Becoming a mother is undoubtedly a wonderful experience. But along with immense joy and happiness, you may feel overwhelmed, worried, or anxious. Each of these emotions is normal, but when negative thoughts and feelings become unbearable and start to hurt your daily life, it may be time to ask for help. Knowing the difference between postpartum anxiety vs. postpartum depression can help.
Studies show that approximately 1 in 5 women experience postpartum anxiety. Postpartum anxiety is a medical condition in which you experience excessive worry during the postpartum period that may result in irrational fears and a persistent state of worry. The anxiety can become so severe that you develop both physical and emotional symptoms.
The good news is that you do not have to go through this alone. Postpartum anxiety is treatable. For some women, symptoms improve over time, while others benefit from therapy or medication.
The most important thing you can do is talk to your family, friends, and medical provider and let them know how you are feeling. Together, you can find the support you need and work out a plan to manage your symptoms so you can focus on the joys of motherhood.
Key Points
- Postpartum anxiety affects roughly 1 in 5 women and is treatable with therapy, medication, or both.
- Anxiety and depression after birth share symptoms like guilt, exhaustion, and trouble sleeping, but differ in key ways.
- Most new mothers experience intrusive thoughts, which are common and not a sign of being a bad parent.
- CBT, interpersonal psychotherapy, and exposure and response prevention are effective therapy-first treatment options.
- A perinatal-trained therapist with a PMH-C certification can offer specialized, informed care.
- Call 9-1-1 or go to the nearest emergency room if you have thoughts of harming yourself or your baby.
Why Postpartum Mood Disorders Are Misunderstood
Postpartum mood disorders exist on a spectrum, from anxiety to psychosis, and the pressure to appear only happy after childbirth keeps many mothers from naming what they feel.
Postpartum mood disorders can range from anxiety to psychosis. As a society, we tend to focus on the wonders of childbirth and motherhood, but we often overlook that this period is full of change. Hormonal shifts, lack of sleep, and adjusting to a major life event can be extremely stressful.
Many new mothers worry that if they mention feelings other than pure happiness and joy after the birth of their child, they will be judged.
There is a broader stigma surrounding mental health conditions in this country, and by asking for help, many new mothers worry they will be seen as a failure or a “bad mom.” For this reason, they often suffer in silence.
Postpartum Anxiety vs. Postpartum Depression: Overlapping and Distinct Symptoms
Postpartum anxiety and depression share several symptoms, including guilt and exhaustion, but each condition also has symptoms that are distinct.
Although postpartum anxiety and depression have many symptoms in common, the two conditions are not the same.
Shared symptoms of postpartum anxiety and depression:
- Guilt, shame, or feelings of inadequacy as a mother
- Changes in appetite
- Feeling overwhelmed, exhausted, and unable to cope
- Persistent mood swings or sadness
- Loss of interest or withdrawing from family or friends
- Trouble sleeping even when the baby sleeps
- Difficulty making decisions or having unclear thoughts
Symptoms specific to postpartum anxiety:
- Excessive worry about the baby’s health, safety, or development
- An overwhelming sense of dread that something bad will happen, especially to the baby
- Inability to relax
- Rapid heartbeat, nausea, dizziness, or chest tightness
- Avoiding certain situations because of a perceived sense of danger
- The need to check on the baby frequently, or the inability to be away from the baby
Symptoms specific to postpartum depression:
- Deep sadness, hopelessness, or a feeling of emptiness
- Crying frequently
- Difficulty bonding with the baby or feeling detached
- Loss of interest or enjoyment in life
- Thoughts of self-harm or, in the most severe cases, harming the baby
- Feeling that you or the baby would be better off if you were no longer around
If you are experiencing thoughts of harming yourself or your baby, call 9-1-1 or go to the nearest emergency room immediately.
Intrusive Thoughts: When to Worry vs. When It’s Normal
Most new mothers experience intrusive thoughts, and having them does not mean something is wrong with you or that you are a bad mom.
Intrusive thoughts are unwanted ideas or images that come to mind and cause distress. Most people experience intrusive thoughts at some point in their lives. For women with postpartum anxiety, these thoughts are often related to infant harm and can be extremely disturbing.
These thoughts are common among new mothers. One study found that at least 70% of new moms experience them after birth. Having periodic, unreasonable thoughts about the baby’s safety or wellbeing can be normal. It is when those thoughts become overwhelming, disrupt your daily life, or progress to thoughts of self-harm or harming the baby that you should seek help.
Therapy-First Approaches: CBT, IPT, and ERP for Intrusive Thoughts
Cognitive behavioral therapy, interpersonal psychotherapy, and exposure and response prevention are three therapy-first approaches used to treat postpartum anxiety.
There are several therapy-first approaches to treating postpartum anxiety, including cognitive behavioral therapy, interpersonal psychotherapy, and exposure and response prevention.
Cognitive behavioral therapy (CBT) is an evidence-based approach that helps women with postpartum anxiety recognize and change thoughts and behaviors that worsen their anxiety. CBT helps promote a personal sense of control, builds self-confidence, and develops healthy coping skills and stress management techniques.
Interpersonal psychotherapy (IPT) is a time-limited, evidence-based therapy that helps women with postpartum anxiety focus on the here and now. IPT assists new moms in improving close relationships and building strong support systems that reduce feelings of isolation and ease the transition into their new role.
Exposure and response prevention (ERP) is a form of CBT that helps new moms with intrusive thoughts break the cycle of fear, avoidance, and compulsion. ERP is especially helpful because it can retrain the brain to recognize intrusive thoughts as thoughts rather than real threats or warnings. By changing the way you think, you can feel calmer and learn to trust yourself and enjoy this time.
When Medication Helps
When therapy alone is not enough, antidepressants such as SSRIs, SNRIs, TCAs, and NDRIs are commonly prescribed alongside therapy and lifestyle changes.
For some women, therapy alone is not enough to treat postpartum anxiety. Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and other antidepressants, including tricyclic antidepressants (TCAs) or norepinephrine and dopamine reuptake inhibitors (NDRIs), are common medications. These can be prescribed alongside lifestyle changes and therapy to help ease the symptoms of postpartum anxiety.
Medications help improve symptoms by increasing the amount of certain neurotransmitters in the brain responsible for mood and emotional regulation. It is important to discuss the risks and benefits with your medical provider before starting any medication, especially if you are breastfeeding.
How Therapists Collaborate With OB/GYNs and Pediatricians
Your OB/GYN or pediatrician is often the first medical professional to identify postpartum anxiety and can refer you to a mental health provider who specializes in perinatal care.
Because your OB/GYN or pediatrician is likely the first medical professional you see after delivering your baby, they can help you get the support you need. Often, these providers can refer you to a mental health professional who specializes in perinatal mental health and coordinate your care with them.
Through an integrated approach that includes therapy and medication as needed, your care team can closely monitor your progress and adjust your treatment plan when necessary.
Support Systems: Partners, Groups, and Online Therapy
A strong support system, whether a partner, a support group, or an online therapist, is one of the most effective ways to manage postpartum anxiety.
Having a strong support system is one of the best ways to manage postpartum anxiety. This can include your partner, a family member, or close friends who can offer understanding and support through this major life change.
Organizations such as Postpartum Support International, the National Maternal Mental Health Hotline, and the 988 Lifeline are additional resources for women experiencing postpartum anxiety. These organizations can direct you to a qualified practitioner in your area, give you someone to talk to during a crisis, and may offer online support groups.
In some cases, your OB/GYN’s office, local hospital, or clinic may offer support groups for new mothers. Online therapy is another option worth considering. Leaving the house or finding time away from home can be difficult for a new mom, and online therapy offers the flexibility and convenience of being at home while still providing comprehensive care.
Finding a Perinatal-Trained Therapist
Look for a therapist with a Perinatal Mental Health Certification (PMH-C), since these providers have specialized training in birth trauma, postpartum depression, anxiety, OCD, and loss.
Finding a qualified therapist who specializes in perinatal and postpartum treatment is a critical part of managing postpartum anxiety. When considering a provider, look for someone who holds a Perinatal Mental Health Certification, or PMH-C. These therapists have training in birth trauma, depression, anxiety, OCD, and loss.
Your OB/GYN is a good resource when searching for a provider who understands the unique challenges new mothers face. They can offer a referral or help you initiate care directly.
The National Alliance on Mental Illness (NAMI) and the Substance Abuse and Mental Health Services Administration (SAMHSA) both offer online resources to help connect you with a provider. For a closer look at how postpartum anxiety fits alongside other conditions that affect new parents, see our guide to postpartum conditions.
Therapy.com also offers a database where you can search for a provider by location, gender, specialty (pregnancy or postpartum), and preference for in-person or online sessions.
Next Steps
Postpartum anxiety is common, treatable, and not a reflection of your ability as a mother, and asking for help is one of the strongest steps you can take.
Do not let postpartum anxiety take away the joy of these early moments with your child. Postpartum anxiety is not uncommon, you are not alone, and you are not a failure.
Recognizing the need for help and asking for it demonstrates strength and is one of the most important steps you can take toward a healthy, happy future for you and your baby.
Contact a therapist today and start reclaiming the joy in this stage of life.
