Recognizing Postpartum Mental Health Conditions and How Therapy Can Help

Entering motherhood is an amazing new chapter of life. However, amidst all the joy and love during this time, it’s important to acknowledge that the postpartum period isn’t all rainbows and butterflies. Many new mothers face difficult mental health challenges during this time.

If you’re a new mom, you might be all too familiar with the emotional rollercoaster of moments of pure bliss mixed with moments that make you want to cry and hide. It’s normal to experience mixed emotions during this time, but if your well-being is severely impacted or you’re having dark thoughts, you may require extra help.

You are not alone if you’re suffering right now. Around 13% of new moms worldwide have some type of mental health condition – that’s more than one out of 10 moms.

Here’s what you should know about postpartum mental health conditions and how to get help.

Why the Postpartum Period Can Lead to Mental Health Struggles

The postpartum period is full of many emotions, stress, and transitions. For some new moms, all the changes during this time can lead to conditions that cause troubling symptoms, decrease quality of life, and affect a mom’s ability to care for the baby, including:

• Postpartum depression

• Postpartum anxiety

• Postpartum obsessive-compulsive disorder

• Postpartum psychosis

There are many reasons why new moms are more susceptible to these conditions, including:

• Hormonal changes: New moms experience major hormonal changes after birth, affecting how they feel emotionally and physically. “The sudden drop in estrogen and progesterone levels after pregnancy can lead to feelings of fatigue, anxiety, and mood swings,” says Melissa Galica, a licensed professional counselor with Grow Therapy. Changes to thyroid hormones may also contribute to feelings of depression.

• Sleep deprivation: New mothers are notoriously sleep-deprived due to constant waking in the night. Unfortunately, sleep deprivation can lead to negative mental health effects, such as an unstable mood and irritability, says Kristina Anzell, a licensed clinical social worker with Grow Therapy.

• Isolation: Social support is crucial for well-being. Some new moms may experience a lack of socializing and isolation, needing to stay home with their baby rather than hanging out with friends the way they used to. Anzell says this isolation can be a risk factor for mental health conditions.

• Adjusting to new responsibilities: All of the sudden life changes and new responsibilities of being a mom can lead to a lot of stress, which can pile up and take a toll on mental health. There are constant demands to feed them, change their diapers, soothe them when they’re crying, and more. External pressure and expectations can further feed into stress.

• Grieving one’s old self: Anzell says it’s common for new moms, especially first-time moms, to feel some grief as they let go of their old selves while also trying to figure out their new selves. This may be confusing for a new mom’s identity and self-esteem.

Put all these factors together, and it’s no wonder so many new mothers struggle with their mental health.

What Is Postpartum Depression?

Postpartum depression (PPD) is perhaps the most commonly known postpartum mental health concern. This form of depression results in distressing symptoms from sadness to thoughts of harming yourself or your baby. It can make it very difficult for a new mother to care for their newborn, says Galica.

Various symptoms of postpartum depression include:

• Sadness and hopelessness

• Losing interest in activities you used to enjoy

• Low motivation

• Loss of appetite

• Difficulty sleeping or sleeping too much

• Trouble concentrating

• Excessive crying

• Thinking of death and suicide

• Losing interest in the baby

• Thinking about harming the baby

• Not wanting the baby

PPD shouldn’t be confused with the “baby blues,” which are even more common than PPD, affecting up to 75% of new moms. The symptoms of baby blues are very similar, except for thoughts of harming yourself or your baby, Galica says. Furthermore, baby blues pass on their own within a week or two with the support of loved ones, but PPD lasts longer and requires professional treatment.

What Is Postpartum Anxiety?

It’s normal to have concerns for the well-being and safety of your baby. However, it’s important to recognize the difference between “normal” anxiety and clinical anxiety. Those with postpartum anxiety may feel extreme worry all day, fearing that they and their baby are constantly at risk of danger. This can result in a long list of symptoms that can manifest emotionally, physically, and behaviorally, including:

• Trouble relaxing and staying calm

• Feeling scared or on-edge

• Non-stop anxious thinking

• Imagining worst-case scenarios

• Difficulty concentrating

• Irritability

• Trouble sleeping

• Upset stomach

• Shortness of breath

• Heart palpitations

• Decreased appetite

• Inability to sit still

• Tense muscles

• Avoiding anxiety triggers

• Being more cautious than necessary in non-threatening situations

• Repetitively checking things

• Controlling behavior

What Is Postpartum OCD?

OCD is characterized by having distressing obsessions or unwanted intrusive thoughts and carrying out compulsions to try to get rid of the obsession or reduce their distress. In the case of postpartum OCD, intrusive thoughts and obsessions center around the baby – such as the baby getting hurt or contaminated.

“The most common intrusive thoughts revolve around harm coming to the baby, whether physical or emotional,” Galica says. “Women may engage in repetitive behaviors such as frequently checking on their child, excessive cleaning, or avoiding situations that could potentially harm the baby.”

While the intrusive thoughts can be very distressing, they’re not an indication of what a mother actually wants to do or will do. These thoughts are scary and upsetting to the postpartum OCD sufferer because intrusive thoughts are the opposite of what aligns with their morals. That’s why they try so hard to eliminate them through compulsions.

Other symptoms of postpartum OCD include:

• Obsessions and unwanted intrusive thoughts that may be violent or sexual in nature, causing the mother great distress

• Fear of acting on the intrusive thoughts

• Carrying out compulsions to attempt to stop the intrusive thoughts (such as excessively  checking on the baby, cleaning the baby, or seeking reassurance from others)

• Avoiding activities related to intrusive thoughts (such as avoiding changing the baby’s diaper in the case of sexual intrusive thoughts, or avoiding holding them in the instance of harm intrusive thoughts)

• Requiring someone closeby to help due to fear

• Becoming consumed by obsessions and compulsions

What Is Postpartum Psychosis?

Of the mental health conditions that can occur after giving birth, postpartum psychosis, or PPP, is the most urgent and serious. It’s characterized by sudden and significant changes in mood, behavior, and thinking – and it’s a mental health emergency that requires immediate attention, Galica says. People with PPP may have trouble knowing what’s real and what’s not and may not even be aware that something is wrong.

The main signs of PPP are experiencing hallucinations, which means seeing or hearing things that aren’t real, and delusions, which are very strong, persistent false beliefs. Delusions specific to PPP include believing you were never pregnant or gave birth. These beliefs persist even despite solid evidence that they aren’t true.

Aside from hallucinations and delusions, other signs of PPP include:

• Changes to mood

• Thinking or behaving unusually

• Depersonalization

• Trouble sleeping

• Feeling irritable and agitated

• Thinking about harming yourself, the baby, or other people

Treatment often involves inpatient mental health care/hospitalization for the mom, for the safety of herself and the baby, making sure she gets all the best help and care she needs.

Postpartum Therapy and Treatment for New Mothers

Help is available for new moms with mental health conditions. Red flags to look out for include thoughts of harming yourself or your baby or an inability to function day-to-day. Another sign that you could benefit from therapy is if your usual coping mechanisms and your support system aren’t enough to get you through this difficult time, Anzell says.

Trained mental health care providers such as therapists, counselors, social workers, and psychiatrists provide a variety of evidence-based interventions and treatment options to help you feel better. Examples of treatments include:

Therapy: Psychotherapy, AKA talk therapy, is a major component of improving overall postpartum wellness and the severity of existing symptoms. Anzell says two commonly used types of therapy for new mothers include cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). In postpartum therapy sessions, new mothers will learn:

• How to address unhealthy and unhelpful thought patterns

• How to engage in healthier behaviors

• How to regulate emotions

• Coping skills for managing stress and other symptoms

• How to improve interpersonal relationships

Medications: For some new moms, psychiatric medications may play a role in recovery. Prescriptions such as antidepressants can help reduce severe symptoms. In many cases, a combination of therapy and antidepressants is used to best help new moms.

Support groups: New moms often feel alone in their struggles, especially when suffering from mental health conditions. Connecting with fellow moms in support groups or group therapy helps to combat feelings of isolation and loneliness. These groups offer a safe space for moms to share experiences, express feelings, and give advice.

Lifestyle changes: Making healthy lifestyle changes and engaging in self-care can help. Some examples include:

• Getting enough physical activity and exercise

• Eating healthily

• Avoiding alcohol and other substances

• Make arrangements for alone time away from the baby

• Leaning on social support

• Asking for help when needed (whether from a partner, family member, friend, or professional)

How Do I Find Postpartum Therapy Providers or Support Groups?

A great place to start is your OB-GYN. They likely have a list of trusted referrals who can address your mental health concerns, as well as local support groups.

Additionally, you can search online for therapists in your area who accept your insurance and have experience helping people with perinatal and postpartum mental health concerns and parenting.

While all therapists are informed about these conditions, Anzell says your best bet for the most specialized care is to opt for a therapist with extensive experience and expertise in the postpartum period.

Postpartum Support International is a great resource for various online support groups. While it’s not a replacement for therapy, they also offer their own helpline that you can text or call.

Will Going to Therapy Result in My Baby Being Taken Away?

Your baby will not be taken away if you seek therapy. Anzell says many mothers may be scared that if they open up about their intrusive thoughts about harming the baby to their therapist, their therapist will report them to Child Protective Services – but this isn’t the case. While therapists do need to report child abuse, they don’t need to report intrusive thoughts, Anzell says.

Mental health care providers are educated on these symptoms and understand that thoughts do not mean the baby is in imminent danger. They’re trained to assess risk, provide treatment, and help moms feel better. In an instance of postpartum psychosis, this is high risk, and the mother will likely be hospitalized.

If you’re a new mother and you think you may be suffering from one or more of these conditions, don’t hesitate to seek postpartum therapy. Anzell urges new moms not to be afraid to ask for help and get professional support.