Meet Christine.  She is a married 30-year-sometime woman who simply had her beginning babe about 3 weeks ago.  While the pregnancy went smoothly, the feel of labor and delivery was difficult.  Later well-nigh twenty hours of labor, Christine had an emergency caesarean department.  The babe was healthy, but he had difficulty breastfeeding.  Christine was worried that she was not producing enough milk.  Her baby  lost more than than x% of his weight during the first calendar week, and Christine was forced to supplement with formula.

Christine went to run across her obstetrician ii weeks after delivery because she was worried that her C-section incision site was infected.  Her obstetrician reassured her that there were no signs of infection simply was concerned because Christine was not her usual self.  She was tearful and reported that she was having problems falling asleep, fearful that something might happen to her babe.  Christine's obstetrician ready an appointment for Christine to run across with the OB social worker the following week.

When Christine met with the OB social worker, she denied feeling depressed.  She acknowledged feeling sleep-deprived, unable to sleep restfully and persistently worried about the babe's health and his ability to gain enough weight.  Although her mother was willing to help intendance for the baby, Christine did not experience comfortable leaving the baby with others.  When she was away from the baby, she was plagued by persistent, intrusive thoughts of something horrible happening to the baby — for case, the baby suffocating in his bed sheets.

Christine is not an bodily patient but an amalgam of the postpartum women we see at our clinic.  During the postpartum period, in that location is a confluence of many significant events: recuperation from labor and commitment, sleep-deprivation, breastfeeding, negotiating the transition to parenthood.  During the first few weeks, many new parents may recognize that things are non going well just may non be able to distinguish what is normal and what is a trouble.

Postpartum Depression or Postpartum Anxiety?

Postpartum depression first gained medical attending in the 1970's.  Like depression which occurs at other times in a woman'south life, researchers observed that postpartum depression is characterized by feelings of sadness, irritability, tearfulness, appetite changes, and slumber disturbance .  But what we have learned over time is that many women with what nosotros typically telephone call "postpartum depression" as well take significant feet symptoms.

This most commonly takes the form of generalized anxiety , persistent and excessive worries, feelings of tension, and disability to relax.  Often these worries are focused on the infant, his or her health and safety.

Many postpartum women have symptoms consistent with obsessive-compulsive disorder (OCD) . Obsessional thoughts are experienced as intrusive, unwanted and inconsistent with one's typical personality or behavior, and patients often express fears of even thinking these thoughts, particularly when they involve thoughts of harm to their baby.  One study demonstrated that 57% of women with postpartum onset major low reported obsessional thoughts (as compared to 36% of women with non-postpartum major depression).  In addition, women with postpartum obsessional thoughts had more than frequent obsessional thoughts than women with not-postpartum obsessional thoughts.

How postpartum depression and postpartum feet relate to i another is not fully understood.  Clinically, information technology seems that women with more severe depressive symptoms also accept comorbid anxiety symptoms.  We exercise see non-depressed postpartum women with generalized anxiety disorder (GAD) or OCD; however, it seems that many women who have postpartum GAD and OCD ultimately report some depressive symptoms, particularly when their symptoms are more severe or prolonged.

A recent report attempts to better empathize the relationship between postpartum low and feet .  This was a prospective study of obstetric patients (n=461) recruited immediately later on delivery and followed for 6 months; 331 (72 %) of the women completed the assessment at 6 months postpartum.

At 2 weeks postpartum, 28 (19.9 %) of the women with low had feet symptoms, compared to iv (one.three %) of the women who screened negative for depression (p?<?0.001). Similarly, 36 (25.vii %) women with depression endorsed obsessions and compulsions compared to xix (viii.4 %) women without depression (p?<?0.001). Anxiety symptoms seemed to subside over fourth dimension. Past 6 months postpartum, there were no differences in symptoms between women with and without depression. Conversely, the differences in obsessions and compulsions between depressed and non-depressed women persisted.

Does It Thing?  Do Nosotros Need to Distinguish Between the Two?

Equally nosotros motion toward universal screening of postpartum women , information technology is interesting to note that many of the  tools unremarkably used to place women with postpartum depression also find women with postpartum anxiety.  For instance, the Edinburgh Postnatal Low Calibration (EPDS) consistently identifies women with anxiety symptoms and full EPDS scores appear to correlate with disorder type.  Women with no disorder take the everyman scores, followed by women with anxiety simply, then past women with low only.  Finally, women with a combination of depression and anxiety scored the highest of the iv. While these screening tools may non give us diagnostic accuracy, they do identify women with clinically significant symptoms who may do good from treatment.

Distinguishing betwixt postpartum depression and anxiety will aid us to make better handling recommendations. Women with milder symptoms may benefit from psychotherapy.  While interpersonal therapy (IPT) benefits women with postpartum depression, we don't really know how IPT works for OCD or generalized anxiety symptoms.  In dissimilarity, nosotros have ample data from both postpartum and not-postpartum populations to indicate that cerebral-behavioral therapy (CBT) is an effective treatment for depression, OCD, and feet symptoms.

When it comes to pharmacotherapy, the antidepressants most ordinarily utilize to treat women with postpartum illness – serotonin uptake inhibitors (SSRIs and SNRIs) — are effective for the handling of major low, generalized anxiety disorder, and OCD. Bupropion is not as effective for managing feet symptoms and OCD .  Women with comorbid depression and anxiety may also benefit from handling with an anxiolytic medication, such as lorazepam (Ativan) or clonazepam (Klonopin), to assist manage feet symptoms and sleep disturbance while waiting for the antidepressant to have effect.

While this question has not been adequately studied, it appears clinically that women with comorbid low and anxiety may have more astringent illness and may be more hard to treat.  According to current guidelines, it is recommended that women with more severe postpartum illness exist treated with psychotherapy and medication.  This may exist particularly an issue with obsessional thoughts where symptoms are more refractive to treatment and CBT alone appears to be less constructive than CBT plus medication .

Ruta Nonacs, Md PhD

Miller ES, Hoxha D, Wisner KL, Gossett DR. The impact of perinatal depression on the development of anxiety and obsessive-compulsive symptoms. Arch Womens Ment Health. 2015 Jun;18(3):457-61.

Wisner KL, Peindl KS, et al. (1999). Obsessions and compulsions in women with postpartum depression. J Clin Psychiatry 60(3): 176-80.

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