Postpartum anxiety (PPA)

Postpartum anxiety

Postpartum anxiety (PPA) is a treatable mood disorder that’s estimated to affect 4 to 18 percent of new moms. It’s characterized by extreme feelings of fear and worry that disrupt daily life and make it difficult to eat or sleep. You may be more prone to PPA if you have a family history of anxiety disorders. If you recently gave birth and you’re experiencing feelings of panic or worry that feel all-consuming, reach out to your healthcare provider. PPA is treated with therapy, medication, or both.

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What is postpartum anxiety?

Having a baby is a huge life change that’s sure to come with some emotional upheaval. Feelings of worry or nervousness, especially in those first couple weeks postpartum, are normal and often subside as you adapt to your role as a new parent.

But if you feel consumed with worry, are unable to sleep, or constantly feel on edge, you may be suffering from a postpartum mood disorder known as postpartum anxiety (PPA). PPA is generally defined as excessive feelings of worry and panic that disrupt your daily life. Symptoms of PPA can include intrusive or persistent thoughts that make it difficult to care for yourself and your baby.

What are the most common postpartum anxiety symptoms?

Postpartum mood disorders can look a bit different from person to person, but in general signs of postpartum anxiety include:

  • Persistent intrusive thoughts
  • Feeling like your heart is racing
  • Shakiness or trembling
  • Panic attacks
  • Fatigue
  • Insomnia or difficulty sleeping even when the baby is sleeping
  • Feelings of dread or overwhelming fear that something bad will happen
  • Chest tightness
  • Nausea
  • Headaches
  • Dizziness

Keep in mind that it’s normal to experience some feelings of worry as a new parent, but if your anxiety is impacting your daily life, keeping you from leaving your house or interfering with your ability to sleep even when your baby is sleeping, reach out to your healthcare provider.

What causes postpartum anxiety?

Experts don’t know yet exactly what causes PPA, but several biological and environmental factors are thought to play a role. One theory is that pregnancy-related hormonal changes may contribute to feelings of depression and anxiety after giving birth. During pregnancy, estrogen levels increase significantly and then rapidly drop in the first 24 hours after giving birth, which can contribute to mood swings and feelings of anxiety.

These hormonal changes are thought to also contribute to the baby blues, which are feelings of sadness and overwhelm in the days after giving birth. The baby blues subside within a couple of weeks, but for some parents though, these feelings may persist and manifest as a mood disorder like PPA.

Some research also indicates that moms who have had previous miscarriages or stillbirths are more susceptible to developing postpartum anxiety or depression.

Environmental factors and life circumstances can also play a role. Financial stress, lack of a support system, experiencing domestic violence, or having a baby with high medical needs can all contribute to postpartum mood disorders, including anxiety. If you’ve experienced clinical anxiety in the past or have a family history of anxiety disorders, you may also be at an increased risk of developing PPA.

What’s the treatment for postpartum anxiety?

Postpartum anxiety is usually treated with cognitive-behavioral therapy (CBT), medication, or a combination of the two.

CBT involves working with a licensed mental health counselor or therapist to examine your thought patterns and how they contribute to feelings of anxiety. This kind of therapy can help you better understand how your thoughts affect your mood, and can help you develop strategies for reducing negative thoughts and increasing positive self-talk.

Medication isn’t always necessary to treat PPA, but if you and your healthcare provider find therapy isn’t enough to ease your symptoms, it can help. Medication options for PPA include serotonin reuptake inhibitors (SSRIs), which can take up to six weeks to take effect. (Your provider may also suggest a fast-acting anxiety reliever, like a benzodiazepine, to help with symptoms until the SSRI kicks in.)

While some providers have steered breastfeeding parents away from mental health medication in the past, current research shows there are several SSRI medications that are safe to use in pregnancy and while breastfeeding. If you’re worried about side effects or how your mediation may affect your baby, don’t be afraid to discuss your concerns with your provider.

In addition to therapy and medication, here are some other lifestyle changes you can make that may help you cope with PPA:

Move your body. Physical activity may be the last thing on your mind if you’re struggling with anxiety, but even a quick, leisurely walk around the block can help boost your mood. In fact, research shows that exercise both during and after pregnancy reduces symptoms of depression and anxiety during the postpartum period.

Find support. Connecting with other parents who are struggling with similar issues can give you a sense of community and help you feel less alone.

Prioritize your sleep. Getting stretches of uninterrupted sleep with a newborn is undoubtedly a challenge, but adequate rest can be a key part of your recovery. Lean on your support system to help make sleep a priority, maybe by trading nighttime shifts with your partner or asking a family member or friend to help out at night for a few days or weeks so you can get the rest you need to feel better.

Practice mindfulness and relaxation techniques. Mindfulness practices, like meditation and muscle relaxation, have been shown to ease stress and decrease symptoms of depression and anxiety. Learning how to meditate may seem intimidating, especially if you’ve never done it before, but starting small with even just a few minutes of deep breathing a day can help you feel calmer.

Can I have PPD and PPA at the same time?

Postpartum depression and postpartum anxiety are different conditions, but you can experience both at the same time. In some cases, anxiety may occur as a symptom of postpartum depression or vice versa.

There’s some overlap in symptoms of PPA and PPD, but in general, PPD is characterized by feelings of hopelessness and sadness, while PPA presents more as excessive worry and fear.

Both PPD and PPA may result in difficulty sleeping and changes in appetite as well as physical symptoms, like fatigue, nausea and headaches, but there are also some distinct differences between the two.

Some of the symptoms of PPD that are different from PPA include:

  • Feelings of extreme sadness, hopelessness or emptiness
  • Loss of interest or lack of enjoyment in activities you used to enjoy
  • Pulling away from friends and family
  • Extreme feelings of guilt

What is postpartum OCD?

Postpartum OCD (obsessive-compulsive disorder) is a type of anxiety disorder that can also present during the postpartum period. It’s characterized by persistent (and often frightening) intrusive thoughts that are accompanied by compulsions or repetitive behaviors in an attempt to ease distress. An estimated 3 to 5 percent of new moms are thought to experience symptoms of postpartum OCD, though it’s often misdiagnosed.

Both postpartum OCD and PPA can cause feelings of fear and hypervigilance, but postpartum OCD is also accompanied by compulsions or the need to perform certain rituals to reduce fears. This may include excessively cleaning the same area, checking that the door is locked and the oven is turned off multiple times before leaving the house, or needing to recount and rearrange certain items to ease stress.

Postpartum OCD (or any postpartum mood disorder) isn’t your fault and you can feel better with proper treatment. Treatment for postpartum OCD is similar to treatment for PPA and can include therapy and medication.

What is postpartum panic disorder?

Postpartum panic disorder is another type of anxiety disorder that manifests as extreme nervousness and panic attacks, which may last for about 20 to 30 minutes. These postpartum panic attacks come on suddenly and trigger physical symptoms such as:

  • Chest pain
  • Shortness of breath
  • Tingling and numbness in fingers and toes
  • Heart palpitations
  • Sweating
  • Dizziness
  • Nausea

Postpartum panic disorder and PPA share many similarities, but people with postpartum panic disorder have distinct fears of dying or losing control that can trigger panic attacks. As with other postpartum mood disorders, postpartum panic disorder is treatable and with the right support, you can better identify panic attack triggers and find ways to manage them.

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