This Disorder is More Common than Postpartum Depression

Postpartum anxiety is common amongst many women but there is a lack of detection amongst women who mistake it for postpartum depression.

Photography by linnhauge via Flickr

Photography by linnhauge via Flickr

It started with a simple misstep on the stairs while carrying my son, Sebastian, when he was just a few weeks old. My hand caught the railing and, heart still pounding, I carefully made my way down.

From then on, every time I took the stairs with him in my arms, my mind played out increasingly frightening scenarios. A slip. A tumble. His screams. His silence. The visions grew horrific. The thoughts became so bad, I avoided taking stairs whenever I could. Soon, other fears infected my life until I had a laundry list of places we couldn’t go and things we couldn’t do alone. Bath time with baby? Hell no. The kitchen? Hot stove, knives on counter. Nuff said.

I hadn’t experienced anything beyond some mild blues with my first child seven years prior so, at first, I chocked up the disturbing thoughts to stress. It had been a high-risk pregnancy that had ended in an unplanned C-section a week after 9 /11. And just days after coming home, we were back in the hospital to treat Sebastian’s jaundice.

While there, I developed a stubborn infection at the incision site. On top of it, Sebastian was a spirited baby who seemed to spend as much time screeching as he did nursing or catnapping in my arms. I was exhausted despite the significant efforts of my husband, who spent long hours trying to soothe our screaming baby so I could catch a few moments of sleep.

The worries, fears and unwanted thoughts grew increasingly worse over the next few months. I was often afraid to be alone with my baby despite our mutual adoration. Then one day, while channel surfing, I happened on a talk show. I listened as the guest described pretty much everything I had been feeling. She called it “postpartum anxiety.”

Anxiety is More Common Than Depression

Dr. Cara Brown, a psychiatrist at the Women’s Mood and Anxiety Clinic at Sunnybrook Health Sciences Centre in Toronto, notes that anxiety in the postpartum period, both new-onset or worsening of previous anxiety, is commonly seen at the clinic. “Some degree of anxiety may be expected in new mothers in terms of adapting to having a newborn, but when it becomes significantly impairing or distressing, this may indicate an anxiety disorder.

Anxiety disorders in the postpartum have not received as much attention as depression,” she says.
Many of us have been conditioned to think of anxiety—post-baby, anyway—as something that goes hand in hand with postpartum depression. And there’s a big overlap, for sure. It’s estimated that about half of moms who suffer from one will experience symptoms of the other, says Martha Capreol, a Vancouver-based registered psychologist who has also produced postpartum resource material for AnxietyBC’s website. Not only can postpartum anxiety occur alone, but it’s also very likely more common than postpartum depression, say Capreol.

Yet not nearly as much research has been done on postpartum anxiety. In a 2013 study published in Pediatrics that examined postpartum anxiety, researchers at Penn State College of Medicine analyzed data from 1,123 new mothers. The study found that 17 percent experienced anxiety, while six percent suffered from postnatal depression. In another study, published in 2011 in the journal Archives of Women’s Mental Health, researchers found that, among Canadian perinatal women referred for psychiatric care, the primary diagnosis of generalized anxiety disorder was more prevalent than the primary diagnosis of a major depressive episode (49.5 percent versus 38.5 percent).

Dr. Brown explains that, along with more research, more education is needed for health-care providers to ensure that women experiencing perinatal anxiety disorders are both detected and treated.

Symptoms of Anixiety

Always a worrier, Hollie Hall of Vancouver, B.C., says her anxiety really ramped up early in her first pregnancy in 1998. “I became very worried that I would lose the baby. I worried about pollution, germs, eating right, contamination—really, the health of the baby.”

But rather than feeling relief when she finally held her healthy baby in her arms, Hall, now a counsellor and group facilitator with the Pacific Post Partum Support Society based in Vancouver, says intrusive thoughts began popping up while she was still in the hospital.

“I worried that I would drop her.” And worse than that, Hall says unwanted and disturbing thoughts and images of intentionally harming her child also occurred. “I thought I was a horrible person for thinking that,” she says, stressing that she never once felt compelled to act on them. Despite that, the intrusive thoughts grew worse as she became more sleep deprived.

Three main things make us more prone to having intrusive thoughts and worries, says Capreol. “One is a stressful event, such as having a baby, and the second is having an increased sense of responsibility.” The third, she says, is fatigue.

Another possible player? Hormones. “After birth, hormones such as estrogen and progesterone drop abruptly,” says Dr. Brown, adding they may contribute to anxiety either emerging or worsening during the postpartum period. And while many women may experience at least some anxiety after having a baby, those prone to it at other times may be especially vulnerable.

Symptoms can range from physical reactions, such as increased heart rate and loss of appetite, to racing thoughts and changes in behaviour. There are a number of anxiety disorders that can occur in postpartum, including generalized anxiety disorder, which is characterized by excessive worry, and obsessive-compulsive disorder, which includes unwanted and disturbing thoughts followed by compulsions to negate those thoughts.

Concerned that her baby would get sick with fevers caused severe anxiety for Hall, who would constantly check her infant to see if she was hot. “I would also have intrusive thinking about cars hitting the pram while we were out walking, so it wasn’t just the fear of me harming her, but harm coming to her in other ways as well.”

Despite being confident that she would never harm her child, the intrusive thoughts persisted.

The Difference Obsession vs Psychosis

Four months after giving birth, Hall called the support line of the organization she now works for. “The woman told me my thoughts were very common. I’m not crazy. I’m not a bad mom. It was a huge relief.” Now that she’s often the person on the other side of the phone, Hall says about 80 percent of calls to their support line are related to anxiety. “I think women are afraid to talk about both depression and anxiety, but especially intrusive thoughts.”

Like Hall, it took me a while to tell someone what I was going through. Why? Because I didn’t think I had postpartum depression. I didn’t have any of the telltale signs I knew to look for: the mood swings, crying jags and sadness. I was scared something might be really wrong. I was afraid that if I told someone what was going on, my kids would be taken away. Or, worse, though I knew with certainty I would never hurt my baby, I worried that another me—one I couldn’t control—could possibly emerge and that those thoughts, fears and worries were the early signs of postpartum psychosis, a rare disorder with symptoms that include hallucinations, mania and delusions.

Not so, says Capreol. “It doesn’t matter how anxious you get; it does not mean that you would ever become psychotic.” Anxiety is something we all feel, but the difference is the intensity. “It’s a difference in quantity, not quality, which is totally different than if someone is psychotic,” she explains, noting that only a very small number of women are at risk for psychosis.

“They’ve lost touch with reality and they start having symptoms that are not in the normal range.” They may hear voices or see things that aren’t there or believe things that are not rational, but they don’t necessarily worry about what they’re experiencing, says Capreol, noting she often tells people that if they’re highly distressed and disturbed by their intrusive thoughts, then they are very unlikely to be psychotic.

That said, Dr. Brown notes that it can be hard for a mother to distinguish between an obsession and psychosis. “Both can at times involve thoughts or images of harm to one’s infant and should always be assessed by a physician to clarify the distinction.”

While intrusive thoughts in postpartum anxiety may not be dangerous (as opposed to psychosis), they still feel very scary—particularly when they don’t let up. “The best predictor of the frequency of an intrusive thought is how much you don’t want to have one,” Capreol says. Because of that, it’s often the gentlest of new moms who experience them, she says.

Hall says she felt like a monster for the unwanted and disturbing thoughts that plagued her post-childbirth, noting that the postpartum anxiety following her second daughter’s birth in August 2011 was considerably worse. That sentiment is a familiar one. Although I was extremely diligent with my son’s care—a common response in those with postpartum anxiety—it was hard to accept that my thoughts were not a true reflection of me as a person or parent. Despite that, I realized I needed to be as gentle with myself as I was with my children.

Thanks to treatment from some excellent doctors, I enjoyed the early days and months with my third and fourth
kids, both boys. I won’t say I didn’t worry, but the intrusive thoughts never resurfaced.

“Mothers and health-care providers alike need to be aware that anxiety disorders can be severe and functionally impairing, impacting both mother and infant,” says Dr. Brown. If you’re experiencing unwanted thoughts, excessive worries or fears that are changing the way you live or affecting the mommy-baby bond, it’s time to tell someone and get some help.

How to Detect and Get Treatment for Anxiety

Because postpartum anxiety disorders haven’t received as much attention as postpartum depression, it may be more difficult for women or their doctors to identify. Treatment may include psychotherapy, medication or both, says Dr. Brown.

“An evidence-based treatment for anxiety disorders is cognitive behavioural therapy, a therapy that involves challenging anxious thought patterns and gradual exposure to anxiety-provoking situations.” Other approaches such as relaxation techniques, mindfulness-based group therapy, postpartum support groups and mother-infant therapy, may help. Some groups also offer hotline services. Medication may also 
be an option for some women. “The class of medication 
generally used to treat anxiety disorders, including those in the postpartum and in breastfeeding, is antidepressants,” says Dr. Brown.

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