Postpartum Mood and Anxiety Disorders

By Sarah Brangwynne, MA, LPC, BC-DMT

It is 3am. Why am I awake? The baby finally fell asleep two hours ago. My husband is asleep and the house is quiet.  I am so tired and I know tomorrow will be miserable if I don’t get rest. Why can’t I sleep?  I keep thinking about the baby in the bath this afternoon. She was so adorable and tiny, but what if she had slipped. What if I didn’t notice? She is so small and helpless. I can’t believe she will be twelve weeks tomorrow. I’m not ready to go back to work. I barely feel like I can function at home.  I’ll miss her so much but maybe she’ll be better off in daycare. They will have more energy for her and can give her better care than her tired mom.

You’ve just read the thoughts of Emily*, first time mother of a 12 week old.  What you are reading are thoughts and symptoms of Postpartum Anxiety, which is under the umbrella of perinatal mood and anxiety disorders (PMAD), commonly known as postpartum depression (PPD). 

What most people (including mothers, family members, and their practitioners) don’t recognize is that many women who suffer from a perinatal mood disorder, don’t know what is going on, and are afraid to share that they don’t feel ok after having a baby. Due to media coverage of the most rare and extreme cases of mothers hurting themselves or their children, many women are afraid they will be misunderstood.  The cases in the news are often about women suffering from a form of postpartum psychosis, a very rare and severe illness. 

PMAD on the other hand is very common. 1 In 7 mothers will suffer from a PMAD.  PMAD is not to be confused with the baby blues, a period of high emotion and frequent crying experienced by many women immediately following birth and resolving by 2-3 weeks postpartum. The symptoms of a PMAD most commonly experienced are anxiety, depression, anger, insomnia, lack of appetite, scary thoughts, obsessive thoughts, compulsive actions (often associated with keeping the baby safe or clean).  Often symptoms don’t present as the common public view of postpartum depression, and so women and their loved ones don’t know what is happening. 

The exact cause of PMAD is not yet known but we do know it is not a mother’s fault. Experts believe it is a related to the neurotransmitters in the brain and hormonal and environmental causes. We know that women who have a history of anxiety and depression, family history of mental illness, abuse history and who tend to be perfectionist are more likely to experience a perinatal mood or anxiety disorder.  

The good news is these issues are very treatable.  Women do get better and return to feeling good about themselves and motherhood. The first step is to share how you are feeling and get support. Tell your partner, friend, mother, doctor, midwife, or doula that you don’t feel like yourself. Treatment can include sleep, nutritional support, group support, psychotherapy by a clinician familiar with PMAD, and    medication.  Medication is very helpful when symptoms interfere with functioning.   For breastfeeding mothers there are medication options that are safe for the baby. 

Twenty years ago we were not having this conversation the way we are today.  It is very important to talk and educate new mothers, their families, friends, pediatricians and health care practitioners about PMAD so the symptoms can be recognized and women can get help.  For generations women have suffered in silence and we aim to change this for future generations.  The better a mother feels and is able to care for herself, the better she will be able to take care of her child.

There are many resources for women and their families to learn more and get support. Both the Postpartum Stress Center and Postpartum Support International (PSI) are two groups that offer great services and information as well as a national directory of clinicians trained in recognizing and treating PMAD.  PSI also offers a warm line for women and their partners to call to get immediate support (1-800-944-4473).

Please reach out if you see a loved one or friend struggling and share this information.  Often women find the transition to motherhood difficult and overwhelming, but after a period of adjustment, they gain confidence and feel good in their new role.  For many women they don’t start to feel better and help is needed.

If you experience any of these symptoms and feel that you are just not yourself and don’t enjoy life or motherhood the way you hoped, reach out and get help.  Mothers who experience this are not alone and will get better with proper support and treatment.