What You Need to Know
What is postpartum anxiety?
Postpartum anxiety is a condition in which worry, fear, and physical symptoms of anxiety become persistent and interfere with a person’s ability to function after having a baby. Unlike typical new-parent worry, postpartum anxiety feels constant, excessive, and hard to turn off, and often comes with symptoms like feeling tense, trouble sleeping, or panic attacks.
How common is postpartum anxiety?
Recent research suggests that about 1 in 5 women experience a diagnosable anxiety disorder during pregnancy or the postpartum period. Some studies indicate that clinically significant anxiety symptoms are as common, or even more common, than postpartum depression.
How is postpartum anxiety different from “normal” worry or the baby blues?
Normal postpartum worry is usually intermittent, tied to specific situations, and improves as confidence grows. Postpartum anxiety is more intense, more persistent, often causing intrusive thoughts, trouble relaxing, and avoidance of certain activities or places.
How is postpartum anxiety different from postpartum depression?
Both conditions can involve low mood, irritability, sleep problems, and difficulty concentrating, so they often overlap. While postpartum anxiety is dominated by excessive worry and physical symptoms of anxiety and postpartum depression is more associated with sadness, loss of interest, and feelings of guilt or worthlessness, postpartum depression and anxiety often occur together.
What are typical symptoms of postpartum anxiety?
People with PPA often describe feeling “on edge” all the time, with intense worry, difficulty relaxing, trouble sleeping, and a constant sense of dread. Distressing, intrusive or “worst-case scenario” thoughts about harm coming to the baby are common. Physical symptoms include loss of appetite, stomach upset, headache and heart palpitations.
What about scary or intrusive thoughts of harm coming to the baby?
Intrusive, unwanted images or thoughts of accidental or intentional harm coming to the baby are common in postpartum anxiety and OCD. These thoughts are ego-dystonic (they feel upsetting and “not me”), and the presence of these thoughts alone does not mean a parent will act on them; however, they are very distressing and are an important reason to seek help.
When does postpartum anxiety usually start, and how long can it last?
Symptoms can begin during pregnancy or any time in the first year after delivery. Without treatment, symptoms may persist for months or longer, but with appropriate care, most people experience significant improvement.
What is postpartum OCD, and how is it related to postpartum anxiety?
Postpartum OCD involves intrusive, unwanted thoughts or images (obsessions) and repetitive behaviors or mental rituals (compulsions) aimed at reducing anxiety, often centered on the baby’s safety. Postpartum OCD is considered an anxiety disorder, and it is commonly treated with CBT that includes exposure and response prevention, often in combination with SSRIs.
Who is at higher risk for postpartum anxiety?
Risk is higher in people with a history of anxiety or depression, previous postpartum mood or anxiety disorders, or a family history of these conditions. Other contributors include traumatic birth, medical complications in the parent or baby, high levels of stress, lack of support, and sleep deprivation.
Can postpartum anxiety happen without depression?
Yes. Postpartum anxiety can occur on its own, without meeting criteria for postpartum depression. That said, postpartum depression and anxiety frequently occur together.
How does sleep affect postpartum anxiety?
Sleep deprivation both worsens anxiety and makes it harder to cope with intrusive thoughts and worries.
Anxiety can also interfere with falling or staying asleep, creating a self-reinforcing cycle of poor sleep and heightened anxiety.
How is postpartum anxiety treated?
Effective treatments include evidence-based psychotherapy (especially cognitive-behavioral therapy) and, when indicated, medication such as SSRIs or SNRIs. Treatment plans are individualized based on symptom severity, co-occurring depression or OCD, medical history, and whether the parent is pregnant or breastfeeding.
Which medications are commonly used, and are they safe in breastfeeding?
SSRIs (such as sertraline and citalopram) are among the best-studied and most commonly used medications for postpartum depression and anxiety. Information on the use of SSRIs and SNRIs while breastfeeding is reassuring, and the risk of adverse events in the nursing infant is very low.
What non-medication strategies can help?
Non-pharmacologic approaches include: cognitive-behavioral therapy, psychoeducation, support groups, mindfulness or relaxation strategies, and structured sleep and rest plans.
When should someone seek urgent or emergency help?
Urgent or emergency evaluation is needed if someone has thoughts of harming themselves or their baby, feels they might act on intrusive thoughts, is unable to care for themselves or their baby, or has symptoms that suggest postpartum psychosis (such as hallucinations, delusions, or severe confusion). These situations are uncommon but serious, and immediate assessment through emergency services, an on-call clinician, or crisis line is essential.
