Not just the baby blues. Swedish experts on postpartum anxiety and depression

May 19, 2023

Swedish Pregnancy & Childbirth Team

[6 min read]

In this article:

Pregnancy, childbirth and the postpartum period often affect mental health, but many birthing parents are still hesitant to get help.
Ups and downs are normal. If they don’t go away with rest and support, you may be experiencing a more serious mood disorder, like postpartum depression.
You are not alone. Help is available. Depression before and after birth can be treated with counseling, medication and other therapies.

There’s so much to look forward to when a new baby is on the way. Picking names. Feeling little kicks. Dreaming about the future. With those little bundles of joy come an emotional time for the whole family. But for many new parents, the time after delivery can be challenging, difficult and sometimes frightening. In fact, 1 in 10 women will experience mental health issues during their pregnancy and 1 in 7 will experience some type of postpartum depression. One in 5 will experience depression, anxiety or both. In fact, the postpartum period is a time when mental health issues can be amplified, even including Obsessive Compulsive Disorder (OCD) or mania.

But there is help available and new parents don’t have to struggle alone. May is Maternal Mental Health Month. To learn more about the mental health challenges that often come with being a new parent, we spoke with 2 reproductive mental health experts at Swedish: Veronica Zantop, M.D., medical director of the Swedish Center for Perinatal Bonding and Support, and Alexandra Fleming, LICSW, a psychotherapist specializing in perinatal and postpartum care.

Giving birth and becoming a mother is a wonderful and transformative experience. It’s also a time of tremendous adjustment.

“Giving birth and becoming a parent is a wonderful and transformative experience. It’s also a time of tremendous adjustment, including changes in sleep, responsibilities, relationships, identity and self-image,” says Dr. Zantop.

“Anxiety and mood disorders are common before, during, and after pregnancy. Women may struggle with uncontrollable feelings of anxiety, nervousness, fear, worry, and/or panic. Women may also suffer from symptoms of depression, including lasting sadness or feeling of emptiness, loss of energy, difficulty sleeping or sleeping too much, eating too much or too little, irritability, decision fatigue, and feelings of hopelessness or pessimism. Women can also experience feelings of grief, guilt, and worthlessness, especially around mothering,” says Dr. Zantop. “These feelings are absolutely nothing to feel ashamed about.”

There can be a stigma associated with postpartum depression and emotional distress during and after pregnancy because of societal pressure to have a perfect and blissful pregnancy and birth.

However, many women are nervous to reach out because they don’t know what treatment will look like or they may be worried that they will be seen as incompetent and someone will take their baby away. In the depths of postpartum depression, feelings and emotions are heightened and linear thinking isn’t always present. A woman may feel paranoid or even too paralyzed with shame to think about getting help. There can also be a stigma associated with postpartum depression and emotional distress during and after pregnancy because of societal pressure to have a perfect and blissful pregnancy and birth.

Fortunately, there is help available. Dr. Zantop shares her insight and advice on how you can improve your mental health, watch for warning signs and get support when you need it.

“It's important to talk to your health care provider and seek treatment as soon as possible if you think you have depression,” Dr. Zantop stresses. “If you have thoughts of harming yourself or your baby, you must seek medical care immediately.”

Understanding perinatal and postpartum depression

“Postpartum depression is an umbrella term for a range of mood and anxiety symptoms that start during your pregnancy and last for up to one year postpartum,” explains Dr. Zantop.

Emotions can ride high (or low) during pregnancy and after giving birth, but the key difference with perinatal or postpartum depression is that those anxious, depressed or unwanted feelings don’t go away on their own.

Dr. Zantop puts it into perspective:

“Pregnancy, childbirth and around-the-clock demands of caring for a newborn put a huge strain on a woman’s nervous and hormonal system. Most – if not nearly all – women experience some range of mood or anxiety symptoms. Some women need more than sleep and general support to help ease fears and feel in control again.”

The first two weeks postpartum are frequently characterized by “the baby blues,” which can include mood swings, exhaustion, more frequent crying, irritability and feeling overwhelmed. These emotions can be caused by sudden changes in hormones and decreased sleep.

“It’s completely normal to feel tired, of course, and to experience doubts about yourself as a new mom,” says Alexandra Fleming. “Most people experience some adjustment period. What concerns us are persistent symptoms of depression, obsessive compulsive disorder or intrusive, distressing thoughts. These are actually fairly common in the postpartum and respond well to therapy and medications. Any thoughts of self-harm, suicide or homicide, or hallucinations are very serious and need to be addressed immediately by a health care provider. Parents also should note if they are not sleeping and go for longer than 24 hours without sleep.”

Emotions can ride high (or low) during pregnancy and after giving birth, but the key difference with perinatal or postpartum depression is that those unwanted feelings don’t go away on their own.

If your symptoms become more severe or don’t improve after a few weeks or with rest, seek care immediately.

You should also be on the lookout for these signs and symptoms of a perinatal mental health issue or postpartum depression, especially if they continue past the initial “baby blues” time frame of two weeks after birth:

Loss of interest in favorite activities
Changes in appetite (including eating much more or less than normal)
Feeling anxious all or most of the time
Panic attacks
Racing or scary thoughts
Feelings of worthlessness
Irritability or rage
Mood swings
Uncontrollable sadness or crying
Fear of not being a good mother
Fear of being left alone with the baby
Changes in sleeping patterns
Difficulty concentrating
Thoughts of hurting yourself or the baby

You are not alone. Help is available.

“Perinatal mood and anxiety disorders (PMADs) can occur at any time in the pregnancy or postpartum. The time right after the baby is born is sometimes referred to as “the baby blues”. This corresponds with a big hormone shift and approximately 80% of birthing people experience tearfulness, mood swings, and emotional ups and downs during those first few days following delivery. We get concerned when the mood changes persist and make it difficult for the person to feel like themselves, function as a parent, and experience joy. Some struggle to sleep and feel either over or under attached to their baby. We believe about 1 in 5 birthing people experience a PMAD,” says Alexandra.

Racing thoughts. Unwanted feelings. Feeling like you’re just not yourself. These are unpleasant experiences – ones that no one should have to go through alone. Dr. Zantop encourages women to reach out for help if they are struggling with their mental health at any time during pregnancy or after giving birth. Many women are surprised to find that their women’s health provider can be extremely helpful in getting them the resources they need to deal with symptoms.

“Depression and anxiety are treatable conditions. We can help you find the tools and strategies you need to feel confident in yourself and your ability to take care of your child,” she reassures.

“Getting help isn’t just for you. It helps benefit your entire family by encouraging bonding, building support and nurturing yourself and your baby,” Dr. Zantop finishes.

The most effective treatments for postpartum mood and anxiety symptoms use an integrated approach. That may include medicine or non-medical interventions, like support groups and individual or group talk therapy.

“Counseling can teach you how to recognize and change disturbing thoughts, manage your feelings and develop positive coping skills that will build your self-esteem,” says Dr. Zantop.

Dr. Zantop also encourages women to seek treatments that lay outside a psychiatrist’s office.

“Massage, yoga, meditation and acupuncture can also be very effective in helping manage your symptoms. Be sure to talk to your therapist or provider about what might be a good approach for you,” she says.

Make your mental health a priority

“Women are not only more vulnerable to mood and anxiety symptoms postpartum, but they also have to deal with much higher expectations and demands during this time. Taking care of a newborn is hard – and even harder when you are feeling sad or down, not able to enjoy your time with baby, are not sleeping, and are having high anxiety frequently centered around the baby’s well-being,” says Dr. Zantop. “Women are more likely to have intrusive thoughts – thoughts or images of something terrible happening to the baby – around this time as well. It’s important to know that having these types of thoughts do NOT mean that women are ”losing their minds” or will act on these thoughts. Having these and other symptoms leads to a lot of shame, isolation, and feelings of guilt.”

Even if you don’t have a history of mental health issues and are enjoying a comfortable, glowing pregnancy, it’s still good to take care of your mental health and prepare for your little one’s arrival.

“Get your support system in place – even before you need it. Knowing that you can pick up the phone and call a friend, family member or neighbor to watch the baby while you take a shower or just walk around the block for fresh air can go a long way in helping you feel less overwhelmed,” explains Dr. Zantop.

She also encourages pregnant women (and women who are trying to become pregnant) to prepare for the stress pregnancy and a newborn can bring:

Find go-to-stress relievers. Maybe it’s reading a book, doing a quick guided meditation or making daily yoga a priority (after healing, of course).
Develop coping skills. Late night feeding sessions or calming a colicky baby are not times to try out new skills. Instead, figure out what helps you calm down – whether that’s a breathing technique, a quick body scan or just counting backwards from 10.
Talk to someone. Sometimes, you just need a shoulder to cry on. Know who you can reach out to for a judgment-free crying or vent session. And don’t hesitate to get professional help if you need it.
Stay connected. Pregnancy and parenting a newborn can be isolating. Find ways to stay in touch with the important people in your life. FaceTime friends. Go on walks with a neighbor.
Set boundaries. It’s also important to let people know what you need – and don’t need. Let them know how to best support you by providing clear boundaries on when you’re up for visitors and any rules you have for visiting baby – like no sick visitors and proper hand hygiene. Your focus is good health (mental, physical and emotional) for you and your baby.

Support is available

At Swedish, we believe that pregnancy and parenting aren’t meant to be solo journeys. We’ve developed resources and support for you to lean on when you need us most. The Swedish Center for Perinatal Bonding and Support was created to help women be comfortable and confident in their roles as a mother – and to help manage anxiety, depression and mood disorders during pregnancy and in postpartum.

Our services include our day program where we help new moms bond with their babies and connect them with women experiencing similar emotions. We also offer counseling to help treat perinatal and postpartum mood and anxiety disorders and strengthen attachment.

Find a doctor

Perinatal mood and anxiety disorders, like postpartum depression, are a common complication of pregnancy. Contact the Swedish Center for Perinatal Bonding and Support if you are pregnant or postpartum and struggling with your mental health.

For more information about comprehensive behavioral healthcare at Swedish, contact Swedish Behavioral Health and Wellbeing.

Whether you require an in-person visit or want to consult with a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow-up as needed. Use our provider directory if you need to find a doctor.

Join our Patient and Family Advisory Council.