Postpartum Anxiety

Postpartum anxiety is a condition that can occur after the birth of a child. It can co-occur with postpartum depression or present on its own. Symptoms can include poor sleep, trouble relaxing, and irritability overlapping with postpartum depression.

What is postpartum anxiety?

Postpartum anxiety is an anxiety disorder that can cause feelings of overwhelm, fear, and panic. Postpartum anxiety can occur in both birthing and non-birthing partners. It can also occur after the birth of any child, not just the first born. If left untreated, postpartum anxiety can have serious consequences for both parents and children (Ali, 2018).

Postpartum anxiety is relatively common. About 10% of people develop the condition after giving birth (Reck et al., 2008), though some estimate this number to be higher. Understanding the causes of postpartum anxiety and how it works can help those experiencing symptoms to explore treatment options.

Symptoms of postpartum anxiety

Signs of postpartum anxiety can include excessive worrying, racing thoughts, and feelings of dread. It can involve difficulty with breastfeeding and bonding and fears about the baby’s and one’s own health. People with postpartum anxiety can experience physical and mental symptoms that include:

  • Increased heart rate
  • Sore stomach
  • Tight chest and throat
  • Muscle tension
  • Shallow breathing
  • Loss of appetite
  • Heart palpitations
  • Trouble falling asleep
  • Trouble concentrating
  • Memory problems
  • Hypervigilance
  • Panic attacks

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What causes postpartum anxiety?

While there’s no single cause of postpartum anxiety, there are a number of contributing factors. The abrupt decrease in estrogen and progesterone at the time of delivery can lead to greater sensitivity to stress. Lack of sleep can exacerbate these feelings. Additionally, caring for and protecting a newborn can be especially overwhelming (Texas Children’s Hospital Pavilion for Women).

Other possible causes and risk factors include:

  • Family or personal history of anxiety and depression
  • Relationship difficulties
  • Stressful life events
  • Traumatic birth
  • Pregnancy complications
  • Fertility issues
  • Previous pregnancy loss
  • Family violence
  • History of abuse
  • Financial difficulties
  • Limited social support
  • Previous mood reactions to hormonal changes
  • History of endocrine dysfunction, such as diabetes or thyroid imbalance
  • Delivering a child preterm

Previous prenatal loss or miscarriage can also be a contributing factor for postpartum anxiety.

How is postpartum anxiety diagnosed?

Establishing the correct diagnosis is important for the effective treatment of postpartum anxiety. The Diagnostic and Statistical Manual for Mental Disorders (DSM-5) does not provide specific or standardized diagnostic criteria for postpartum anxiety disorder, nor does it offer a diagnostic approach.

The DSM-5 suggests clinicians apply principles for postpartum depression to postpartum anxiety. In this case, a patient would need to meet the diagnostic criteria for an anxiety disorder within a specified perinatal period.

The DSM-5’s criteria for generalized anxiety disorder includes:

  • Excessive worry about a variety of topics
  • Worry that is experienced as hard to control
  • Anxiety or worry that make it hard to carry out daily activities and responsibilities
  • Symptoms unrelated to other medical conditions and that cannot be explained by the effect of substances, including prescription medication, alcohol, or recreational drugs
  • Symptoms that are not better explained by a different mental disorder

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Postpartum Anxiety Treatments

Postpartum anxiety is highly treatable. Treatment options include therapy and medication.

When to seek treatment

If you are having trouble bonding with or caring for your baby, if you’re experiencing uncontrollable, racing, or overwhelming thoughts, if your symptoms are adversely affecting your daily life, and/or if your worry becomes all-consuming, you may want to seek treatment for postpartum anxiety.

Therapy

Cognitive behavioral therapy (CBT) can teach skills to change the behavioral patterns that lead to anxiety.

Medication

Postpartum anxiety medication in conjunction with therapy may help relieve symptoms.

Antidepressant medications such as serotonin or noradrenaline reuptake inhibitors (SSRIs and SNRIs), can help to increase levels of mood-stabilizing brain chemicals. Anti-anxiety medications, such as benzodiazepines, can work to reduce anxiety.

Additional strategies

The following, non-medication strategies may help decrease symptoms of postpartum anxiety:

  • Cuddle your baby to release oxytocin, which lowers anxiety levels in your brain
  • Try to maximize sleep, aiming for at least one four-hour stretch of sleep per night
  • Minimize caffeine intake
  • Spend time with other parents to help share experiences and validate emotions
  • Increase physical activity
  • Ask for help
  • Be gentle with yourself (Collier, 2021)

References