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In the months before and after giving birth, it is completely normal and even expected to feel more on edge than you usually do. After all, you are now responsible for growing and nurturing a new life. It’s when that edginess begins to impact your day-to-day responsibilities that it becomes an issue. This is typical for women who suffer from postpartum anxiety.
As someone previously diagnosed with general anxiety disorder (GAD), I was aware postpartum anxiety could be something that might affect me after having my baby. I’ve been on Lexapro for a number of years and in therapy for even longer. I know when my anxiety is beginning to spiral out of my control, beyond the scope of my management techniques. So, I prepared myself by knowing what symptoms to look out for and having a plan of action to get help.
Let’s take a look at PPA and unpack what it is, how it presents, how long it can last, and how you can treat it.
What is postpartum anxiety, exactly?
Postpartum anxiety, or PPA, is the lesser talked about but close relative of postpartum depression. PPA is classified by excessive worrying that occurs before or after childbirth. Women who suffer from PPA might feel completely consumed with worry, nervousness, or panic.
“Postpartum anxiety is more prevalent than you may think. It is estimated that between 10-20% of postpartum women will experience PPA and that 6% of pregnant women will experience anxiety (often called antepartum anxiety). This anxiety can also start anytime in the first year after having a baby,” explains Elyse Shull, MS, LPC, LCPC, PMH, a licensed professional counselor certified in perinatal mental health.
For many women, postpartum depression and anxiety can go hand-in-hand. The two conditions have some overlapping symptoms, such as difficulty sleeping, irritability, inability to rest, and even a disinterest in doing things they once enjoyed.
“For women experiencing both PPA and PPD simultaneously, it's good to remember that they are both treated the same way: with therapy and/or medication. Seeking help for one will also help to heal the other,” assures Shull.
How do you know if you have postpartum anxiety?
Postpartum anxiety can result in several emotional, physical, and behavioral symptoms. Physically, you might experience heart palpitations or an increased heart rate, nausea, loss of appetite, muscle tension, panic attacks, or obsessive thinking. You might find yourself avoiding certain places and people, being overly cautious, and obsessively checking and rechecking things. You may even experience irrational fears or constant worries about unlikely scenarios. This was exactly how I knew I was struggling with PPA.
About two weeks after having my son, the intrusive thoughts began. I envisioned falling down the stairs while holding him or other people dropping him. I fixated on his body temperature, whether or not he was too hot or too cold, and what that would mean for his health. I couldn’t sleep because every time I shut my eyes, a bad scene would play out in my mind.
When does postpartum anxiety typically go away?
Because PPA is often caused by a combination of factors, it’s unfortunately not something that will just “go away” on its own. One of the main culprits is the drastic hormonal changes your body goes through during and after pregnancy.
Hormones do tend to balance out around 6 months postpartum, but you can still experience symptoms for up to a year or more after giving birth. It really depends on your individual experience and how promptly you seek treatment from your healthcare provider.
“Breastfeeding can also impact hormone levels. Many women experience an increase in anxiety symptoms during the weaning process, with the symptoms leveling out within a few weeks of weaning. For those especially sensitive to hormonal fluctuations, you may even experience a sudden rush of anxiety during letdown while breastfeeding,” says Shull.
Some other factors that affect your likelihood of experiencing PPA are lack of sleep, the overwhelming feelings of responsibility that come with having a newborn to care for, stressful events such as difficulties with breastfeeding, a traumatic delivery, or your baby having health issues, as well as prior risk factors such as physical or mental health conditions.
When my son was six months old, he was diagnosed with Food Protein-Induced Enterocolitis Syndrome, FPIES, a rare gut allergic reaction to foods. The first time he had a reaction was traumatic. He couldn’t stop vomiting. He couldn’t stay awake, slumping over between bouts of vomiting. It took about two to three months to get an official diagnosis and in with a team at CHOP who could tell me exactly what was going on and how to take care of him.
Needless to say, my anxiety skyrocketed.
So, what can you do about postpartum anxiety?
After I noticed those first obsessive negative thoughts when my son was a few weeks old, I called both my OB and PCP to talk about increasing my Lexapro dosage. They were both on board and eager to see my symptoms improve. Within another two to three weeks, I could shut my eyes without those obsessive thoughts taking over. I was finally sleeping — or as much as was possible with a newborn.
After his FPIES reactions and diagnosis, I restarted therapy every other week. I had dropped down to once a month after him because I was scared to leave him, which, in and of itself, should have been a warning sign that I needed more help with my anxiety.
Therapy, support groups, mindful exercising, prioritizing your physical health, and SSRI medications are all options for treating postpartum anxiety.
As soon as you think you might be experiencing symptoms, contact your healthcare team. No one should have to suffer in silence.
Lastly, be gentle with yourself. Give yourself grace. You are now responsible for taking care of and protecting a tiny, perfect human. It’s no easy feat, and no one expects you to be perfect at it.
Don’t be ashamed to seek help for PPA if you need it
Even now, I struggle to leave my son with anyone other than my husband, mom, or sister. In fact, thinking about leaving him with anyone else makes my stomach knot. He is now 18 months old, and I have never spent a night away from him. I plan to do so for the first time at the end of this month, and quite frankly, I feel extremely anxious about it. Is this still postpartum anxiety, even though he is older than a year? Is this my general anxiety? Or is this a normal amount of attachment and concern between mother and child, and we’ve just been conditioned to think it’s problematic?
I tend to think it’s the latter. I no longer have obsessive negative thoughts. I sleep, exercise, and take care of myself as much as I take care of him. I think feeling anxious about our little ones is normal and part of parenthood.
"All parents worry and have anxious thoughts from time to time- this is a typical human experience. If you think of these experiences on a spectrum from typical, everyday worry and anxiety all the way to debilitating worry, it can be helpful to realize that some anxiety is going to be normal and expected as a parent. It's when those anxious or worried thoughts reach the debilitating side of the spectrum and start changing the way you live your life that it is recommended to seek professional support,” says Shull.
Brighid Flynn is a freelance writer based in Philadelphia where she lives with her husband and puppy. She is just beginning her journey toward motherhood.