Postpartum Anxiety and Depression
Postpartum Anxiety & Depression: How to tell if you’re suffering from it; how to get the help you need.
Anxiety and depression are leading postpartum complications, and, unfortunately, are often overlooked by providers and patients.
Forty percent of patients do not attend a postpartum visit. Others are unaware of the signs and symptoms of perinatal anxiety and depression and do not ask for help. Diagnosis is complicated by the shame that many feel about admitting their negative emotions when society expects them to be exuberant over their newborn. Lack of diagnosis and treatment has serious consequences as these symptoms have the potential to interfere with successful pregnancy and bonding. Once identified, the conditions are most often treatable with adequate support, education, and/or medication.
Diagnosing Baby Blues vs Postpartum Anxiety and Depression
Postpartum anxiety and depression occur more commonly in individuals with previous psychiatric diagnoses. However, they also occur in patients with no previous history.
Many patients and providers attribute postpartum mood symptoms to temporary hormonal shifts. Hormones indeed contribute to shifting moods, but are more likely to cause “baby blues.” Baby blues occur in 80% of patients and are characterized by sadness and moodiness beginning 2-3 days after birth, and typically dissipate after two weeks. Postpartum depression lasts longer and is more severe than baby blues.
When symptoms endure past two weeks and/or interfere with functioning, a diagnosis is suspected. Postpartum depression and anxiety can occur up to one year after birth.
Symptoms can include some or all of the below:
Difficulty bonding with your baby
Excessive crying
Withdrawing from family and friends
Loss of appetite or eating much more than usual
Inability to sleep (insomnia) or sleeping too much
Overwhelming fatigue or loss of energy
Reduced interest and pleasure in activities you used to enjoy
Intense irritability and anger
Fear that you’re not a good parent
Hopelessness
Feelings of worthlessness, shame, guilt or inadequacy
Diminished ability to think clearly, concentrate or make decisions
Restlessness
Severe anxiety and panic attacks
Constant worry
Thoughts of harming yourself or your baby
Recurrent thoughts of death or suicide
The Importance of Early Detection and Treatment
It’s important for patients, families, and providers to monitor mood and irritability in post-partum period. Awareness of nonverbal cues such as withdrawal, distraction, and/or restlessness is critical as many are hesitant to admit their history and symptoms.
Recognizing and treating these symptoms early positively impacts infants’ psychiatric and neurological development. For example, parents with depression and anxiety are more likely to have poor nutrition and higher rates of preterm birth and low birth rate. Studies have shown that babies and toddlers of patients with postpartum depression
are less adaptable, more likely to suffer from psychiatric conditions, and have lower cognitive ability. It is incumbent on the provider to screen for these symptoms. Medical providers, psychiatrists, and therapists can create a safe space by acting nonjudgmentally of the difficulties associated with pregnancy and newborns.
Repeat pregnancies in patients with a History of Postpartum Psychiatric Symptoms Patients can respond to each pregnancy differently. One episode of postpartum depression, anxiety or both, does not automatically mean that you will have a second.
However, it should alert you to seek psychiatric monitoring and have a low threshold for seeking support during your pregnancy. There is no harm in reaching out for assistance early. Once you identify a problem, you can discuss different options with a mental health care provider and together choose one that takes into consideration your symptoms and personal choice.
Treatments for Postpartum Depression & Anxiety
Psychotherapy
The treatment for postpartum depression and anxiety depends on the severity of the symptoms. Talking through your concerns with a mental health provider helps in several ways. First, it decreases the feelings of loneliness and isolation that one often feels during periods of despair and vulnerability. Suffering is difficult enough, but you should not have to bear your feelings alone. In addition, therapy can help you to manage your feelings, problem solve, set boundaries and goals, and approach situations with a new perspective.
Psychoeducation can help to ease the pressure that new caregivers experience. For example, not every newborn is interested in nursing. Caregivers need to learn that they are ENOUGH. Self-care, sleep, hydration and proper nutrition are important to the individual and her baby. An individualized and well thought out discussion between the patient and their medical, psychiatric and nursing team can be useful to set realistic goals that meet the needs of the entire family.
Antidepressants
Sometimes, even with proper support and psychotherapy, patients can suffer with feelings that interfere with their self-care, care of the newborn, and/or quality of life. In these instances, your provider might suggest antidepressants. If you are pregnant or breastfeeding, certain medications will be less likely to interfere with fetal development or enter the breast milk. Your provider will discuss the risks and benefits of beginning an antidepressant, and together you will determine whether it is the right decision for you and your family.
Jordana Cotton DNP, PMHNP-BC, PMHCNS, has specific experience with peripartum and postpartum depression and anxiety. Initial conversations will address whether she is the right person to help, and if so, Jordana will work with you to navigate and treat your symptoms. She has helped patients with depression and anxiety across the lifespan, from the time prior to pregnancy, during times of infertility, pregnancy, loss, and of course postpartum anxiety and depression. Early detection and treatment can impact quality of life, prognosis, and emotional and physical well-being of you and your children.
References
Kingston, D., Tough, S. & Whitfield, H. Prenatal and Postpartum Maternal Psychological Distress and Infant Development: A Systematic Review. Child Psychiatry Hum Dev43,683–714 (2012). https://doi.org/10.1007/s10578-012-0291-4
Priest SR, Austin MP, Barnett BB, Buist A (2008) A psychosocial risk assessment model (PRAM) for use with pregnant and postpartum women in primary care settings. Arch Womens Ment Health 11:307–317
About the authors
This article was written by Dr. Jordana Cotton & Dr. Julia Samton of the Midtown Practice for Psychiatry, July 2021.
Long COVID Brain Fog is Real: Here’s What to Know and How to Lift It
It all begins with an idea.
April 2020, an early peak of the SARS-COV-2 (Covid-19) pandemic in the United States, was a difficult month.
I knew I would cry in the bathroom or on a cab ride home. I recognized that I would watch someone painfully gasp for their last breath. Yet, as challenging as those early months of the pandemic were, I did not anticipate what was to come for many.
Unfortunately, even after the resolution of the initial infection, a percentage of COVID survivors are plagued by a constellation of persistent symptoms that continue to plague patients months after infection. This syndrome is called long COVID, and although it is not completely understood, it has negatively impacted many survivors physically and psychologically.
What is Long COVID?
Long COVID, seen in approximately 30 to 40 percent of patients, consists of one or more of the following symptoms: persistent brain fog, dull lingering headaches, fatigue, malaise, trouble falling and staying asleep, early morning awakening, and appetite changes with persistent GI distress.
Brain fog can be especially troubling for patients dealing with long COVID, making it difficult to focus and perform everyday tasks at work and home. Left untreated, brain fog can significantly impact quality of life.
Identifying Brain Fog
Patients struggling with brain fog often report feeling cloudy, and struggle to concentrate and attend to conversations and social cues, be they auditory or visual, virtual or in person. Slowed processing of events and communication is seen in these patients.
Individuals report having a difficult time shifting focus between topics and relating to abstract, theoretical discussions. Brain fog is best described as the feeling of being stuck in an unrelenting cloud.
Preventing Long COVID
Using multiple layers of precaution in your daily life is the best way to prevent COVID infections and the possibility of developing lingering symptoms. These protective measures include proper mask-wearing, hand washing, and vaccination.
Maintaining a structured daily regimen (as described below), as well as increasing visual and auditory processing cues by getting outside and seeing new things, can help decrease the frequency and intensity of agoraphobia, and work to build resilience against brain fog before it starts.
Treating Long COVID
I have noted a decrease in frequency and intensity of brain fog, headaches, fatigue, insomnia, and GI distress with low doses of selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SNRIs).
Within 6 to 12 weeks, low dose treatment has led to a lift in the so-called “dreary clouds” of Long COVID brain fog. Patients can quickly see light at the end of the COVID tunnel, and thus feel collectively less sad and worried. They stop dreading waking up the next day to a headache or inability to concentrate. Patients have a renewed ability to work, play with their children, establish routines, and find meaning in life.
Psychotherapy and Peer Support
Cognitive Behavioral therapy can shift negative ruminations and catastrophic thoughts to more neutral thoughts. I teach patients that it is not necessary to force positive thinking at this chaotic time, and coach them instead on shifting to neutral thoughts.
Virtual peer support through Survivor Corp can also play an important role in long COVID recovery.
Creating Healing Routines
Daily self-care routines are essential to health and overall well-being, especially for those struggling with ongoing neurological COVID symptoms. These routines can be as simple as getting into bed at 10 pm each night and reading for 10 minutes in bed.
Patients should have a morning routine that includes 15 minutes of movement, such as a walk outside. This will help maintain circulation and stimulate the brain with outdoor visual and auditory cues. Hydration is also a critical part of a healthy daily routine. I recommend drinking half of your weight in ounces.
In addition to morning and evening routines, patients must work towards eating at similar times, creating an environment conducive to improvements in appetite and limit mindless snacking. For example, someone with long COVID might feel more comfortable skipping breakfast due to initial COVID-19 belly aches in the mornings, but should work toward eating three meals a day at consistent times.
Maintenance of a healthy sleep routine should include getting into bed at 10 or 10:30 p.m. with the goal of falling asleep by 11 p.m. Consider an audiobook or podcast instead of visual reading at the end of the day. This will help alleviate visual processing fatigue associated with constant Zoom meetings.
Taking healthy breaks from social media and news media is also an important piece of the recovery process. It is vital to maintain healthy boundaries with the type of online information you are consuming. This will eliminate processing fatigue and reactivation of the media trauma cycle. It is also crucial to have things to look forward to after school, work, or on the weekends, rebuilding joy and pleasurable activities into their routines.
You Don’t Have to Live with Brain Fog
With new cases of COVID on the rise and the spread of the delta variant, long COVID will likely impact millions of Americans.
If you are struggling with brain fog due to long COVID, please reach out. Working with me to help tailor your daily regimen can alleviate lingering symptoms, giving you renewed ability to focus, sleep, and enjoy life.