The Other Postpartum Problem: Anxiety

Not sick, not depressed -- just on edge and overwhelmed. If those first days of motherhood aren't all that you expected, know this: You're not alone.
anxious mother

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With the arrival of her third child, Katie Kavulla expected to be physically and emotionally exhausted. After all, what new mother doesn't feel somewhat frayed at the ends? She was even alert to the signs of postpartum depression because she'd experienced some of the symptoms after the birth of her second child. But this time was different. "My anxiety level was overwhelming," says the Seattle mom. "I'd get hot and sweaty and irritable, and I turned into a late-night worrier. It was like there was a scrolling list of concerns going through my mind, and I had trouble sleeping. That wasn't like me."

Because she didn't feel depressed, however, Kavulla didn't know what was happening. "I wanted to put a label on what I was feeling and I couldn't, which only added to my frustration," she recalls. Finally, after talking to the pediatrician during a well-baby visit, she realized she was suffering from postpartum anxiety, a cousin to postpartum depression that affects about 10 percent of new moms, according to Postpartum Support International. With postpartum anxiety, a mom may have constant worries about the baby's health and development, her ability to be a good parent, and how she's going to balance work and home or care for multiple children. She may become restless and moody, or experience physical symptoms like a rapid heartbeat, dizziness, nausea, or insomnia.

"We call postpartum anxiety the hidden disorder because so few moms recognize it and it goes undiagnosed," says Jonathan Abramowitz, Ph.D., associate chairman of psychology and director of the Anxiety and Stress Disorders Clinic at The University of North Carolina at Chapel Hill. "It hasn't been discussed or studied much, even though it's a lot more common than postpartum depression (PPD)." In a study that tracked 1,024 women during the first three months after they gave birth, researchers from the University of Heidelberg in Germany found that more than 11 percent fell victim to postpartum anxiety disorders, while roughly 6 percent developed postpartum depressive disorders. The two often go hand in hand too -- in fact, about half of women who have PPD 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," Abramowitz says.

How It Happens

"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, Ph.D., director of postpartum depression at Day Hospital at Women & Infants' in Providence. That's why, according to the Mayo Clinic, 89 percent of 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 her? "For most parents, this is just mental noise," says Abramowitz. "They learn to dismiss it, so the thoughts stop cropping up."

On the other hand, if you know your worries are irrational (say, you have an intense fear that your baby will get hurt if you don't hold him) but you can't get them out of your brain, that suggests you may be tipping the scale. The same is true if your anxiety isn't tied to any particular threat, if it leads you to dread everyday situations (like driving with Baby), if panic attacks come out of the blue, or if it interferes with your ability to function (because you check on him throughout the night). "Anxiety is a problem when it overshoots reality," Howard says.

The condition often results because of 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, M.D., 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 round-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 that you should know what to do instinctively, and it's no wonder so many mothers start to come unglued.

While any new mom can develop postpartum anxiety, those who are especially vulnerable include women with a personal or family history of anxiety or previous experience with depression, certain symptoms of PMS (such as feeling weepy or agitated), eating disorders, or obsessive-compulsive disorder (OCD). Women who have had a miscarriage or stillbirth are more susceptible to postpartum anxiety and depression with a subsequent healthy delivery, according to a study by the University of Rochester in New York, because they're so worried something else might go wrong. Personality may also come into play: "Moms 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.

Getting Help

You may assume your symptoms will go away, but that's risky: Left untreated, postpartum anxiety can interfere with your ability to bond with your baby. Seek help if anxiety is disrupting your sleep or "if you can't concentrate, can't eat because your stomach is in a knot, or are constantly preoccupied with worries," Howard says. Unfortunately, the onus is 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 percent had one or the other; yet the majority of them had not been diagnosed.

Tell your ob-gyn or pediatrician how you're feeling and ask for a referral to a psychologist who specializes in cognitive behavioral therapy (CBT). "It gives you the skills to change the thinking and behavior patterns that lead to anxiety," Abramowitz explains. For instance, if you tend to think 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 -- it's about being rational," says Abramowitz, who worked with a mom who was terrified her child would get sick if held by someone else. "She genuinely believed it was a foregone conclusion, so we discussed the fact that people hold other people's babies all the time without a problem," Abramowitz recalls. Her homework was then to allow trusted family members to hold the baby. She was also asked to resist washing her infant's sheets every day in an effort to lower her anxiety about germs.

An expert can teach you techniques to help you relax, such as meditation, progressive muscle relaxation, and mindfulness training. Done before bedtime, they can set you up for a good night's sleep (which can in turn ease anxiety). Getting moving can also relieve anxiety by helping you feel more empowered, Howard says. Six weeks of resistance training or aerobic exercise led to a remission rate of 60 percent and 40 percent, respectively, among women ages 18 to 37 with generalized anxiety disorder, a study done by The University of Georgia finds. Kavulla learned that having a good support system is also key. "My husband, Josh, played a huge part in my recovery," she says. "He gave me the time and space I needed to take care of myself -- no questions asked." So share your angst with people you trust: Tell a friend, your mom, or your next-door neighbor when you're starting to feel overwhelmed or need to take a break from baby-care duties.

For more severe cases of postpartum anxiety, medications can be used, even if you are 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 that at some point they take precedence over the low or theoretical risk to your baby of taking an antidepressant."

That's what convinced Julianna Lewis (not her real name) to take medication when her firstborn was 3 weeks old. "I was anxious about my ability to care for him, nursing, his sleep schedule -- everything," says the mother of three in Houston. "I couldn't enjoy my time with him." Her doctor prescribed a commonly used antidepressant, and within a month she was symptom-free; she stopped taking the medication after 10 months. Before her twin girls were born, a little more than a year later, Lewis worried that her anxiety would come back, so on her doctors' advice, she started taking the antidepressant again right after delivery. "I had some mild symptoms but nothing full-blown."

Regardless of whether your anxiety falls 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."

Is It OCD?

While moms with anxiety tend to have constant worry, racing thoughts, or fearful feelings that something bad is going to happen, those with postpartum obsessive-compulsive disorder often develop rituals (or compulsions) to combat that angst. Like postpartum anxiety, OCD can be treated using cognitive behavioral therapy or medication. Concerned for your own health? Discuss your options with your doctor.

What Postpartum Depression Looks Like
What Postpartum Depression Looks Like

Originally published in the November 2013 issue of American Baby magazine.

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