Is it postpartum depression or postpartum anxiety? How to tell the difference between them

In recent years, postpartum mood disorders have (rightly) gotten a lot more attention. And as maternal health providers and clinicians have taken a closer look at the up to 85% of women who suffer from mood disturbance after pregnancy, it’s become clearer that the effects do not end at postpartum depression. Another incredibly common mental health issue that often accompanies new parenthood is anxiety, but it can be difficult to identify and even harder to know what to do if you think you may be suffering from it.

“There’s actually not a[n official] diagnosis of postpartum anxiety,” says Dr. Teresa Tan, MD and OB/GYN at Stanford Children’s Health. “However, as we know, there’s mom anxiety, there’s new parent anxiety—there are a lot of anxieties that can come up in the postpartum period. So what is popularly described as postpartum anxiety is a generalized anxiety that occurs within that first few weeks up to the first year after the baby is born.”

While PPA might not have an official diagnosis yet, many experts agree that anxiety often plays a role in postpartum mood disorders. Tan says that OB/GYNs make a point of screening their pregnant patients for a variety of mental health issues—including anxiety—both before and after the baby is born. The screens, like the Edinburgh Postnatal Depression Scale, are designed to be efficient, taking moms only minutes to complete and giving medical professionals a baseline to monitor their patient’s mental health throughout the third trimester to the 6-week appointment. The American College of Obstetricians and Gynecologists (ACOG) recommends that clinicians screen women for depression and anxiety at least once during the third trimester and postpartum, but some have suggested that more specific screening for anxiety should be done in addition to this.

“Postpartum depression is in the most current psychiatric manual as a subset of major depression,” says Dr. Tan. “And it’s specifically patients who meet a criteria of major depressive disorder in that first year after delivery, and especially if it’s related to delivery issues. The difference between depression and anxiety in the postpartum period is really the difference between depression and anxiety in the general population.” In fact, new studies have found that the effects of PPD can last up to three years after giving birth.

For new moms, PPD can manifest as excessive crying, feeling detached from their baby or difficulty in engaging in things they once enjoyed. Postpartum anxiety can often have the opposite effect, leaving new moms with a heightened or obsessive sense of worries, rational or irrational, that consume their thoughts, usually about the health and safety of their baby. Of course, the symptoms vary from woman to woman. In The Motherly Guide to Becoming Mama, there’s a full list of potential symptoms, including:

• Feeling sad for long periods of time without an easy-to-pinpoint cause
• Lack of desire to do the things you used to love
• Difficulty getting out of bed
• Difficulty falling asleep
• Lack of motivation
• Feeling guilty often
• Anger or rage
• Worrying about things that seem odd or that you did not use to be worried about
• Repetitive thoughts or actions, such as the need to clean something over and over or ensure that a door is locked multiple times
• Fear of being left alone with your baby
• Reliving difficult aspects of your birth
• Not wanting to talk or think about your birth at all
• Inability to make decisions
• Periods of being extremely energized (lots of talking, moving, cleaning)
• Feeling invincible or that you have powers beyond human ability
• Hallucinations
• Intrusive and disturbing thoughts; violent thoughts
• Not being able to sit still
• Not feeling bonded to your baby

Both PPD and PPA generally come with day-to-day challenges, like difficulty sleeping when baby is sleeping or inability to leave the house. While some of these symptoms can be normal for a short period of time, Dr. Tan recommends new moms seek help if the symptoms persist for more than two weeks or they make it difficult to manage daily tasks, affect routines of daily living, interfere with normal activities and/or cause concern. And if someone has thoughts about harming themself or others they should seek medical attention immediately.

Fortunately for new moms suffering from PPD or PPA, there are many resources available. Dr. Tan recommends anyone who thinks they may have symptoms of any mood disorder in the postpartum period reach out either to a mental health therapist, their primary care doctor or they can contact their OB/GYN or midwife. They will likely be screened for mental health concerns using a brief question and answer survey like the Generalized Anxiety-7 (often called the GAD-7). If deeper mental health care is needed, the provider can assist with finding a mental healthcare specialist or clinician familiar with treating anxiety and depression. In either case, cognitive behavioral therapy with a trained therapist is often the first step in treating mild to moderate symptoms.

If more aggressive treatment is needed, a psychiatrist can also be referred to potentially recommend medication. “Many people are concerned about taking psychiatric medications during breastfeeding—they worry, ‘does it affect the baby?’ The answer is yes, it does cross into the breastmilk—but just a little bit,” Dr. Tan says. “So we really are weighing the risks and benefits. We want a healthy mom because a healthy mom means a healthy baby. We want moms to be able to take care of their children in the best way possible, and sometimes medication is what’s needed to really calm those anxious thoughts down or help somebody get out of a real depressive episode.”

For many new parents, though, simply understanding their risk factors and knowing that the pressures associated with new parenthood are completely normal can make a huge difference in their mental health postpartum.”Finding a good support system is really important for new moms,” Dr. Tan says. “When there’s not a strong support system, there’s a higher risk of depression and anxiety.” This is especially important when a new mom has some of the more common risk factors of postpartum depression and anxiety, such as having a baby in the NICU or a traumatic birth experience or having suffered from depression or anxiety prior to getting pregnant.

Regular screening throughout pregnancy can help new parents understand and recognize changes in their mental health so they can seek help quicker, but Dr. Tan also recommends finding a community of other parents who can help provide support and perspective to help new parents know what’s normal and what’s not. Stanford Children’s Health even offers free online support groups for new moms and moms of babies 5-10 months old where in-person support may not be available.

Discussing mental health can be tricky any time, but it becomes more complicated with motherhood. As understanding of mental health in relation to pregnancy and childbirth continues to improve, though, we hope to see more support for mothers in every way.

This article was sponsored by Stanford Children’s Health. Thank you for supporting the brands that support Motherly and mamas.