How to Manage Postpartum Depression and Anxiety

After the baby comes, many new parents are simply relieved that they got through it. However, mothers may be unprepared to face one of their biggest potential challenges—how to manage postpartum depression and/or postpartum anxiety.

Risk Factors

Risk factors for postpartum depression or anxiety include:

• Prenatal or previous depression
• Life stress
• Lack of social support
• Marital dissatisfaction
• Unwanted pregnancy
• History of sexual abuse
• Traumatic birth experience
• High expectations of birth/parenting
• Physical problems with the baby
• Problems with health providers

Depression of Some Sort After Birth Is Common

Childbirth classes often limit the postpartum discussion to the mother's physical recovery and taking care of the baby. Rarely do parents have the opportunity to prepare themselves for such an emotional roller coaster.

It may help to look at the range of depression disorders from the mildest (postpartum blues) to the most severe (psychotic depression), as well as ways for mothers and their families to cope.

Postpartum Blues

As many as 80% of first-time mothers experience postpartum blues or baby blues. Symptoms often start 2 days after the birth as the hormones of pregnancy suddenly drop and moms are adjusting to taking care of a new baby with constant demands. Most mothers will have periods of elation and joy, followed by despondency and depression. These drastic mood swings are much easier to manage if you realize that they are based on hormonal shifts and fatigue. But some mothers might feel that having symptoms means they are not good mothers or that they shouldn't have been mothers.

Managing Postpartum Blues

The best way to manage the blues is first and foremost to get plenty of rest. Mothers need sleep for both physical and mental recovery. In addition, you should eat nutritious meals, drink plenty of fluids, and take walks outside (weather permitting) every day. It also helps if family members tackle household chores and put off any major projects for several months. If relatives are not able to help, it might be helpful to hire postpartum assistance from a postpartum doula. New mother support groups can be a great way to share with other new mothers, most of whom will be experiencing post-baby blues as well. Most mothers with postpartum blues will not need medication but may benefit from other therapies such as herbs and acupuncture. Typically postpartum blues will resolve within about 2 -3 weeks after birth.

Beyond the Baby Blues: Postpartum Depression

For around 15 percent of women, giving birth can send them into a full-fledged depression, making it difficult to care for themselves and/or their families. You may feel extreme sadness and anxiety that begins anywhere from before you give birth to a month afterward. Other symptoms include:

• Excessive crying
• Either sleeping too much or sleeping too little (and not because of your new baby)
• Feeling angry, irritable, and/or restless
• Feeling hopeless or worthless
• Isolating yourself
• Not doing activities you once enjoyed
• Appetite changes (either eating too much or too little)
• Physical symptoms such as stomach aches or headaches
• Difficulty concentrating
• Difficulty bonding with your baby
• Feeling like you can't take care of your baby

If you suspect you have postpartum depression, it's crucial that you see your doctor for treatment, for both your sake and your baby's sake.

Postpartum Anxiety Disorders

Postpartum anxiety disorders are more common than postpartum depression. There are several specific disorders that are included in the category of postpartum anxiety disorders, including:

• Generalized anxiety disorder (GAD): Excessive worry or anxiety that you find difficult to control and associated with restlessness, fatigue, irritability, muscle tension, and/or insomnia.
• Obsessive-compulsive disorder (OCD): Obsessions or thoughts that are persistent, frequently about hurting the baby, and/or compulsions that are repetitive, ritualistic behaviors that you find difficult to control.
• Panic disorder: Extreme anxiety accompanied by chest pain, dizziness, sweating, shaking, etc., that's often associated with a certain place or event.

Diagnosis

You can answer the following questions to help you determine if you might be suffering from any of these anxiety disorders:

• Are you so anxious that you cannot adequately care for your baby?
• Are you afraid of hurting yourself or the baby to the extent that you are not sure you can stop yourself?
• Are your compulsive behaviors harmful to the baby?
• Are you so anxious that you cannot eat or sleep?

Identifying Postpartum Anxiety Disorders

Although anywhere from about 6% to 28% of women may develop postpartum anxiety. If you think you have an anxiety disorder, your healthcare professional will probably recommend ruling out any physical problem first, such as hypoglycemia and hypothyroidism, before assuming anxiety is the cause.

In addition to good eating habits, rest and exercise, you can also benefit from relaxation exercises, support groups, counseling, and/or anti-depressants. Some of the support groups also offer referral services to mental health practitioners with a special interest in postpartum anxiety disorders.

Psychotic Postpartum Depression

One of the ways to distinguish postpartum psychosis from the more common anxiety disorders or postpartum depression is that in addition to those symptoms, you will often have hallucinations or delusions. Sometimes family members may not pick up on psychosis because you may have periods where you appear fine. However, during the time when you're irrational, your judgment is impaired and both you and your baby are not safe. You may not even remember what you have done during these periods of psychosis.

Postpartum psychosis, though rare (1 to 2 in 1,000 births), must be considered an emergency and treated immediately. Moms usually respond quickly to medication and in most cases will need to recover in a hospital or clinic. You also need to know that you're at risk for developing postpartum psychosis sometime in the future and that it will likely recur if you should have another child. There is some limited research that mothers at risk may benefit from the use of estrogen after birth to prevent psychotic depression.

Recommended Treatments

The recommended treatment for postpartum blues includes:

• Rest
• Nutritious meals and snacks
• Help from family and friends w/household chores
• Exercise
• New mother support groups
• Herbal remedies
• Acupuncture
• Postpartum doula services

The recommended treatment for postpartum depression and/or anxiety disorders includes:

• All of the above
• Light therapy
• Counseling
• Support groups
• Medication (antidepressants)

The recommended treatment for postpartum psychosis includes:

• All of the above
• Hormone therapy to mothers at risk as prevention*
• Assistance with caring for the baby while the mother is in recovery
• Hospitalization until you're stabilized

See your healthcare provider for information about the most appropriate medications or herbal remedies for you and/or those safe to use while breastfeeding. In 2019, the Zulresso became the first FDA-approved drug prescribed specifically for postpartum depression.

The Bottom Line

The bad news is that almost all mothers will experience at least the mildest form of postpartum depression. However, the good news is that all of these disorders are treatable. We are also learning more and more about mental health issues today so new mothers and their families have many resources at their fingertips to help them through this rocky emotional journey.