A Toolkit for Postpartum Anxiety & Panic Symptoms

The term postpartum depression can be a disservice to many, many women who struggle during pregnancy and/or postpartum. Many of these women don’t reach out for help because, well, they are not necessarily depressed and so therefore assume that their struggle is not with postpartum depression.

In fact, the most common symptom of postpartum depression is not sadness at all: It is anxiety and agitation. While many women who struggle might have periods of sadness, depression and tearfulness, the overwhelming symptoms that cause them great pain are difficulty concentrating, excessive worry, high level overwhelm, racing thoughts, and difficulty sleeping. Many of these women will suffer from a varying degree of panic, and anxiety attacks are not uncommon (or perhaps have postpartum anxiety or OCD).

So, what is this all about and what can be done in the moment to alleviate some of the fear that comes along with these symptoms? So often moms want an answer, understandably to “Why is this happening to me? What is causing this?” As always, this is a question that does not necessarily come with one quick answer as each woman has a unique set of circumstances that might be playing a part. But we do have ideas of what may be at issue here and there are certainly a number of strategies that are known to work well and alleviating some of the symptoms of mild to moderate anxiety.

Brain chemistry imbalance: High-level anxiety (including postpartum OCD) is often caused by imbalances in the “feel good” chemicals in our brains. Serotonin, dopamine, and norepinephrine are the neurotransmitters that are responsible for emotional balance, and sudden drops in hormones postpartum are believed to have a direct impact on the functioning of these important systems of the brain. Antidepressant medication such as SSRI’s (including but not limited to Zoloft) have been shown to effectively work at reducing symptoms of anxiety in the postpartum period (usually a woman will notice a reduction in symptoms after 2-3 weeks of starting a medication). Many of these medications have been shown to be safe during pregnancy and while breastfeeding. Benzodiazepines (including but not limited to Xanax) have been shown to effectively work at reducing symptoms associated with panic attacks and high-level anxiety (often in conjunction with an SSRI). While it is recommended that women not cease using a benzodiazepine during pregnancy or breastfeeding if her symptoms are severe and/or if she has benefited from them prior to her pregnancy, some of these medications have a small risk to infants and so careful monitoring by a physician is important. For women whose anxiety is severe, the recommended treatment is medication along with psychotherapy. Negative thought patterns: Oh, the many changes that occur when a baby is born! Women who are worriers, perfectionists, have high and often unrealistic expectations for themselves, and who have a tendency toward negative thinking prior to becoming pregnant are at risk of developing more severe postpartum anxiety once a baby is born. For these women, the new lack of control, many responsibilities of parenting and reality of caring for a newborn all contribute to racing thoughts and heightened worry. Psychotherapy is an important part of the treatment for these women. Cognitive-Behavioral Therapy (CBT), mindfulness, and stress reduction strategies, work around identity shifting, and early trauma history processing (if it exists) have all been effectively supported through psychotherapeutic work with a trained professional. Nutrient depletion: Numerous studies have linked nutrient depletion during pregnancy and postpartum to depression and anxiety in many mothers. The role of healthy eating and monitored vitamin supplements if/when necessary cannot be underestimated in moms’ health and wellness. Even women who think that they are eating a balanced diet may not be replenishing themselves after childbirth and breastfeeding enough to facilitate the production of serotonin and the balance of blood sugar. Often, symptoms such as agitation, shakiness, foggy-headedness and nervousness can be linked to hunger and poor eating habits in many women. Sleep deprivation: Yes, I know: Having a newborn drastically limits the time that all moms spend asleep. Frequent night waking, breastfeeding, and high anxiety make it difficult for most moms to get the rest that they need for optimum health. But here is the thing: Moms who are moderately or severely anxious are usually also moms who report less than four hours of uninterrupted sleep a night. When these moms increase their sleep time through medication, strategy building, and/or relaxation techniques, their anxiety symptoms often decrease. Dehydration: Some studies have suggested that dehydration contributes to anxiety symptoms including jumpiness and agitation. Moms, especially those who are breastfeeding, are often not drinking adequate amounts of water (at least eight 8 oz glasses of water a day or more). Proper water consumption is required for efficient transportation of the hormones and neurotransmitters required for balanced emotion. Pregnancy related physical ailments and insufficient breathing: Most women who feel anxious will notice that their breathing is shallow. Whether this is because a mom’s diaphragm is being squished by her growing baby or because she is simply not focused on the length and quality of her breath, lacking oxygen to a brain leads to dizziness, further shortness of breath, light headedness, and elevated heart rate. Often, focused and mindful breath work will noticeably reduce these symptoms.

So … now for that toolbox. You know, the one that you need by your side if and when you begin to notice the early signs of anxiety and/or panic emerge.

Take 10 deep belly breaths (also known as diaphragmatic breathing). Drink a big glass of water. Eat a protein-based snack such as lean meats, nuts, cheese, or a hard boiled egg. Ground yourself in the present: Look around you and note (out loud if possible) everything that you can access in all five senses. What do you see? What can you hear? What do you smell? What does it feel like to be sitting on your chair? What, exactly, do you taste as you eat your snack? Find a “mantra” of sorts that you can tell yourself such as “I am going to be okay,” “I am doing the best that I can,” or “I am taking care of myself.” Go outside. Stretch. Feel yourself move and notice the sensations in your body. Once your initial symptoms decrease, find some help so that you can take a nap and get the rest that you need. If need be, call your therapist, your doctor, or someone who you trust to come and be with you until you feel better.

** As with all of my posts, this information is not intended as a substitute for in person medical or therapeutic support. For a trained mental health specialist near you, check out our list of mental health treatment programs and specialists.

Kate Kripke, LCSW