When my second child, Ethan, was 9 months old, I wore faint tracks in our dining-room rug from pacing so much. I had tingling in my arms, twitching muscles, and galloping thoughts. I loved my children, but over the previous few months, the bliss I’d experienced after the birth of my son had faded. My brain became a very bad neighborhood, and I was scared to be there alone. During brief breaks while my husband watched the kids, I’d go for jogs, trying to outrace the anxiety that followed me like a storm cloud. How could I be in charge of two needy little people? I kept wondering when the real parents were coming home.
Of course, as a second-time mom, I knew to expect some stress and worry. But this time around was definitely more challenging: Ethan was still waking up every two hours the way newborns do, and his 3-year-old big sister, Hannah, was demanding and sulky over losing her spot at the center of the universe. I had decided to wind down breastfeeding, so my hormones were probably in a free fall. Still, none of it explained my flashes of terror, bolt-awake panic, and the fear that I was literally going crazy. It all felt like nothing I had ever experienced before.
After one particularly miserable night, I went to my family doctor. Once he had ruled out physical causes, he chalked my symptoms up to stress, handed me a prescription for an antidepressant, and sent me on my way. I doubted a little vial could ease the storm inside my brain, but within a few weeks, the medication kicked in. Ethan also started—at last!—sleeping better. Gradually, the combination allowed my mind to quiet and my twitching body to follow suit. I began to feel normal again.
I know now that there’s a clinical name for the scary time I survived: postpartum anxiety. While postpartum depression is the condition that celebs and the media tend to talk about, the truth is that anxiety strikes a lot more moms: 17 percent compared with 5 percent. (Some experts theorize that they are variations of the same illness.) But many moms don’t realize that the overwhelming anxiety they feel isn’t a normal reaction to their baby. Some may be ashamed to admit they can’t cope the way it seems other moms do. “As a result, postpartum anxiety is the huge problem that no one hears about,” says Tamar Gur, M.D., Ph.D., professor of psychiatry at The Ohio State University Wexner Medical Center, in Columbus.
The difference between normal mom jitters and postpartum anxiety is that it disrupts your ability to function and enjoy your baby. “Worry becomes a runaway train,” says Dr. Gur. “It is painful and all-consuming.” The symptoms can run the gamut and include insomnia, a stomach in knots, and overwhelming fear. A mother may check on her sleeping baby a dozen times a night, or she might be terrified to carry the baby up the stairs because she’s panicked she will drop him. Symptoms can show up at any point in the first year of your baby’s life.
For Courtney Novak, a mom in Pasadena, California, the anxiety was primarily physical. “My skin was crawling, my heart was pounding. It felt like I was sitting through the scariest part of a horror movie,” she says. Many moms say that the most frightening symptom is intrusive thoughts—when you envision catastrophes as if you’re watching a video on a loop. “If I heard on the news that someone had forgotten their baby in a hot car, I was sure that I was going to do the same,” recalls Jenny Oldenburg, of Memphis. Some moms have recurrent, scary thoughts about harm coming to their baby—which can be traumatizing. Says Carly Snyder, M.D., a reproductive and perinatal psychiatrist in New York City, “Women are haunted by images of things they would never actually do. They might think, ‘What if I left my baby in the bathtub on purpose and just walked away?’ They are terrified and believe they are the worst mother in the world.”
In reality, these types of fantasies are a hallmark of postpartum anxiety, not a sign that you’re a dangerous person. It’s extremely rare for women to have a different disorder called postpartum psychosis, in which they are not in touch with reality and are at risk for harming themselves or their baby. When a mom lacks awareness about these disorders, she may be even more scared to reach out. “She thinks everyone will realize she’s crazy and her baby will be taken away,” says Dr. Snyder.
New moms are wired to feel some level of worry—it’s what makes us keep a hand on our baby while he’s wiggling on the changing table. “We know the areas of the brain involved in maternal caregiving overlap with those involved in depression and anxiety,” says Jodi Pawluski, Ph.D., a researcher at the Research Institute for Environmental and Occupational Health, in Rennes, France. Experts believe that postpartum anxiety might develop when these natural protective instincts kick into unhealthy overdrive.
Having anxiety during pregnancy is the greatest risk factor for postpartum anxiety. A personal or family history of depression and anxiety comes in second. Shifting hormones also play a role, since levels of estrogen and progesterone plummet after birth, and oxytocin and prolactin drop during weaning from breastfeeding. Like any mood or anxiety disorder, postpartum anxiety is an interplay between biology and circumstances: Add potential sleep deprivation, isolation, and marital role changes, and it can be a perfect storm, says Samantha Meltzer-Brody, M.D., director of the Perinatal Psychiatry Program at the University of North Carolina at Chapel Hill Center for Women’s Mood Disorders.
Plus, motherhood is now more burdensome than ever. “There is so much pressure on moms to do things perfectly. But having a baby is a messy, stressful time,” says Kate Kripke, a social worker and founder of the Postpartum Wellness Center of Boulder, Colorado.
Novak recalls how she would beat herself up if her house wasn’t neat or if she didn’t have her daughter, Pippa, in a cute outfit. These types of unreasonable standards add to the stress that can send vulnerable women over the edge. “I just wanted to run away because I thought my husband and daughter deserved better,” says Novak.
Recovery Starts Now Unfortunately, at a time when you feel most rocky, you may have to take the initiative to get help. “Often, doctors don’t know the right questions to ask and women aren’t telling their doctor how bad they really feel,” says therapist Karen Kleiman, coauthor of Dropping the Baby and Other Scary Thoughts. The most commonly used screening test—the Edinburgh Postnatal Depression Scale—does ask about anxiety, but only in one question out of ten. Plus, sometimes even when depression resolves, anxiety can continue and be undertreated. If you are suffering in silence, take the following steps.
“Just hearing that your condition has a name and you are not crazy can be a tremendous relief,” says Dr. Gur. “I tell women that this is a common condition that’s very treatable. They won’t always feel like this.” All the moms quoted here, including me, can vouch for that. I always knew in my heart that I was a good mother. After I got help, I could at last relax my shoulders and feel the joy again.