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Postpartum Mood & Anxiety Disorders

Symptoms to watch for, treatment and support resources, and tips for partners and family members

It’s not a secret that pregnancy, childbirth, and jumping into motherhood takes a major physical toll on mothers. However, many new moms and their partners aren’t prepared for the mental health impacts that can happen during this time. While postpartum depression is often discussed, other postpartum mood and anxiety disorders are not widely known, despite the fact that many women experience them.

The most important thing to remember is that these conditions don’t make a woman a bad mother if she experiences them during or after pregnancy. Postpartum mood and anxiety disorders are caused by chemical changes in the brain and can improve with proper treatment. It’s crucial to learn about the different types of disorders, symptoms to watch for, how to be supportive, and the treatment options available so everyone is prepared. Early intervention is key.

Postpartum depression, or PPD, is one of the better known postpartum conditions. Approximately 15% of women will experience depression after childbirth. Women with PPD may experience feelings of anger, sadness, guilt, irritability, lack of interest in the baby, changes in eating and sleeping habits, trouble concentrating, thoughts of hopelessness, and thoughts of hurting themselves or the baby. PPD is different from the “baby blues,” which many new moms experience.

An estimated 10% of women experience postpartum anxiety, or PPA, and it can be accompanied by PPD. Symptoms to look out for include constant worry, feeling that something bad is going to happen, racing thoughts, changes in sleep or appetite, inability to sit still, physical symptoms including dizziness, racing heart, and hot flashes.

Women with PPA can also experience postpartum panic disorder, where they feel very nervous and have recurring panic attacks. These attacks can bring shortness of breath, chest pain, claustrophobia, dizziness, heart palpitations, and numbness or tingling in hands and feet. Although these sensations are very uncomfortable, they are not harmful.

Postpartum OCD is the most misunderstood and misdiagnosed postpartum disorder. About 3-5% of new mothers will experience postpartum OCD.

Postpartum OCD is characterized by obsessions and compulsions. Obsessions, known as intrusive thoughts, are persistent, repetitive thoughts or mental images related to the baby. They can be very upsetting thoughts, and are not something that the woman has experienced before. Compulsions are when the mom does things over and over again to reduce fears, such as cleaning constantly, checking things many times, counting or reordering things.

Other symptoms of postpartum OCD include a sense of horror about the obsessions, fear of being left alone with the baby, hypervigilance in protecting the baby. These moms know that their fears are unlikely to occur, but they cannot stop them.

Postpartum post-traumatic stress disorder, or PTSD, is often caused when women have a traumatic delivery. This can include an unplanned c-section, baby going to the NICU, use of vacuum or forceps to deliver the baby, or poor communication or lack of support during delivery. About 9% of women will experience postpartum PTSD.

Symptoms include intrusive thoughts re-experiencing of the past traumatic event, flashbacks or nightmares, avoiding stimuli in association with the event, persistent increased arousal, anxiety and panic attacks, and feeling a sense of unreality and detachment.

Bipolar disorder is characterized by experiencing highs and lows in mood, also known as depressions and manias. These highs and lows can also happen at the same time, known as a mixed episode, often causing further confusion.

There are two common types of bipolar disorder, known as bipolar I and bipolar II. With bipolar II, manic episodes are less apparent because the highs are not as extreme. It may be easier for friends and family to notice the symptoms than the mom.

It is very easy to mistake bipolar disorder for severe depression, so it's important to have symptoms analyzed if bipolar disorder is suspected. To be diagnosed with bipolar disorder, symptoms must last longer than 4 days, and interfere with daily functioning.

Symptoms of Bipolar I:

  • Periods of severe depression and irritability

  • Periods of moods much better than normal

  • Rapid speech

  • Not needing a lot of sleep

  • Racing thoughts/ trouble concentrating

  • High energy, overconfidence

  • Delusions

  • Impulsiveness and poor judgment

  • Inflated sense of self important

  • Hallucinations and delusions in severe cases

Symptoms of Bipolar II:

  • Periods of severe depression and periods of improved mood

  • Rapid speech

  • Not needing a lot of sleep

  • Racing thoughts/ trouble concentrating

  • Anxiety

  • Irritability

  • High energy

  • Overconfidence

Postpartum psychosis occurs in 1 to 2 out of 1,000 births. Onset can be sudden, typically occurring within two weeks of birth, but can happen anytime within the first year.

A woman with postpartum psychosis experiences a break from reality. While in this psychotic state, the delusions feel very real and make sense to the woman. They can often be religious in nature. Postpartum psychosis is temporary and treatable, but it is imperative to receive help immediately. While not all delusions are violent or destructive, research shows there is a 5% suicide rate and a 4% infanticide rate.

Symptoms of postpartum psychosis include delusions or strange beliefs, hallucinations, feeling irritated, hyperactivity, severe depression, inability to sleep, paranoia or suspiciousness, rapid mood swings, and difficulty communicating.

Treatment Resources:

If you are experiencing suicidal thoughts or thoughts of harming your baby, don’t wait! Call 911 for emergencies. Text HOME to 741741 from anywhere in the USA, anytime, about any type of crisis, call 988 to reach The Suicide and Crisis Lifeline. You can also call 211 in Connecticut to be connected to mobile crisis teams.

Taking Care of Yourself

Self-care seems like a buzzword you hear all of the time. You know you’re supposed to take care of yourself, but how exactly do you do that with a newborn (and maybe more children). It’s not easy, but make time every day for yourself, even if it’s only a short time to be alone. Read a magazine, go for a walk if you (if you have someone to watch your child), get into a hobby like painting, puzzles or baking.

One thing all moms need is support, but sometimes it’s hard to get out of the house. Some of these groups below are offering online meetings or other resources.

If you are looking for ways to support a new mom, Motherly provides this great list of ideas that are truly helpful.

How Partners & Families Can Help

If you believe someone in your life is experiencing a postpartum mood disorder, there are many things you can do to help. The most important thing to remember is that she is not at fault, and is likely just as surprised as you are by the onset of the disorder.

  • Make sure they know this is not their fault, and they are not alone

  • Encourage them to talk about what they are feeling, and do not pass judgment

  • Help out with daily tasks such as housework

  • Encourage them to take breaks and focus on self-care

  • Don’t put too much on their plate just because they are home all day, for example don’t expect them to have all the housework done and dinner on the table

  • Be realistic and honest about what time you will be home and make sure you stick to it

  • Schedule dates and find childcare

  • Offer simple affection and comfort

  • Help them find support and treatment

  • Low blood sugar can contribute to low mood and frustration, so make sure they are eating throughout the day

  • Do your best to listen and find the real cause of their frustration

  • Make sure you are openly communicating with them

  • If the anger is so much that you cannot be supportive, try asking for a break and using language such as, “I want to listen to you. I know this is important, but I’m having a hard time because you’re so mad at me. Can we take a break and talk about it later?”

  • Ask them how you can help in the moment and offer suggestions

  • Ask for help, information, and support for yourself

  • Develop a support team for your family

  • Talk to and find other families who have experienced this

  • Spend time with your baby to strengthen your own confidence

Helpful things to say and what to avoid

Postpartum Support International suggests the following:

  • We will get through this.

  • I’m here for you.

  • If there is something I can do to help you, please tell me. For example, care for the baby, run her a warm bath, put on soothing music.

  • I’m sorry you’re suffering. That must feel awful.

  • I love you very much.

  • The baby loves you very much.

  • This is temporary

  • You’ll get yourself back. As she recovers, point out specifics about how you see her old self returning; such as, smiling again, more patience, or going out with her friends.

  • You’re doing such a good job. Give specific examples.

  • You’re a great mom. Give specific examples, such as “I love how you smile at the baby.”

  • This isn’t your fault. If I were ill, you wouldn’t blame me.

  • Think about everything you have to feel happy about. She already knows.

  • Just relax.

  • Snap out of it. If she could, she would have already.

  • Just think positively.

Find more help resources for your loved one and yourself here.

If you are a parent and are struggling, find more resources and help here.

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