Postpartum Mood & Anxiety Disorders

The Baby Blues – (70-80% of all new mothers) occurring within the first two weeks after childbirth, it is a mild and temporary period of distress due to a sudden drop in hormones. A woman may feel weepy, exhausted, anxious, irritable, and vulnerable.
Postpartum Depression – (10-20%) is more serious and lasts longer than two weeks. A woman may experience rapid or gradual onset of hopelessnes and tearfulness, and intense feelings of inadequacy, worthlessness, guilt, and fatigue.  She may develop sleeping or eating problems and a lack of feeling for the baby. These symptoms can appear any time from the first few months up to one year after the birth.
Postpartum Anxiety – (10-20%) characterized by excessive worry and nervousness, it can occur by itself or will often be present along with depression. Specific anxiety disorders that can also occur are:
Panic Disorder – (10%) recurrent panic attacks that may include palpitations, hot or cold flashes, chest pains, shaking, dizziness, shortness of breath, fear of losing control or going crazy.
Obsessive Compulsive Disorder (OCD) – (3-5%) repetitive and unwanted thoughts, images, or behaviors that are disturbing (including thoughts of harming or harm coming to the baby), and avoiding the baby or situations in order to cope with the unsettling feelings.
Post-Traumatic Stress Disorder (PTSD) – (1.5-6%) a traumatic pregnancy or birth experience can trigger symptoms such as re-experiencing the event through vivid memories, flashbacks or nightmares, jumpiness or hypervigilance, numbing and detachment. Symptoms can occur right after the trauma or months later.
Bipolar Disorder – (.1-.2%) can develop or worsen (if pre-existing) after childbirth. Symptoms include intense mood swings from depression to mania. The manic phase is characterized by an elevated, expansive or irritable mood with inflated self-esteem, a decreased need for sleep, pressure to talk, racing thoughts, and agitation.
Postpartum Psychosis – usually associated with an underlying Bipolar Disorder, it is an extreme, rare (.1-.2%) condition requiring immediate medical attention. It usually occurs within the first 4 weeks postpartum. Symptoms include agitation, confusion, loss of touch with reality, hallucinations, delusional thoughts usually around harming baby or self that frequently are religious in nature (important distinction from OCD thoughts in which the mom knows there is something wrong with her thinking and the thoughts are not delusional in nature).
While the causes of postpartum mood and anxiety disorders are not fully understood, we do know that hormonal changes that take place after childbirth can affect a woman’s mood and behavior, including later events such as weaning and start of menstruation. Thyroid problems, which have been associated with depression, will affect some women after childbirth.  Other risk factors include: Lack of support, low self-esteem, personal or family history of mental health disorders, relationship or financial problems, a recent loss or disappointment, complicated pregnancy or birth, difficulties nursing or a difficult baby, and severe sleep deprivation. Biological, psychological, and social factors can all play a role. Postpartum difficulties may occur immediately after the birth or many months later. They can also occur after giving birth to any child, not just the first. They can even happen after adoption.
While some women with postpartum mood and anxiety disorders recover without incident, many others need professional help. A woman experiencing any of these symptoms should contact her health or mental health provider right away to discuss her situation. A complete medical evaluation, including a comprehensive thyroid screening, is necessary.  Counseling and support groups provide an invaluable source of help during this difficult time. Psychotropic medications are often helpful in treating women with postpartum mood disorders, and women tend to recover more quickly with their use. In severe cases such as postpartum psychosis, hospitalization may be necessary to stabilize the situation. Women with thyroid symptoms often benefit from both thyroid and psychotropic medication. Other hormonal treatments such as estrogen have been used successfully, but are still experimental. Alternative treatments such as light and wake therapy, acupuncture, herbs, and supplements can be beneficial but should be used under the supervision of a trained professional.
Most women suffering from postpartum mood and anxiety disorders realize that something is wrong, but often do not seek help. The important thing to remember is that you can get better with skilled professional care and support. It has been found that the more quickly you get help, the more quickly you recover. Most importantly, don’t try to get through it alone.
Postpartum Health Alliance