Postpartum Depression and Anxiety

Having a baby can be one of the most challenging and rewarding times for mothers. The postpartum period refers to the period between giving birth and one year after delivery. The postpartum period is different for each person. Some women experience little to no change in mood or functioning and if they do, it resolves rather quickly. For others, however, changes in mood and functioning can be significant and can last for several months. Today, you are going to gain a deeper understanding of postpartum mental health disorders such as postpartum depression (PPD) and postpartum anxiety (PPA).

Changes during the perinatal period

The pregnancy and postpartum period marks a time of transition for women. Physical, social, familial, and emotional changes occur during this time that can result in many symptoms that range in severity. Mild symptoms can occur and dissipate within a few weeks after childbirth when more moderate and severe symptoms can impact a woman’s mood, behavior, and functioning. Many women experience a phenomenon called the baby blues. The baby blues are common symptoms that occur after childbirth. They are temporary and result in mild symptoms of depression that resolve on their own rather quickly. For purposes of this piece, any mood disorder that occurs during pregnancy or the postpartum period is going to be referred to as perinatal mood disorder.

Definition of postpartum depression and symptoms

Postpartum depression refers to the symptoms of depression that occur after a woman gives birth and up to 1 year postpartum. Only a healthcare professional can diagnose PPD and the criteria used to diagnose PPD may surprise you. To be diagnosed, you must have met the criteria for major depressive disorder (MDD) and experienced symptoms during the pregnancy period or within the 4 weeks after you give birth and experience at least five symptoms for at least two weeks:

• Experiencing a depressed mood for most of the day
• Having feelings of worthlessness, hopelessness, or guilt
• Sleeping too much or having difficulty falling or staying asleep
• Loss of energy or fatigue
• Loss of interest in once pleasurable activities, also known as anhedonia, for most of the day
• Your psychomotor activity (the way you walk, talk, move) speeds up or slows down)
• Frequent thoughts of death or suicide
• Impaired concentration or focus
• Difficulty with decision-making
• Poor appetite or weight loss
• Over-eating or weight gain

Definition of postpartum anxiety and symptoms

Postpartum anxiety (PPA) is not as widely studied as PPD and, oftentimes, anxiety symptoms present in conjunction with PPD. Many women find themselves experiencing stress and anxiety related to the health of their unborn baby, worries about their upcoming labor and delivery, and fears of being able to keep their baby safe and healthy once the baby is born.

Symptoms of PPA include:

• Feeling as if something bad is going to happen
• Restlessness or an inability to sit still
• Constant worrying about small or large concerns
• Physical symptoms like dizziness, nausea, and hot flashes
• Racing thoughts

Under the anxiety umbrella, postpartum panic disorder and postpartum obsessive-compulsive disorder (OCD) exist. With postpartum panic attacks, you experience severe and chronic anxiety as well as symptoms of:

• Chest pain and pressure
• Feeling claustrophobic
• Heart palpitations and racing heart
• Dizziness
• Parathesis (numbness and tingling of the hands, arms, feet, and toes)
• An overwhelming sensation of doom and gloom
• Fear of dying or death

It is important to understand that postpartum panic attacks, while incredibly overwhelming and scary, can’t hurt you and they will pass in due time. Postpartum OCD (PPOCD) is the most misdiagnosed and misunderstood perinatal mood disorder that women experience. PPOCD is misdiagnosed as a result of the disturbing visual images that accompany this order. More specifically, women who experience PPOCD experience intrusive, disturbing, and terrifying visuals (usually of something negative happening to their baby) that have been misconstrued as delusions; however, women who experience PPOCD symptoms go out of their way to avoid the visuals and have a very low risk of acting on them.

Additional symptoms of PPOCD include:

• Obsessions, also known as intrusive thoughts, include disturbing chronic images or thoughts related to the health and safety of the baby that seemingly come out of nowhere
• Compulsions, which are behaviors that are repeated by the mother in an attempt to decrease feelings of horror and fear (this can include compulsive cleaning behaviors, checking locks, and rearranging things in the home)
• Feelings of terror or horror about the obsessive thoughts or images
• Hypervigilance and proactivity in trying to protect the baby from harm
• Feelings of fear and insecurity in being left alone with the baby

If you experience symptoms of OCD while pregnant or during the postpartum period, you may be experiencing feelings of fear, shame, and guilt. The obsessions can be incredibly disturbing and it is a powerless feeling to experience them out of nowhere, with no identifiable trigger. It is important to reiterate that mothers who experience symptoms of OCD have a very low risk of acting on the thoughts and visuals they experience.

Risk factors

As with most mental health and mood disorders, there isn’t one identifiable “cause” for postpartum depression, anxiety, panic disorder, or OCD. Rather, several factors combine to increase a mother’s risk for developing these perinatal mood disorders. The risk factors are similar across the aforementioned perinatal mood disorders and they include the following:

• Your social support system: Having minimal social support may increase your risk of developing perinatal mood disorders.
• Hormones: Estrogen and progesterone levels drop to pre-pregnancy levels within 24 hours after childbirth and during childbirth, they are at the highest levels they will ever be. This drastic change in hormones can contribute to mood swings.
• Thyroid: Your thyroid levels can fluctuate after giving birth.
• Age: Being 20 years old or younger may increase your risk of developing certain mood disorders.
• Breastfeeding status: You tried but had difficulty breastfeeding.
• Delivery and health of the baby: Your risk of perinatal mood disorders can increase if you experience a premature birth or your child is born with special needs.
• Your pregnancy was unplanned.
• Stress levels: You are experiencing financial, interpersonal, or other stressful life events that can increase your vulnerability to certain disorders.
• You have a history of difficulty conceiving or having experienced a problematic/traumatic birth.
• You are a past or current victim of domestic violence or intimate partner violence.
• History of mental health concerns: You have previously experienced depression, anxiety, or other mental health disorders before pregnancy.
• Family history: You have a family history of anxiety, depression, or other mental health disorders, and/or your own mother experienced postpartum depression or anxiety.

Prevalence of perinatal mood disorders

Getting an accurate understanding of the prevalence of perinatal mood disorders can be challenging as women can underreport their symptoms out of fear of being judged and/or fear that their baby may be taken away. Current studies on the prevalence of perinatal mood disorders suggest that:

• As many as 5%-20% of women will experience postpartum depression after giving birth to their baby.
• The approximate rate of anxiety in pregnant women is 25-33%.
• At least 17% of women experience symptoms of anxiety immediately after giving birth.
• 20% of women report anxiety symptoms 6 weeks postpartum.
• Co-occurrence of PPD and PPA is estimated to be as high as 75%.

Impact of perinatal mood disorders on the baby and mother

Untreated perinatal mood disorders of anxiety and depression can harm both the baby and the mother. Below is a list of potential outcomes if PPD or PPA is left untreated:

• The child’s physical and mental development is negatively impacted.
• Bonding between the mother and baby can be impaired.
• Problems in relationships with family and friends as well as marital conflict.
• Dysfunctional and detrimental parenting practices can develop.
• A mother’s ability to breastfeed can be compromised.
• Poorer outcomes in the child’s mental and physical development.
• Fetal heart rate and motor activity can be compromised.
• Decreased self-confidence in the mother.
• Preterm

Treatment options

As a society, we can do more to normalize the existence of perinatal mood disorders and help mothers feel comfortable and secure in asking for help because treatment is available. If you or someone you love is struggling with a perinatal mood disorder, it is important to reach out and get the help you need. Talk to your doctor or trusted medical professional about your symptoms. Together, you and your doctor can create a treatment plan that is specific to you and your symptoms. Common ways to treat perinatal mood disorders include medication, counseling, psychoeducation, and support groups.

If medication is part of your treatment plan and you would like to save money on your prescriptions, WellRx provides a free prescription savings card that can help you save a lot of money on your medications. Many people who use the prescription discount savings card save as much as 80% with average savings around 65%.

Jacquelyn Buffo began writing at the age of 10 when she won a county-wide essay contest explaining why her mother is worth her weight in gold. Since that time, she has written for several newspapers and a health and wellness blog. Her education and experience is in mental health and addiction. She is a licensed counselor and currently provides therapeutic services on an outpatient basis. Her counseling and substance abuse experience includes inpatient residential, in-home, and early recovery counseling. She is a certified addiction specialist and is working on obtaining her certification in Dialectical Behavioral Therapy. She also specializes in working with pregnant and post-partum women and has received advanced training on women's health.

Resources:

1. Azhar, Y., Moghals, S. & Siddiqui, W. (2022). Postpartum depression.
2. Herman, R., Rados, S.N., & Tadinac, M. (2018). Anxiety during pregnancy and postpartum: Course, predictors and comorbidity with postpartum depression. Acta Clinica Croatica, 57(1), p.39-51.
3. Postpartum Support International. (n.d.). Anxiety during pregnancy and postpartum.
4. Postpartum Support International. (n.d.). Pregnancy or postpartum symptoms.
5. U.S. Department of Health & Human Services. (2023). Postpartum depression.