Postpartum Depression and Anxiety

Postpartum depression and anxiety are very common disorders, affecting as many as 1 in 6 new mothers. Very severe forms of postpartum depression and anxiety can make the experience of motherhood nearly intolerable, and a small percentage of women may even experience delusions or hallucinations (known as postpartum psychosis). Postpartum depression and anxiety disorders can be effectively treated with cognitive behavioral therapy (CBT) and/or medication.

Characteristics

Postpartum depression can occur any time within 12 months of giving birth. Typical symptoms might include feeling overwhelmed, feeling guilty, not feeling bonded with your baby, poor appetite, sleep problems, irritability, lack of interest in your baby, sadness and crying, feelings of numbness or emptiness, and/or possible thoughts of harming yourself or escaping. Not all women with postpartum depression experience all of these symptoms.

Symptoms of postpartum anxiety can include racing thoughts and distractibility, worry that is difficult to stop, obsessions (intrusive thoughts, especially thoughts that you might harm your baby), trouble sleeping, feeling pressured to be doing something all the time, a sense of dread, and/or worrying that you have “gone crazy.” You may experience these symptoms almost all the time, or only during some parts of the day or night.

Many women experience both postpartum depression and postpartum anxiety. It is not yet clear why some women have these symptoms and others do not, but risk factors include:

• A history of depression or anxiety (particularly a past episode of postpartum depression and/or anxiety)
• Childhood trauma
• Treatment for infertility
• Young age at motherhood
• History of physical or sexual abuse
• Poverty/Low income
• Unplanned pregnancy

Generally, if the symptoms have lasted for more than two weeks and they start to interfere in any aspect of your life, you may be suffering from postpartum depression or anxiety.

Treatment

Cognitive behavioral therapy (CBT) is a very effective treatment for postpartum depression and anxiety. Treatment is often short-term (12-16 sessions) and is focused on identifying unhelpful thoughts, feelings, and behaviors. You can learn to avoid “triggers” for depression or anxiety and identify “automatic” negative thoughts. You will also learn different ways of thinking and reacting to situations that trigger depression and/or anxiety.

Therapists teach behavioral activation, which involves scheduling activities, such as exercise, social activities, or even just “getting out of the house,” that make you happy, as well as looking for ways to help you get additional support to help with your baby or household duties. CBT might also involve sessions with your partner or spouse and finding ways of improving communication so that you can ask for help when you need it.

One particular kind of postpartum anxiety is called postpartum obsessive- compulsive disorder (OCD). Women with postpartum OCD have intrusive, unwanted, and disturbing thoughts or images. They may be thoughts or disturbing images about something bad happening to you, your baby, or your loved ones; some mothers even have thoughts about harming their baby if left alone with their baby. Because of the fear created by these thoughts, you may feel driven to constantly check on your baby to make sure he or she is breathing or safe, or you may feel anxious and avoid being alone with your baby. If you are having any of these symptoms, a CBT therapist can help you overcome them. Research has shown that women with perinatal depression are significantly more likely to see a reduction in depressive symptoms if they are in CBT versus a control condition and they are also significantly less likely to have another depressive episode relative to women in a control condition.

There are other treatments for postpartum depression and anxiety, as well. Support groups (either online or in person), or treatment with antidepressant medication may also be a helpful option for some new mothers. There are a number of medications that are safe for women who are breastfeeding. About one-third of mothers using CBT overcome postpartum anxiety and depression.

Additional Resources

• www.postpartumprogress.com: includes a list of support groups and helpful information about screening and treatment
• www.postpartum.net: includes various tools for mothers, as well as a link to an online support group and offers training and certification for clinicians