Exploring the anxious side of postpartum/peripartum depression

"Here is the world. Beautiful and terrible things will happen. Don't be afraid."  -Frederick Beuchner

It's definitely one of those seasons when it feels like it was a very bad decision to have had children.  If you're like me; overloaded on news about US action in Syria, despairing over the ever-growing incidence of gun violence, and new and grim records on climate change – then read on.  It's been a season when our mama-bear instincts are on high-alert and the good and safe world we hoped to offer our children feels like a mythical fantasy.  Weeks like this can feel tenuous, fragile, and dangerous and many can begin to exhibit some signs and symptoms of anxiety.  It can be all the more worse for those who are new moms and already in a very psychologically fragile time in life.  For a woman in a postpartum stress/depression reaction there can be ongoing suffering - not just in one week that is fraught with bombings and worry - but for weeks at a time.

I'm going to devote this brief essay to 5 of the lesser known symptoms of postpartum stress/depression which don't always make the lists of symptoms to look for.  We as clinicians understand postpartum depression to be an agitated depression, but often the focus is on the depressive symptoms and not always the anxiety responses that can frequently accompany it.  The risk is that the anxious responses can go unrecognized as a part of the postpartum depression, and go untreated for longer than necessary.

Anger:  Anger is one of those very handy emotions - it is a red-flag that lets us know that something is going wrong - that the system is overloaded, and in need of relief.  Beneath anger, is fear.  If a woman is afraid of, or ashamed of her anger - (perhaps because she believes that it's not the way a mother is "supposed to" feel) then it can also lead to intense guilt.  At its essence though, anger is self-protective - a helpful indicator that some critical self-care, and restructuring is needed.  Whether it's throwing shoes, yelling at our partner, or beating the steering wheel - most of us have been there.  The round-the-clock demands of a baby and of all that comes with a thoroughly changed life can indeed bring about anger.  The intensity of the anger, length of episodes, and frequency can begin to paint a picture of postpartum depression / stress, and can be a sign that help, in some form, is needed.

Insomnia:  Everyone tells new moms to "sleep when the baby sleeps!", and it is indeed very good advice - except for the mom who cannot calm her body and mind enough to nap, or even to be able to sleep at night.  For some moms the anticipation of the next cries and the hyper-vigilance that can accompany it is enough to interfere with sleep.  For others the swirling mind of thoughts and worries cannot be quieted, and even in the face of total exhaustion, sleep can be elusive.  Even good-sleepers can end up feeling completely wasted because of the regular waking of the new baby.  Imagine how much worse it is for a new mom suffering with insomnia. The nervous system is on overdrive, and this can be in response to the new and relentless demands of a new baby (not to mention a job, mortgage, and other obligations that still go on even in the postpartum period).  However, sleep is critical to quality of life and sanity, and a new mom who is not able to rest well needs assistance as soon as possible.

Intrusive thoughts:  Intrusive thoughts are often scary and always unwanted.  These thoughts can sound like: "what if I drop the baby?", "what if she drowns while I'm giving her a bath?", "what if I drive off the road while he's in the car?" Let me be clear - an intrusive thought does not mean intent or plan to do harm - it is understood to be an aspect of obsessional thinking patterns.  An intrusive thought is often fleeting, and it causes piercing anxiety because it is at odds with who the mom is fundamentally, and what she wants for her baby (Kleiman, 2009).  The scary, intrusive thought terrifies, and the anxiety and the thoughts can become a vicious cycle.  Many moms experiencing intrusive thoughts experience shame about them - women can become afraid to even admit these thoughts to them-self, let alone share them with another person.  This is a very common stress response to having a baby, and I'm quite certain it's not being talked about very often on playgrounds or over coffee with friends - but rest assured, once the anxiety has settled down, the thoughts will often disappear.

Panicky feelings: Feelings of panic can emerge in the postpartum period with the classic physiological symptoms of chest tightness, shortness of breath, racing heart and sweating.  These panicked moments may accompany intrusive thoughts, or may just break though out of the blue, and often leave a new mom feeling confused about what is going on.  I think it's helpful here to remember how overwhelmed the mind and body is at this time in life-- there are new physical and psychological vulnerabilities as coping skills are maxed out, and the anxious symptoms become a sign of this.

And finally,

Brain fog / confusion:  The word, 'zombie' seems to succinctly describe the state of brain fog and confusion.  It's like the brain is literally full of fog that is blocking the moms ability to concentrate, problem solve and remember things - and this often makes a mom feel more easily overwhelmed and confused.  Women also describe that this can feel like operating from behind a blanket, or like they've had too much alcohol to drink.  It can be a frustrating state--especially when it feels most important to have your wits about you - but this symptom will generally clear up as a woman starts to feel better. 

Any surprises here? Many women suffer with these anxious symptoms and do not get the help they need because they are not the most familiar symptoms of postpartum depression / stress.  However, they are troubling and can be just as debilitating as the depressive symptoms.  Women experiencing these symptoms should know that they are not alone, and that there are many ways - through varied resources of trusted caregivers, to get assistance through this challenging time.*  It's definitely fitting to quote Vimala McClure here, from her book The Tao of Motherhood; "Tell the truth, allow what is - and allow it to be known." 

*Peripartum depression is the most common complication of childbirth, effecting 20% of women.  If you think you may be experiencing symptoms of peripartum depression, you can reach out to your OB or midwife for support and resources.  You can also get in touch with Kellie Wicklund at the contact information below for a free phone assessment, free advice and referral to resources, or to make an appointment with her for specialized therapeutic support. 

Bibliography:

Kleiman, K. (2009).  Therapy and the Postpartum Woman.  New York, NY: Taylor & Francis Group

Chelsea Hibbard

Greenville, SC