Postpartum anxiety: Symptoms, tips & how to treat

What is postpartum anxiety?

Postpartum anxiety is (as the name suggests) anxiety that happens during the postpartum period, in the first year after you have a baby. It’s typically characterized by excessive worrying and thoughts that are hard to control, often focused on the health or safety of your baby [1]. 

A common example is worrying that your baby will stop breathing and constantly feeling the need to check on them, or thoughts about something bad happening if you’re not around. You may also walk around feeling on edge, or have other anxiety symptoms like heart palpitations or trouble sleeping [1].

Postpartum anxiety has only just started getting more attention as a condition in its own right in recent years. Because it’s traditionally been lumped together with postpartum depression, it’s still likely underdiagnosed. However, a recent review article (which summarizes several studies) found that as many as 1 in 8 women globally experience postpartum anxiety. Out of all new mothers who struggled with mental health, around 25% were found to have postpartum anxiety in some form, making it one of the most common mental conditions during the postpartum period [1].

Let’s pause here for a moment. It’s only natural to feel a bit overwhelmed as a new parent. Worrying about your new baby sometimes or having some anxiety is normal and not necessarily something to be concerned about. However, with postpartum anxiety as a condition, similar to other anxiety disorders (like generalized anxiety disorder or panic disorder), these feelings go a bit haywire. They start to take over and affect your daily life — it’s like your body and mind are stuck in a state of constant fight or flight. 

Postpartum anxiety vs postpartum depression

Previously, postpartum anxiety was often considered a part of postpartum depression, since they often occur at the same time and even share many of the same symptoms. Even though the relationship between these two conditions isn’t entirely understood, both are common mental health conditions that affect new mothers [1]. So, what's the difference?

Postpartum anxiety will, in most cases, look like excessive worry that something bad will happen to your baby. These thoughts become hard to control, and aside from the more general anxiety symptoms (nervousness, feeling on edge, or physical symptoms), they can lead to changes in our behavior as we try to manage the thoughts. Those with postpartum anxiety may start repeatedly checking that their baby is still breathing or become scared to leave the home.

Postpartum depression, on the other hand, is characterized by feeling very low and depressed, losing interest in things you normally like, hopelessness, mood swings, and fatigue [2]. 

It’s common for those with postpartum anxiety to also have symptoms of depression, and vice versa, for those with postpartum depression to also experience anxiety symptoms. However, it’s also possible to have one without the other [1, 3]. 

Even though these two conditions often occur together and symptoms overlap to some degree, it’s still important to get the right diagnosis since the treatment can look a little different depending on whether you have postpartum anxiety or depression. Your healthcare provider will be able to find the right option for you.

How can I tell if I have postpartum anxiety?

As a new parent, it’s very common to feel some anxiety from time to time. Your whole life has just changed, and it’s completely normal to feel a little off balance. Feeling anxious now and then isn’t necessarily something to worry about, and doesn’t guarantee you’d be diagnosed with postpartum anxiety. 

You can think of it like this: most people have felt anxiety at some point in their lives. It’s part of our body’s natural fight or flight response that’s triggered when we face a threat — anything that makes us feel stressed, scared, or worried. For example, you might have had heart palpitations, felt tense, or like your stomach is churning before giving an important presentation at work or in school. That feeling is anxiety, but it should pass when the “threat” disappears (when the presentation is over). 

However, with postpartum anxiety, it’s like the threat is constant, and the symptoms don’t pass. You should keep an eye on it if you have anxiety very often or all the time, if you worry excessively about your baby, have intrusive thoughts, or if your anxiety affects your well-being [4]. 

Even though it can be hard, it’s also good to listen if someone around you expresses that they are worried about you — they may have noticed signs even if you haven’t.

What are the symptoms of postpartum anxiety?

Symptoms typically start within the first few weeks after giving birth, but they can happen at any time during the first year [5]. For some, anxiety symptoms start already during pregnancy and carry over to the postpartum period [4].

So, what are some symptoms to look out for? Postpartum anxiety can present with a number of symptoms that may be mental or emotional, physical, or behavioral. You may experience many of these or only a few; it depends on the person. 

Mental or emotional symptoms

These are symptoms that have to do with your mood and thoughts, and you might experience some of the following [1, 4, 6].  

• Excessive worrying: Constant or excessive worrying, often focused on the health or safety of your baby; for example, that they might be sick or that something will happen to them.
• Intrusive or obsessive thoughts: These are unwanted and scary thoughts that are hard to control. It can be thoughts about harming your baby or that something else will harm them, for example, that they will stop breathing in their sleep.
• Being on edge or restless: You might feel like you’re constantly on edge and unable to relax.
• Irritability: It’s common to feel more easily irritated or moody than normal.
• Mood swings: Ups and downs in your mood are also common with postpartum anxiety.
• Difficulty concentrating: You might feel easily distracted or that you have a hard time focusing on tasks.
• Feeling anxious or nervous: Feeling constantly anxious or nervous without any outside reason is a common symptom of postpartum anxiety.
• Panic attacks: Short episodes (usually between 5-20 minutes) of very intense anxiety, where you might have symptoms like your heart racing, shortness of breath, chest pain, feeling faint, sweating, tingling in your hands, or a fear of dying or like you’re not connected to your body. Panic attacks aren’t dangerous but can be very scary.  
• Thoughts of self-harm or suicidal ideation: If you have thoughts about harming yourself, it’s important that you seek help right away. Call emergency services or reach out to the National Suicide Prevention Lifeline (in the US, other countries have similar resources) to talk directly to a counselor.

Physical symptoms

Anxiety doesn’t just affect your emotions; it puts your body on edge, too. You may experience physical symptoms like [1, 4, 6]:

• Fatigue: Feeling very tired and low on energy.

• Sleeping issues: Having a hard time falling asleep, waking often, or not sleeping deeply.

• Heart palpitations: Feeling like your heart is beating faster or harder than normal.

• Loss of appetite: Not feeling hungry or wanting to eat as you normally would.

• Stomach problems: Nausea or stomachache are common symptoms of anxiety.

• Feeling tense: Feeling like your muscles are tense and that you’re not able to fully relax, even when resting.

• Feeling like you can’t catch your breath: It might feel like your breathing is shallow or like you can’t fully catch your breath. 

Behavioral symptoms

Postpartum anxiety can also affect our behavior, so we might start doing certain things to try to control or lessen the feelings of anxiety symptoms [1, 4, 6].

• Avoiding certain things or situations: You might start avoiding situations or things that trigger anxiety or intrusive thoughts, such as going out in public or letting other people take care of the baby.
• Repeatedly checking things: You might check over and over again that your baby is breathing, or that there’s nothing around they might choke on.
• Being overly cautious: You might start being very cautious about things that aren’t dangerous or in situations where you’d normally not.

Though these types of behaviors may help suppress the anxiety symptoms in the moment, they don’t help it in the long run and can severely limit your life. That’s one of the reasons it’s so important to get help if you or someone around you exhibits these signs — treatments like cognitive behavior therapy are effective for anxiety, so you no longer have to rely on these types of behaviors.

Causes of postpartum anxiety

The cause of postpartum anxiety isn’t entirely clear, so we don’t know exactly why some people get it and others don’t. It’s easy to feel guilty when we’re not feeling well mentally, but it’s important to know that it’s not your fault that you’re feeling this way — you haven’t done anything wrong.

Research into postpartum anxiety is still ongoing, and while we don’t know exactly what causes it, there are a few known risk factors that mean you may have a higher risk of developing it [1, 4]:

• You’ve previously had an anxiety disorder or depression
• You have a family history of anxiety disorders
• You had a health scare during pregnancy or a difficult delivery
• Your baby has had health issues or was pre-term 
• You’ve experienced trauma in your past 
• Stressful life events during pregnancy and postpartum
• Being a first-time mother
• Having a C-section delivery 
• Not getting enough support from a partner 

Risk factors aside, there’s also a lot going on that can make us more susceptible to anxiety during the postpartum period. Having a baby is a big adjustment all on its own, and it’s completely normal to feel overwhelmed with this new reality. It’s not so strange if anxiety pops up when we’re struggling to get our bearings again.

Our bodies also go through a lot during pregnancy and postpartum. To start with, there are big shifts in our hormone levels after giving birth. We know that hormonal shifts can affect our mood in other situations (for example, we can experience PMS symptoms — including anxiety — when our hormones shift as our period approaches) [7]. It’s possible that hormones may be involved in postpartum anxiety, too. At the same time, sleep deprivation can also make symptoms of anxiety worse or make us more vulnerable to them.

How is postpartum anxiety treated?

Postpartum anxiety is treatable, so it’s important to get help if you’re struggling. Options typically include therapy or medication, sometimes combined with lifestyle adjustments to help support the treatment [4]. In some cases, the most effective will be a combination of medication and therapy or other treatments. Your doctor will be able to help figure out the best treatment for you.

Cognitive behavioural therapy for postpartum anxiety

Similar to other types of anxiety disorders, postpartum anxiety is often treated with therapy. Cognitive behavioral therapy (CBT) in particular has been shown to be effective for postpartum anxiety [1]. CBT is a therapy form focused on identifying and changing harmful thought patterns and feelings, as well as changing how we behave in response to them [8]. Because postpartum anxiety is often characterized by symptoms like intrusive thoughts and accompanying behaviors, it can be an effective treatment option for this condition.

CBT can be done in person with a therapist, but there are also online and phone options that you can do at home [8]. 

What medications are used for postpartum anxiety?

Even though there isn't a ton of research into medications specifically for postpartum anxiety (most studies have been done on postpartum depression), there are a few medications available. 

• Selective serotonin reuptake inhibitors (SSRIs): SSRIs are a type of antidepressants that work by balancing our brain chemicals, mainly serotonin, a neurotransmitter that helps regulate our mood. SSRIs can be used to treat both postpartum anxiety and depression, and one of the most commonly used for this purpose is called sertraline [1, 9]. Usually, it takes a few weeks for SSRIs to start working [10].

• Zuranulone: A new medication that’s been shown to be effective when used to treat anxiety and depression in the postpartum period. Zuranolone is a neurosteroid and works quickly compared to SSRIs [1, 11].

• Selective norepinephrine inhibitors (SNRIs): SNRIs work by balancing serotonin and norepinephrine to stabilize mood, and they can be used to treat postpartum anxiety. Similar to SSRIs, SNRIs take a few weeks to reach full effect [10].

• Benzodiazepines: These are a type of medication used to treat acute anxiety. They work quickly compared to SSRIs and SNRIs, but are only used for short-term treatments [10].

It’s a good idea to talk with your doctor or healthcare provider about treatment and see which option might work well for you. The choice can also depend on whether you have other conditions too, for example, if you have postpartum depression and anxiety at the same time.

Should you take medications for postpartum anxiety when breastfeeding?

We understand that you might feel some hesitation about taking medications while breastfeeding. There are antidepressants and anxiety medications that are safe to use while breastfeeding, but the best thing is always to discuss your options with your healthcare provider  [4]. 

The most important thing is that you get support and treatment for your symptoms. The key is finding a treatment plan that works for you, whether that’s with medication, therapy, or a combination.

How long does postpartum anxiety last?

The postpartum period can be a very challenging time. Taking care of a newborn can be overwhelming; you may feel like life has changed all at once and that your body feels different now, and that comes with many emotions, too. It won’t be like this forever, and you will get your bearings again. However, postpartum anxiety won’t usually go away on its own if you don’t treat it — that’s why it’s so important to get the right support and seek help from your doctor. 

How can I reduce my risk for postpartum anxiety?

There are a few things you can do to support your well-being that may reduce the likelihood of postpartum anxiety or help support your recovery if you have symptoms of anxiety:

• Talk to your healthcare provider: If you know you have some risk factors for developing postpartum anxiety, such as a history of anxiety or depression, it’s a good idea to tell your healthcare provider already during pregnancy. That way, they can help you and your support system prepare for what to do if you start having symptoms, and they can also be more vigilant during check-ups after you give birth.

• Lean on your support system: Share responsibilities with a partner or ask loved ones for help if you can.

• Prioritize sleep: We know sleep isn’t always easy to come by when you have a newborn, but if you can, try to prioritize sleep as much as you can. Sharing nighttime feeds or taking turns on the night shift with the baby can help if you have that option. Lack of sleep can make anxiety symptoms worse, and even a little extra rest can be helpful [4].

• Do things you enjoy: Taking care of a baby is a full-time job, but try to carve out a little time each day for an activity you enjoy. It doesn’t have to be big — even if it’s just for a few minutes, it can make a difference.

• Physical activity: Exercise can be a good way of reducing anxiety, even in small doses. Staying active in a way you enjoy and that works for your body, even just a little bit each day, can help you feel better [4]. 

• Healthy food: Eating a balanced diet is a good way to support your recovery after having a baby [4]. 

• Skin-to-skin contact: This isn’t only beneficial for bonding with your baby (and cozy) — some research also suggests that skin-to-skin contact can reduce the risk of postpartum anxiety [1].

It’s important to know that having postpartum anxiety doesn’t mean you’ve done something wrong. You can experience it even if you have followed all the guidance out there and have a good support system around you. As with other kinds of mental health issues, there’s still a lot of stigma around it, and postpartum anxiety can come with a lot of guilt, but many new parents go through this. You’re not alone.

When to speak with a healthcare provider

If you feel anxious, it’s important to bring it up with your healthcare provider during your postpartum checkups. They may also ask questions about your mood during these visits to see how you’re doing. 

You should also reach out to your healthcare provider if you’re constantly worrying, have intrusive or scary thoughts that won’t go away, or have any other anxiety symptoms that are interfering with your daily life. Remember that postpartum anxiety is very common, nothing to be ashamed of, and that there is help out there.

Lastly, if you feel like you may hurt yourself, seek help immediately. You can contact the National Suicide Prevention Lifeline if you’re in the US or call your regional emergency services.

Support your postpartum recovery with Natural Cycles

We know having a baby is a big change, and there’s a lot going on both physically and mentally during the postpartum period. That’s why we created NC° Postpartum, a dedicated mode in the Natural Cycles app designed to support your mental and physical recovery after birth. By keeping track of your symptoms in the daily check-in, you can better understand how your recovery is going and spot trends that may need extra attention. You also get access to curated content and guides, including ones about mental health and sleep after giving birth, to help you navigate this sensitive time. Why not see if Natural Cycles could be right for you?