Post-Partum Depression and Anxiety

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Leann Clink BSN, RN

You may have heard the term thrown around a lot. Postpartum depression, postpartum anxiety or psychosis, the “baby blues.” But, what does it actually mean? And, how can you prepare if you’re at risk?

Risk Factors for Postpartum Depression:

When most people hear the term postpartum depression, an image of a person who looks sad or crying may come to mind. However, this is not always the case.  This diagnosis is really misnamed. Postpartum depression can occur at any time during pregnancy and after delivery. It can include anxiety as well as depression. According to recent studies, about 1 in 7 women may experience symptoms of pregnancy related or postpartum depression or anxiety.

Having a history of depression or anxiety is a risk factor that would increase your likelihood of experiencing these symptoms, but that does not mean it is absolute. Childhood trauma, hyperemesis gravidarium (HG), thyroid issues, teen pregnancy, or military service may increase a woman’s risk for postpartum depression. A woman’s history of physical or sexual abuse and being of low socio-economic status may also play a part in determining if a woman is at risk. While these are some of the main risk factors, this list is not exhaustive.


Symptoms for postpartum depression may include anxiety, anger, or irritability. Most people do not realize depression is anger turned inward, so outward expression of anger and irritability is something to look at. This may show up as being easily annoyed with small things that would not have bothered a woman earlier – with a partner or with other children. It may also show up as explosive arguments or outbursts or even feeling judged by others because of her parenting choices.

Thinking scary thoughts can be another symptom of post-partum anxiety or depression. Some refer to them as “intrusive thoughts.” Anxious thoughts about “bad things that could happen” or about “terrible things a woman might do” to herself or others can be a sign. They are thoughts a woman does not want to think or dwell on but thinks about anyway and cannot stop herself from thinking. Having these thoughts does not mean a woman is evil or will act on those thoughts, but it is something to be aware of – letting doctors, counselors or a trusted person know.

Problems sleeping is probably the most common symptom a woman may experience and is most recognizable to family and friends. Not being able to sleep when you have the opportunity or falling asleep but awaking and not being able to get back to sleep is insomnia. The opposite – sleeping all the time and having no energy is another symptom.

Brain fog or numbness is often included as a postpartum depression symptom. It may look like having a hard time remembering things or having no emotions about people, places, or situations. It may feel like there is a disconnect. It is important to know that there is no right or wrong way to feel. If there are concerns, talk to a trusted advisor or health care provider.

Lastly, postpartum depression or anxiety can affect a woman’s body and mind. Many never realize that it can be as hidden as reoccurring headaches or changes in a woman’s thyroid to even more noticeable physical symptoms of nausea, panic attacks, or body aches and pains. There are a wide variety of symptoms as well as a variation of symptom severity. Having milder symptoms for a short duration of time (about 2-3 weeks) is what many consider the baby blues. The baby blues are considered part of the normal adjustment to all the changes that have occurred postpartum. Symptoms that are longer in duration (months at a time), tend to have increased severity and are more likely to be considered postpartum depression or anxiety. However, this is not always the case. Postpartum depression may begin shortly after birth and last many months if left untreated. Postpartum psychosis, while rare, is extreme in severity and duration with the possibility of acting on the intrusive thoughts or feelings. Postpartum psychosis usually develops in the first weeks after delivery and may include hallucinations, delusions, or paranoia.

What About Dads?

Fathers can experience postpartum depression just as a woman can. About 1 in 10 can experience this but may not have all the same symptoms. The peak symptoms usually occur when baby is 3-6 months. Symptoms may also be influenced by his partner’s hormones and struggles, family history and sleep deprivation.

Is There Treatment?

After reading all this information, it would be easy to get disheartened or feel hopeless. It is important to know that there IS hope and help. Treatment for postpartum depression has many components and is similar for both partners. There are medications, psychotherapy, counseling, and support groups. Talking to your obstetrician, pediatrician or general doctor can be a great place to start. Healing time from postpartum depression or anxiety can vary and is based on cause and severity of symptoms.

Some initial steps to take with postpartum anxiety or depression is to avoid scary triggers, overscheduling your life (leave margins), accept help from family and friends, set realistic expectations, and create time for yourself and/or connecting with other new moms.

Psychotherapy can assist those with postpartum depression by prescribing medications such as antidepressants, anti-anxiety medications or mood stabilizers if needed.

The only medication that would be prescribed to women would be Brexanolone (Zulresso) which was specifically approved for women with postpartum depression. It is a medication that is only given by IV. It does work within a few days, but it does have other drug interactions and may pose some risks to a woman.