Note: After Stephanie and I did our QA about her postpartum anxiety last week, I got a great followup text from a reader who said, "I still don't understand what postpartum anxiety is, exactly. I want to know how it's different from postpartum depression because it's a new term to people, I think. And maybe hard to distinguish." I was super thankful for this feedback and brought it to Stephanie, who generously agreed to dig back in to her experiences with both and try to outline how they differ from each other. She explains it here from 5 different angles. - Meredith
1. The Feeling of it : How Postpartum Anxiety Felt Different from Postpartum Depression
Postpartum Anxiety snuck up on me because I’ve always been anxious, always concerned about the things yet to be. As a kid, I worried about how I would protect my baby sister if bears blundered into my family’s cabin. Or how close my dad seemed to be driving to the edge of a Canadian mountain which seemed to have non-existent guardrails. Or how to save myself from a shark attack in a freshwater lake. In the middle of Michigan.
So when I started freaking out about child abductions, and cars jumping the curb to crash into me and the baby, or what would happen if I accidentally let go of the stroller and it rolled into the street, it all seemed perfectly normal to me. I mean, every parent worries about SIDS or their child dying in some horrible way or getting some extremely rare cancer at any age. But I worried about it ALL THE TIME.
That was the difference. I couldn’t turn it off.
I’d read one headline about a child abduction and my mind would leap and leap and leap: my child, abducted at this age, and raped, and murdered, and never found, and I’ll never get over it, and my marriage will fall apart, and I will die. Those were the racing thoughts that my therapist conditioned me to stop in their tracks so I didn’t spin out.
The Postpartum Depression just made me sad. It was a heavy, weighty, soul-crushing sadness. As it is with depression, no one thing made me sad as much as nothing made me feel happiness. I remember asking my husband, “Do you ever feel like you have nothing to look forward to for the rest of your life?” And his response was, “No, I look forward to this and you and us.” The “this” was our boys and their growing up. But I didn’t look forward to that because I just saw difficulty and torture and disappointment and tragedy.
I didn’t fully form suicidal thoughts along the lines of: “I want to kill myself by doing x, y, or z.” What I did feel was that I was such a misery of a mother that I was ruining my boys’ childhood and they would be so much better without me around.
2. Timeline: Postpartum Anxiety Hit at a Different Time Than Postpartum Depression
In both cases, the Postpartum Anxiety hit me at six months. The Postpartum Depression snuck in when I weaned my second son at nine months. I also weaned my first son at nine months but at the time I didn’t think I had Postpartum Depression. However, looking at how it manifested with my second son, I probably did have with my first son. I was simply able to deal with it without even knowing I was dealing with it.
In both cases, I lost my appetite when I weaned. When you’re nursing and losing vats of calories through breastmilk, you have the hugest, most awesome appetite. Everything tastes amazing and you want to eat it all. When I weaned, that all stopped: I wasn’t hungry and nothing tasted amazing or even just okay.
When I felt a sort of ennui or heaviness during this period with my first baby, I was able to do something to make myself feel better. I was able to go on regular walks — either alone, with the baby, or with the baby and another friend and her baby — and I was able to go to a regular postpartum baby and mommy yoga class. This constant stimulus of exercise or social contact helped keep off that vague heaviness I was starting to feel but never truly recognized.
However, with the second son, I had far less flexibility to just go on a walk or go to a yoga class or see another mother because I had my first son’s schedule or needs to consider along with everything else. The depression then cascaded over me, completely unchecked.
3. Treatment: How I Treated Postpartum Anxiety Differently Than Postpartum Depression
With the first occurrence of Postpartum Anxiety, I eventually saw a therapist. I wanted medication, but I was still breastfeeding so my therapist was hesitant to jump into that right off the bat. She wanted to try a cognitive approach and see if it would work. If it didn’t, we would find meds that were safe for nursing. Her cognitive approach came in the form of sessions with her combined with snapping a rubber band on my wrist to stop the racing thoughts from spinning me out of control. Also, keeping my walks long and regular and remembering to breathe deeply.
It worked. Within three months, I felt more in control of those horrible thoughts. They still lurked (as they do even today), but I could move on and just leave them where they were without it melting me down where I stood. As I mentioned above, I probably (and inadvertently) handled the burgeoning depression.
With the second occurrence of Postpartum Anxiety, I used the tools my therapist had given me the first time around. It was harder to deal with the second bout, though, because once again, I didn’t recognize it when it hit. It’s possible that because so much about the second birth seemed much easier than the first time (the hospital stay, the breastfeeding, those initial days, the first pediatrician visit, my own vaginal recovery), I thought the anxiety would be non-existent. That it was emotion amplified by being a first-time mother.
But I was wrong. Some things might have been easier the second time around, but the anxiety wasn’t. It was still there and it was still huge. Once my husband recognized what was happening, then I realized it as well and could start to deal with it. This time, it took more than the rubber band, though.
Because going to the postpartum yoga was impossible to schedule, I actively sought out meditation and started using Headspace. 10 minutes of meditation a day was about all I felt I had time for, but it made a huge difference to me and for my anxiety.
Treating the Postpartum Depression was harder. I had come to the realization that even one glass of wine intensified my anxiety the following day, so I cut out alcohol. Alcohol is an appetite stimulant so losing that along with losing my regular appetite (post-weaning) meant that I started losing lots of weight. Too much.
I lost my baby weight and then I kept going. At one really dark point, I weighed less than I did in high school, and it scared the crap out of me because I felt that I wasn’t able to do anything about it. My clothes bagged and hung on me, and my friends told me I looked gaunt. Not only did I look gaunt but I felt gaunt everywhere on the inside. Just hollowed out.
Some idiots will say, “Oh, I’d take that weight loss!” to which I will say, “Will you take the crushing, closely suicidal misery that came with it? Because you can’t have my weight loss without that.”
There was nothing good about my weight loss.
There was nothing healthy about my weight loss.
At no point did I feel inclined to dash off to Anthropologie and buy a bunch of their ridiculous outfits that only look good on the tiny and the wee because you can only feel inclined to do that if you feel happy. And I did not.
My exterior weight loss was a physical manifestation of my interior horror.
Part of my self-therapy was to go on runs instead of walks. My walks are usually long to be effective, so a 30-minute run was better for everyone’s schedule. However, they were also “better” for weight loss. I was burning calories at both ends and I knew it. But the runs — the despised, painful, can’t-think-of-anything-during-this-run-other-than-how-much-I-fucking-hate-runs — were my only true relief. I needed those endorphins so desperately. I also needed to think about nothing other than the act of running.
One talisman I had on these runs was a special red iPod touch given to me by a dear friend. She had it inscribed “See Stephanie run. Run, Stephanie, run.”
It kept me going. It still keeps me going.
I am happy to say that I gained all that weight back. I gained all my happiness back.
A major turning point was when my older son’s preschool teacher took me aside to tell me I looked really skinny. I sort of brushed her off by saying I was weaning and dealing with postpartum “issues.” She gave me my space. But on another day, she said to me, “Those boys do need you, Stephanie” and I broke down in tears. I cried in the car on the way home. I cry every time I tell that story. (I’m crying as I type this now.) Because it just hit me so hard right then. Not what was going on, because I KNEW by then what was going on, but what I needed to do to get myself better.
I needed to shower.
I needed to get dressed.
I needed to put on makeup.
I needed to run.
I needed to breathe.
I needed to breathe.
I needed to breathe.
It’s different for everyone, but every one of those tiny things was a huge success for me. Every single one of those things meant I was taking that time for myself. And that was incredibly important. NOT selfish. Important. Lifesaving.
It’s like that whole airplane thing where you put on your own oxygen mask before helping others: I had to take care of myself before I could take care of others.
But before I did anything else, I had to talk about it and talk about it and talk about it. Without talking, there was no acknowledgement and no help or treatment.
4. The Lifting: Postpartum Anxiety's Departure
For me, the Postpartum Anxiety seemed to dissipate around nine months when the Depression ate it up. I think I still had intense flashes of the anxiety while also dealing with the depression but the depression seemed to black hole everything else around it so it’s hard for me to know.
It’s much harder for me to pinpoint when the depression finally lifted. I know it was gone by the time my second son had his first birthday but it might have just vanished the month before. I think I got to the point when I finally could tell that every day was a little bit better than the last. One day I woke up and it was truly gone.
I was very close to going back to the therapist and getting medication when the relief started to peep in the cracks. I still have anxiety and I still deal with it, albeit as a now-larger presence in my life.
5. Awareness: Talking about Postpartum Anxiety versus Postpartum Depression
Mostly, I find that people know what Postpartum Depression is but they don’t know that Postpartum Anxiety exists until they go through it or know someone who goes through it.
I don’t have an explanation why this is other than people seem to accept that Postpartum Depression — cuted up with a verbal hair bow and fat cheeks as “Baby Blues” — is something that “sometimes” happens to “some” people. But it’s shunted away from polite society as something “we just don’t talk about because it’s rather unseemly.”
That kind of head-in-sand, bullshit attitude is out-of-touch, ignorant, and deadly. It’s also that attitude that is making damn sure we don’t know a whole lot about Postpartum Anxiety. And that we fail to recognize out-of-control anxious thoughts as something far more serious than just the stress of being a new parent. As something that needs to be acknowledged, investigated, called to carpet, and treated.
In some ways, Postpartum Anxiety is more insidious than Postpartum Depression because it looks like, walks like, and talks like regular anxiety amplified by a life-changing event.
But both need to be dragged into the light to stop the suffering.
Going through the Postpartum Anxiety and Depression helped me recognize my anxiety for what it is and probably for what it has always been.
I am not afraid of medication and I do take Ativan when I need it.
I also run, do yoga, and am taking a Mindfulness Based Stress Reduction class at Stanford, which has been another game-changer for my life.
However, I will not be afraid or ashamed about going back to therapy or taking a daily medication if the need arises.
My family and I deserve my best self and if my best self needs more help: Bring. It. On.
Stephanie has been a writer and editor for fifteen years, during which time she wrote a non-fiction narrative on the secret lives of picky eaters (Perigee 2012) and been a contributor to The New York Times, Motherlode, The Washington Post, Entertainment Weekly, CNN's Eatocracy, Previously.TV, The Hairpin, The Atlantic Wire, and Avidly/LA Review of Books. Stephanie has also developed cookbooks for William-Sonoma, worked on a TV show with Jacques Pepin, and been known to compose cheese-based Christmas carols on the fly while mongering in one of San Francisco's stinkiest cheese shops.
She lives in Menlo Park with her two cats, two boys, and her math professor husband.