is highly recommended. 

When postpartum depression is left untreated, both the mother’s health and her relationship with her baby deteriorate. She may not be able to care for her baby, and the baby may begin to display problems of their own due to the lack of connection with their mother. Experts have found that these children may be more prone to sleep disturbances, impaired cognitive development, emotional insecurity, and frequent temper tantrums.

Unfortunately, a study by Babycenter found that 40 percent of women experiencing symptoms of postpartum depression do not seek treatment. This is a surprising statistic, given that 90 percent of participants in the study were aware of postpartum depression, and most believed it could be treated with counseling or medication. Women cited embarrassment and guilt about their feelings as deterrents to seeking treatment. Many thought they could overcome the disorder on their own — additionally, several confused postpartum depression with postpartum anxiety or a more severe condition like postpartum psychosis.

What is postpartum anxiety?

Postpartum anxiety is often mistaken for postpartum depression simply because it’s less often discussed in the media or social circles. Another reason is that many women suffering from postpartum depression also suffer from postpartum anxiety. About 10 to 15 percent of new moms suffer from postpartum anxiety, but an exact definition of the condition has yet to be developed. Postpartum anxiety is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the gold standard of reference for mental health professionals.

Parents magazine explains that postpartum anxiety symptoms “manifest themselves mainly in the form of worry.” According to Postpartum Support International, symptoms of anxiety after the birth of a child can include a feeling that something terrible is going to happen, racing thoughts that you have difficulty controlling, disturbances in sleep and appetite, the inability to sit still or focus, and physical symptoms like dizziness, hot flashes, and nausea.

Like postpartum depression, a personal or family history of depression, anxiety, or a thyroid imbalance may contribute to a new mother’s increased risk for postpartum anxiety. Also, like depression, expectant moms may be diagnosed with an anxiety disorder even before the baby is born. Perinatal anxiety can be brought on by a variety of triggers, including the endless advice that well-wishing friends and family shower upon newly pregnant women. Other contributing factors could be pre-existing anxiety disorders, fear of miscarriage, or even the stress from trying to get pregnant. Genuine threats, such as the baby being diagnosed with a serious health condition during pregnancy, can also lead to perinatal anxiety.

Dr. Sarah Allen, founder, and director of the nonprofit Postpartum Depression Alliance of Illinois explains that all new parents will worry they’ll do something that will cause harm to their baby. Anxious actions could include avoiding places, people, or activities that you may feel will expose your baby to harm (real or imaginary). It’s when these worries become constant, and the concerns become so excessive that you feel dread or think you’re going “crazy” that you should seek help. 

Panic attacks, which Allen describes as “anxiety multiplied by 10,” are another symptom of postnatal anxiety. Panic attacks usually include physical symptoms like shortness of breath, chest pain, and heart palpitations accompanied by feelings of losing control and intense fear that something terrible is going to happen. 

Treating postpartum depression and anxiety

If you’re experiencing symptoms of postpartum depression or anxiety, reaching out to a mental health professional or licensed counselor is the most essential step in treating your condition. Such therapists are experienced in providing personalized treatment plans tailored to your specific needs. If your therapist’s approach is cognitive-behavioral therapy (CBT), for example, they will help you learn to view some things differently and change other things to improve your wellbeing. Your doctor may also prescribe an antidepressant or anti-anxiety medication in addition to your psychological therapy. 

Alternative self-care practices can complement your professional therapy and prescribed medications. Studies have shown that exercise, massage, meditation, and relaxation techniques like deep breathing can alleviate symptoms of depression and anxiety. Additionally, Postpartum Progress, a blog devoted to maternal mental illness, recommends avoiding things like overscheduling, scary movies, negative thoughts, unsupportive people, and procrastination while working through your postpartum depression or anxiety with a professional. You might also seek out a support group near you through the Postpartum Resource Center of New York.

There is no time limit for a diagnosis of postpartum depression or anxiety. Although these diagnoses can be detected as early as weeks after giving birth, some women may still experience symptoms more than one year later. One study found that 30 percent of women suffering from postpartum depression who did not seek help were still experiencing chronic symptoms up to three years post-birth.

Sometimes your obstetrician/gynecologist will recognize that you’re demonstrating symptoms of postpartum depression or anxiety during your post-delivery follow-up visits, as will your child’s pediatrician. However, you are the best judge of what’s going on differently in your own body. When you feel that something’s not right, don’t hesitate to ask for help. No matter what postnatal mental health symptoms you’re experiencing, seeking treatment is critical.