Postpartum Mental Health

I realized something was wrong for me postpartum when my spouse offered to take the baby for a bit so I could do something I enjoyed. I told him nothing sounded fun, and I was a bad mother, because why did I not like spending time with my newborn? He and I both had a silent moment—hearing those words out in the world, not just in my head, changed my perspective—and I called my doctor immediately after that conversation to start on treatment. I understand firsthand how important the postpartum period if for women’s mental health. And I want to make sure people know that there is treatment available that works.

The postpartum period can be a time of joy, excitement, and wonder, right alongside frustration, isolation, and exhaustion. While there are mental health challenges that can arise during the prepartum period, the changes experienced after that little bundle of joy arrives can be dramatic in terms of physical differences, routine changes, role adjustments, financial stress, and many other elements. These combine to create a space that leaves many women vulnerable to new or worsening mental health symptoms.

The Baby Blues?

Most women may have a period of time after pregnancy where they feel down, moody, irritable, or tearful. As many as 3 in 4 women have this experience described as “the baby blues.” Generally lasting for 1-2 weeks post-delivery, there are many possible factors that contribute to these changes. Often there is significant disruption to daily routines, including sleep. The newborn challenges can also weigh on anyone, learning how to navigate feeding, sleeping, and overall care of this tiny human.  Additionally, there are numerous internal changes—such as healing or hormone adjustments—that are occurring and may further drain energy levels. With lack of comprehensive support around maternity leave, there can also be significant financial pressures that add to stress. It is natural that women may have an emotional reaction to this time period. Feelings of fatigue, low mood, tearfulness, and lack of interest in other activities may show up for a brief period.

For many women, after this 1–2-week period is up, they return to their prior emotional state (albeit still a bit sleep deprived!). Symptoms during this time period are mild in nature and do not generally disrupt a person’s ability to take care of daily tasks, but they add an additional burden.

However, for some women, symptoms may persist and worsen following the “baby blues” period, leading to development of more serious postpartum mental health conditions.

Postpartum Mental Health Conditions

Postpartum depression (PPD) affects around 1 in 8 women, though, as with many studies into mental health, this may be an underestimate since not everyone will report their symptoms. PPD may overlap with the timeframe of the baby blues, but it persists beyond this 1–2-week window and may have more substantial effects on a woman’s daily life. This may include strong feelings of depression, a lack of interest in activities, feelings of guilt, harsh and negative thoughts about oneself, crying spells, loss of appetite, and sometimes thoughts of hurting oneself or the baby. 

In addition to depression, some people may experience significantly heightened anxiety, called postpartum anxiety (PPA). Some increased anxiety is normal—there is an entirely new set of routines and practices to learn, all dealing with a relatively fragile infant. However, postpartum anxiety takes that “normal” worry and substantially increases it. Fears and worries may be exaggerated and intense, making it hard to do everyday things. Activities like driving to the grocery store and taking a walk may seem full of dangers. For some women, they may have difficulty trusting other caregivers or family members to care for the baby due to fears that something bad may happen.

Postpartum rage is a condition that has begun to be discussed more often, but may be surprising for many to hear about. This is described as periods of strong, sudden irritability, anger, and frustration in situations. Women may notice they lash out when they normally would not, hold onto anger, and struggle to find a place of calm after a minor issue. While this can exist alongside PPD or PPA, postpartum rage may also present on its own.

Postpartum psychosis is a rare, but very serious mental health condition. It may include aspects of depression, anxiety, and irritability, but notably incorporates symptoms signifying difficulty correctly perceiving reality. This may show up as hallucinations—seeing or hearing things that are not there. For others, they may experience delusional thinking, which occurs when someone holds onto extreme beliefs despite significant evidence to the contrary, such as believing someone is trying to harm them when there is no indication of danger. Given the significantly increased risk of harm to mother or baby during such episodes, it is recommended to seek emergency mental health help in such situations.

Beyond new conditions that appear in the postpartum period, some women with existing mental health concerns may also notice changes or increases in their symptoms, which require additional care and support.

Treatment for Postpartum Mental Health Conditions

Treatment of these mental health conditions will often start with referral from an OB/GYN or primary care provider. Medication options may be discussed, and can be beneficial and safe during the postpartum period. Best outcomes usually occur when an individual combines evidence-based talk therapy, positive social support, and medication to address symptoms.

Building a network, whether that is friends and family or connecting with other women in the same life stage through a support group, can also be very beneficial. So many things change in the postpartum period, and it can be hard to find time to connect with others. Having strong social support is a benefit in many ways though it alone may not “treat” the mental heath conditions discussed.

Talk therapy can be highly effective, providing a place to process thoughts and feelings related to depression, anxiety, and rage. At Upward, we pride ourselves on providing effective, evidence-based treatment designed to help you get back on track and living the life you love. Cognitive behavioral therapy can be very effective at addressing many postpartum mental health symptoms, and other therapy options may also address patient-specific needs.

Treatment at Upward is time-limited, targeted, and based on the best research into what works for patients. If you have been struggling during the postpartum period, please contact us to schedule a free 15-minute consultation and learn how we can help you get back to yourself again.