Yes, having a baby and worrying go together like diapers and wipes, but new moms face unique challenges and barriers when it comes to their mental health. While many women experience postpartum mood disorders in the first two weeks after delivery, such distressing symptoms as depression and anxiety do not improve for approximately 10-20% of women. This can result in debilitating difficulty functioning and bonding with their baby, notes Philadelphia College of Osteopathic Medicine psychology faculty member Alexa Bonacquisti, PhD, PMH-C, a licensed psychologist with expertise in reproductive health psychology. Here, Dr. Bonacquisti, an assistant professor in PCOM’s Doctor of Psychology in Clinical Psychology (PsyD) program, dispels five myths about postpartum mood disorder types, signs and symptoms, and treatment options.
Not necessarily true. Studies have shown that postpartum anxiety affects between 11% and 21% of women. Because it’s more difficult to diagnose postpartum anxiety, we can’t know precisely how many people suffer from the condition. Postpartum anxiety is usually identified during an assessment for postpartum depression.
”Often when we consider psychiatric responses after childbirth, we think about depression,” says Dr. Bonacquisti. ”Many may be surprised to know the range of other symptoms that may occur in the perinatal period. In my research and clinical work, I’ve found that anxiety is very common during pregnancy and postpartum, but often is overlooked or unrecognized.”
Anxiety receives less attention likely because it results in fewer impairments in functioning than depression and because mothers might expect that anxiety is a “normal” experience following the birth of a baby, so they are less likely to discuss anxiety with others, says Dr. Bonacquisti. However, anxiety can be debilitating for a new mom and can reduce quality of life and limit their ability to enjoy life and be the kind of parent they want to be, she adds. Perinatal anxiety may also adversely impact maternal-infant engagement and child development and functioning.
“Effectively addressing anxiety involves increasing awareness of the deleterious effects of anxiety and improving screening practices for anxiety symptoms in addition to symptoms of depression,” says Dr. Bonacquisti.
While it’s common for women with postpartum depression to experience signs of postpartum anxiety, not everyone with postpartum anxiety is also depressed. Postpartum anxiety can occur along with postpartum depression, and many of the signs of postpartum depression overlap with postpartum anxiety—disrupted sleep, heart palpitations and feeling afraid, for example—but the conditions are different despite sharing many of the same symptoms.
An easy way to distinguish one from the other: Those suffering from depression are sad and have trouble finding joy in their baby while those afflicted with anxiety are wracked with worry. Those with postpartum depression may experience excessive sadness, frequent crying, or feel like they can’t take care of themselves or their baby. Postpartum anxiety is associated with excessive worrying, not with sadness. If you feel panicked or overwhelmed with fearful thoughts, you may be suffering from postpartum anxiety, says Dr. Bonacquisti.
For future research projects, Dr. Bonacquisti plans to continue to investigate not only depression, but also anxiety and other psychiatric symptoms in order to better identify and understand the range of emotions women experience in the perinatal period, she says.
“Increasing our understanding of psychological symptoms during this time period is critical for refining screening practices, and developing and tailoring clinical interventions that can be applied at the appropriate time points and target specific symptoms,” she says. “In addition, it is important to normalize the range of emotions that may occur during the postpartum period so that mothers do not feel isolated or alone in their experiences.”
Some women feel like they are the only mothers feeling sad or anxious, and this makes them more depressed or worried, says Dr. Bonacquisti. For others, they may feel guilt or shame that they are not enjoying every moment of motherhood, which also contributes to a cascade of negative feelings.
“More research in this area can help to identify and normalize the mixed emotions that accompany motherhood,” says Dr. Bonacquisti, “which is important for helping mothers adjust and cope with the ups and downs of parenting.”
Intrusive thoughts are actually common in the context of postpartum mental health conditions, says Dr. Bonacquisti, pointing to research that suggests that a majority of postpartum mothers regularly experience intrusive thoughts. These scary or unusual thoughts often occur around concerns for the baby’s safety or worries about something bad happening to the baby, such as “What if I drop the baby over the railing? What if the stroller rolls into a busy intersection? What if the baby stops breathing while sleeping?”
It’s important to note that there is a difference between having these thoughts and intending to act on them, says Dr. Bonacquisti. Intrusive thoughts are distressing and anxiety-provoking for the mother and the thoughts are often related to a desire to keep the baby safe, which causes even more anxiety and behavioral avoidance (for example, mom might avoid taking the baby for walks in the stroller for fear of the stroller rolling into the intersection).
Intrusive thoughts may also occur with postpartum psychosis, which is a rare condition where mothers may experience hallucinations, delusions, and functional impairments. In these cases, mothers don’t experience frightening intrusive thoughts; instead, they lack the ability to distinguish those thoughts from reality. Postpartum psychosis is an emergency and requires hospitalization, says Dr. Bonacquisti.
Thankfully, this is not the case. Postpartum mood disorders are treatable with both psychological and medication interventions.
Postpartum mood disorders refer to a group of symptoms that may include depression, anxiety, loss of interest or pleasure in daily activities, irritability, feelings of worthlessness or guilt, difficulty concentrating, or changes in appetite or sleep habits. Postpartum mood disorders may also occur with other symptoms such as psychosis, suicidality, or mania.
There is an expectation in our society that becoming a parent is a time of joy and contentment, and there is stigma associated with admitting that there are challenges or problems during the postpartum period, says Dr. Bonacquisti.
“Mothers look around at family, friends, social media, and see perfect images of other people who seem to be adjusting very well to motherhood, and they start to compare their experiences to others and as a result feel isolated and afraid to admit that they are struggling,” she says.
In addition, there are a number of logistical and practical barriers to seeking help, such as childcare, financial constraints, and prioritizing self-care.
“In the postpartum period, mothers are focused on physical recovery from childbirth and the non-stop caretaking for their babies,” says Dr. Bonacquisti, “and they often put their own needs last, especially when it comes to mental health.
“As a society, we can recognize that the postpartum time period is both a joyful and a challenging time that reflects a major life transition with shifts in values, identity, positionality, along with substantial physical and mental changes,” she adds. “Being more open about the challenges and expectations placed on parents during the postpartum period can help to reduce stigma and help mothers connect with care.”
In addition, Dr. Bonacquisti says better societal supports for families, such as universal paid family leave for both birthing and non-birthing parents, would make a critical difference in terms of postpartum adjustment and functioning.
Lastly, more research is needed on enhancing psychological screening and interventions, particularly how to identify and treat postpartum mood disorders early, and to connect mothers with care that is accessible and affordable, says Dr. Bonacquisti.
“Postpartum mood disorders can have a devastating impact of families when left untreated,” she says. “More research is needed to understand the biological and psychological underpinnings of these disorders so we can identify them earlier and provide evidence-based treatment to postpartum mothers.”
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