Where’s the Postpartum Anxiety?
Baby blues? Postpartum depression? What about postpartum anxiety? Many people have heard of baby blues and postpartum depression while postpartum anxiety seems to be less researched independently or researched in combined with postpartum depression. Even when one searches postpartum anxiety in the search bar on the National Institute of Mental Health website, only resources for postpartum depression appear on the main page of results. The Diagnostic Statistical Manual of Mental Disorders 5 (DSM-5) includes peripartum depression as a subtype of Major Depressive Disorder. It also notes they utilize the term peripartum to include postpartum since many studies show depressive episodes typically begin prior to the postpartum period (American Psychiatric Association, 2013). However, peripartum anxiety is not included with Generalized Anxiety Disorder and is briefly mentioned in combination with peripartum depression subtype to note that symptoms of anxiety can increase risk of a peripartum major depressive episode (American Psychiatric Association, 2013).
The prevalence rate of postpartum depression for women between delivery and three months is 19.2% (van der Zee-van den Berg et al., 2019). In comparison, the prevalence rate of postpartum anxiety for women between the first week after delivery and 24 weeks is 15% (Dennis et al., 2017). According to Miller et al. (2015), women are at an increased risk of developing depression when these women experience generalized anxiety independent of other disorders in the postpartum period. Additionally, when women experience the presence of both postpartum depression and postpartum anxiety, they are more likely to experience prolonged symptomology and ineffective response to treatment (Miller et al., 2015).
The screening tool typically used in hospital and/or primary care settings to assess mental health of postpartum women is the Edinburgh Postpartum Depression Scale (van der Zee-van den Berg et al., 2019). The Edinburgh Postpartum Depression Scale includes three items that are used to assess anxiety while the other 10 items are targeted toward depressive symptoms. According to van der Zee-van den Berg et al. (2019), this three-item subscale for anxiety only correlates moderately with anxiety criteria and does not seem to be an adequate measure of anxiety screening. Increasing awareness of the comorbidity and being able to differentiate the symptom presentations of postpartum anxiety verses postpartum depression can be helpful in identifying the needs of each woman.
Postpartum Depression vs. Postpartum Anxiety
Postpartum depression is characterized by several symptoms including (American Psychological Association, 2008; MGH Center for Women's Mental Health, 2015; Postpartum Support International, n.d.):
- Appetite changes
- Sleep disturbance
- Crying or tearfulness
- Mood changes (e.g., sadness, irritability)
- Guilt, worthlessness, shame
- Lack of interest in the baby
- Thoughts of hurting the baby or oneself (refer to the phone numbers below for assistance)
Postpartum anxiety is characterized by several symptoms including (MGH Center for Women's Mental Health, 2015; Postpartum Support International, n.d.):
- Excessive worry
- Racing thoughts
- Unable to relax or sit still
In many women, the worry and anxiety are often focused on the baby and their health and/or safety. Even though the symptoms may look different, many times women can experience symptoms of both postpartum depression and postpartum anxiety, and symptoms can overlap (MGH Center for Women's Mental Health, 2015; Miller et al., 2015).
Importance of Distinction
Understanding whether a woman is experiencing postpartum depression, postpartum anxiety, or both can be critical to her treatment. Determining the comorbidity can aid in understanding medication management and what medications may work best to support and aid in reduction of symptomatology (MGH Center for Women's Mental Health, 2015). In many cases of postpartum anxiety, women experience physiological symptoms (e.g., heart racing, dizziness, shortness of breath, chest pain, etc.) that can be distressing (Postpartum Support International, n.d.). This can factor into a decision regarding adequate medication. For example, a woman experiencing postpartum anxiety may likely benefit from an anxiolytic rather than an antidepressant, depending on her presentation. If that same woman is experiencing both postpartum depression and anxiety, she may benefit from a medication with rapid effectiveness to manage her anxiety while the antidepressant is slower to take effect in the body. When a provider has better insight into the postpartum presentation of symptoms, they are likely to have an increased understanding of the medication regimen that can help that patient obtain some relief.
Nonpharmacological treatments that have been found to be efficacious for treating postpartum mental health disorders include interpersonal therapy, cognitive behavioral therapy, and rational emotive behavior therapy (Dennis et al., 2017; Mahdi et al., 2019; Miller et al., 2015). These three interventions have been found to be effective when studied with women who are experiencing postpartum depression and comorbid postpartum depression and anxiety. Specifically, when postpartum anxiety has been studied independent of postpartum anxiety, cognitive behavioral therapy has been found to be effective (Dennis et al., 2017).
Giving birth is filled with joy and excitement and at the same time can be combined with worry and stress. Postpartum mental health disorders can pose as an additional challenge to this major change in a woman’s life. Through the use of the Edinburgh Postpartum Depression Scale, identifying postpartum depression has increased in the healthcare system, which assists in managing the difficulty of this disorder. Being able to differentiate between experiencing postpartum depression or postpartum anxiety can be helpful to many mothers who may be struggling. Acknowledging that some women may only experience postpartum anxiety can help these mothers feel heard and find treatment that can aid in their adjustment to a newborn. While much research needs to be conducted on understanding the intersectionality of postpartum depression and anxiety, we understand there is treatment available for those who are experiencing postpartum depression, postpartum anxiety, or both.
National Suicide Prevention Lifeline: 1-800-273-8255
Canada Suicide Prevention Service: 1-833-456-4566
SAMHSA National Helpline: 1-800-662-HELP (4357)
Dial 9-1-1 (Emergency)
Cite This Article
Schroeder, Kourtney. (2021, January). Where’s the postpartum anxiety? [Web article]. Retrieved from http://www.societyforpsychotherapy.org/wheres-the-postpartum-anxiety
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
American Psychological Association. (2008). Postpartum depression. Retrieved January 20, 2021, fromhttps://www.apa.org/pi/women/resources/reports/postpartum-depression
Dennis, C. L., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. The British Journal of Psychiatry, 210(5), 315-323.
Mahdi, A., Dembinsky, M., Bristow, K., & Slade, P. (2019). Approaches to the prevention of postnatal depression and anxiety–A review of the literature. Journal of Psychosomatic Obstetrics & Gynecology, 40(4), 250-263.
MGH Center for Women’s Mental Health. (2015, October 07). Is it postpartum depression or postpartum anxiety? What’s the difference? Retrieved January 20, 2021, from https://womensmentalhealth.org/posts/is-it-postpartum-depression-or-postpartum-anxiety-whats-the-difference/
Miller, E. S., Hoxha, D., Wisner, K. L., & Gossett, D. R. (2015). The impact of perinatal depression on the evolution of anxiety and obsessive-compulsive symptoms. Archives of Women’s Mental Health, 18(3), 457-461.
Postpartum Support International (n.d.). Anxiety during pregnancy & postpartum. Retrieved January 20, 2021, from https://www.postpartum.net/learn-more/anxiety-during-pregnancy-postpartum/
Postpartum Support International (n.d.). Depression during pregnancy & postpartum. Retrieved January 20, 2021, from https://www.postpartum.net/learn-more/depression-during-pregnancy-postpartum/
van der Zee-van den Berg, A. I., Boere-Boonekamp, M. M., Groothuis-Oudshoorn, C. G., & Reijneveld, S. A. (2019). The Edinburgh Postpartum Depression Scale: Stable structure but subscale of limited value to detect anxiety. PloS one, 14(9), e0221894.