A Toolkit for Postpartum Anxiety & Panic Symptoms

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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 … and 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.

  1. 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.
  2. 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.
  3. 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.
  4. Sleep deprivation: Yes, I know: Having a newborn drastically limits the time that all moms spend asleep. Frequent night waking, breastfeeding, and high anxiety makes 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.
  5. 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.
  6. 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…

  1. Take 10 deep belly breaths (also known as diaphragmatic breathing).
  2. Drink a big glass of water.
  3. Eat a protein-based snack such as lean meats, nuts, cheese, or a hard boiled egg.
  4. Ground yourself in the present: Look around you and note (out loud if possible) everything that you can access in all 5 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?
  5. 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”.
  6. Go out side. Stretch. Feel yourself move and notice the sensations in your body.
  7. Once your initial symptoms decrease, find some help so that you can take a nap and get the rest that you need.
  8. 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, visit www.postpartum.net.

Kate Kripke, LCSW

For more on self care, you might enjoy visiting the blog Living Self-Care. There you can learn more ways to take care of yourself, and also join a contest where you can win self-care related prizes! They are also hosting a Twitter chat tonight at 9pm Eastern. To participate, use the hashtag #MEchat.

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Tell Us What You Think

  1. Excellent suggestions…and important point to note about "PPD" being the generic, but not comprehensive label for perinatal mood disorders. I really enjoy Kate's posts here.

  2. terrific post! something i will definitely share with others. as always, well-written, easy to understand and digest, non-threatening. i love your posts!

  3. You do offer some great points. I worry thought about people misunderstanding your medical advice. I was told by both my psychopharacologist and my midwife that benzos (xanex, etc.) were a "NO WAY!" unless absolutely needed. I had been on them for quite some time before the pregnancy with great success (as you mentioned in your article) but was taken off them immediately once I became pregnant. Just some food for thought…diff docs may have diff opinions.

  4. Thank you for your comments, Heidi. As you mention, each mom absolutely does need to be able to trust and follow her own particular medical team's advice (hopefully this team is up to date on current perinatal mood disorder treatment information). And I certainly don't want to mislead folks into believing that I am an MD. However, what we do know is that the potential effects to mom and baby of severe anxiety (including panic and OCD) outweigh the potential effects of many medications including many SSRIs and a number of benzos. For moms who require these medications to be well, it is currently recommended that these medications be prescribed and/or monitored under the guidance of a trained professional. A great resource for breastfeeding and medication use can be found at: http://www.womensmentalhealth.org/specialty-clini
    I am hopeful that your advice was appropriate for you. I do worry when women are told that meds are a "No way" and are taken off quickly upon becoming pregnant if their providers are not current on what is and is not safe (and the risk benefits of all options). Some women really do require these medications to be well. Hope that clarifies and, again, I really appreciate you speaking up.

  5. Thank you so much for this post, as it describes what I went through perfectly. The depression and sobbing didn't start up until after the several weeks of sudden and extreme insomnia brought on by the horrendous anxiety and racing thoughts. Of course it all went downhill after that. And I was in my third trimester. Awfulness!! I had experienced anxiety prior to pregnancy, but nothing like this new anxiety. I didn't even recognize that it was anxiety due to the severity and sudden onset. It didn't help that my doctors weren't informed and made me feel like a loon. I did end up taking a benzo and an AD for the remainder of my pregnancy, as it was quite necessary. I was not eating or sleeping. But, that was after I was given a different benzo at first (they called it a band aid for my problems) and then told by another doctor in the practice that I was harming my unborn child. She was angry with me and asked if I wanted to know exactly what I was doing to my baby? Just what a freaked out anxiety ridden pregnant woman needs to hear, right? She ended up taking my husband out in the hallway and scaring him to death with the info. I was eventually shuffled off to a psychiatrist who put me on the benzo (that I still take occasionally) and the AD which I am now off of. My daughter was perfectly healthy and is absolutely thriving, very advanced for her age in everything. And so is mama! I am so thankful for the help I finally received, even if I had to fight for it. And believe me, I did. I've also discovered that my progesterone is low, which I whole-heartedly believe is linked to all that I went through, and still suffer remnants of monthly. My hormones and brain chemistry went wonky during my pregnancy for sure.

  6. It was a constant diologue between me & my med team. We did the cost-benefit analysis at just about every single appt. I was able to make it w/o the meds.

  7. Hooray Hooray Hooray for you, Kristin! These issues are always so unique and involve a very thoughtful cost-benefit analysis to see what decision is best for each mom and family… and it sounds like your choices around medication (once in the hands of an informed clinician) were spot on. Stories like yours make me smile. What a lucky kiddo you have!
    Many of us are working hard to train and inform physicians who work with moms (Obgyns, Midwives, psychiatrists, GPs) about current research around appropriate PMD treatment so that early experiences like yours are lessened. Thanks for sharing…

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