Mother Cloud

Updated: Feb 28, 2020

Postpartum anxiety, ofter misdiagnosed as depression is beginning to catch the medical field's attention. Here is what you need to know.

After Manhattan pediatrician Deena Blanchard, M.D., gave birth to her second son, in 2010, she was looking forward to, as she terms it, “four months of glorious maternity leave.” She planned on spending sweet, drowsy mornings bonding with her newborn in her Upper West Side apartment; enrolling in postnatal yoga; and taking long walks in Central Park. “I was going to totally engulf myself in new mom–hood,” she says.

But Blanchard was immediately consumed with paralyzing worry, barraging her husband and fellow doctors with phone calls. “I’d say, ‘I think he has reflux. I think he has a milk-protein allergy.’ ” She lost an alarming amount of weight—30 pounds in just six weeks. She couldn’t sleep. She took her son to a specialist and a lactation consultant as her thoughts swirled with “a never-ending cycle of ‘What if, what if, what if?’ ”

Standing in her humming office in the Flatiron District recently, clad in jeans and a lilac cashmere sweater (“The white lab coat scares kids”), Blanchard and her smooth chestnut bob telegraph confidence and capability. “That’s why anxiety is so deceptive,” she says. “I consider myself very accomplished, and at the time, I just felt like, ‘I don’t get it. I’ve had a baby before, and I’m a pediatrician.’ ” When debilitating panic attacks struck two weeks before she was due back at work, Blanchard finally took herself to a therapist. She was told she had postpartum anxiety. She had never heard of it.

Postpartum anxiety, or PPA, afflicts an estimated 10 percent of new mothers, according to the advocacy nonprofit Postpartum Support International. A 2016 University of British Columbia study found that it’s more than twice as common as postpartum depression (PPD), a mental disorder that can range from feelings of hopelessness and sadness to thoughts of suicide. PPD has become a much more widely reported and talked-about phenomenon in recent years. Yet—as in Blanchard’s case—PPA is so little known that it often goes undiagnosed.

Or it’s misdiagnosed as postpartum depression, “which is a wastebasket term,” says reproductive psychiatrist Catherine Birndorf, M.D., of the Motherhood Center in Manhattan, which specializes in perinatal mood disorders. “I feel like bazillions of women get missed because they are anxious,” she goes on. “Often the first, second, and third symptoms they list off in consultations are anxiety, anxiety, and anxiety, but unless there is some flavor of depression, they don’t get identified.” (There’s a movement afoot, she says, to replace the term postpartum depression with the more inclusive perinatal mood and anxiety disorders—or PMADs.)

What complicates the issue is that, like Blanchard, many moms who have symptoms of PPA don’t even know it; they just assume that they’re failing to adjust to motherhood. All new parents are plagued by fretful thoughts—for first-timers in particular, every sniffle sends them scurrying to the phone. Even the most together mother is already more susceptible to scrambled nerves due to hormonal ricocheting and a hallucinatory lack of sleep, which, of course, make anxiety worse. And if women sense something is amiss, they still may be too ashamed to seek help, according to a recent North Carolina State University study, which found that 21 percent of those experiencing postpartum mood disorders, such as anxiety, don’t confide in their doctors.

A history of anxiety can contribute to PPA, but cultural factors play a part as well. Leading the way is the enormous pressure new mothers face for this to be the most blissful time of their lives; the ability to self-diagnose medical problems on Google (rampant use of which can result in a real affliction known as cyberchondria); and a relentless news feed of the many mishaps that can befall your child. The condition is treatable, however, says Jonathan S. Abramowitz, Ph.D., professor of psychology and neuroscience at the University of North Carolina at Chapel Hill. “This is not the kind of thing where there’s a problem with your brain or your neurotransmitters,” he says. “It’s not a biological illness. It’s a psychological problem.”

If you suspect you have PPA, it’s easier to look for stark changes in your behavior and activities than try to analyze your moods, which are more ephemeral. One question Birndorf often asks new moms is if they can rest when they know someone else is watching their sleeping baby and monitoring their safety. “The mom that needs to be treated will say no,” she reveals.

Recovery usually involves one or more of four elements: stepped-up self-care; behavioral therapy; social support, such as helplines; and, if necessary, antidepressants, a decision that requires a detailed conversation with one’s medical provider—especially during breast-feeding. (The National Institute of Health’s website, LactMed——provides additional information on drugs and breast-feeding.)

Blanchard, with the support of her doctor, ultimately decided to start taking Zoloft, and the clouds lifted, she says. Her pediatrics practice began screening new mothers for PPA soon after. “When I got the help I needed, I was able to fall in love with my baby in a way I never thought I could experience,” she says. “Now I feel like myself.” She smiles before backtracking. “No—an improved version. I’m a better mother and a better doctor. I tell patients that support is out there—and taking care of yourself is a gift to your child.”