Mom-to-be with social anxiety disorder — Risk of postpartum depression?

Dear Alice,

I'm an anxious person. My clinical diagnosis is social anxiety disorder, but I have anxiety in many other situations and a couple of phobias to boot. I've seen therapists on and off for the past 20 years and have been on multiple SSRIs (I am off of anti-anxiety medications currently). I manage my anxiety with plenty of exercise, sleep, and relaxation exercises, but mostly I just accept that this is the way I am. My husband and I are starting a family soon, and my new worry is post-partum depression or anxiety. If I'm already moody, will the hormones and stresses of pregnancy drive me completely crazy? Does having a history of mental illness put me at a greater risk for developing a disorder like post-partum depression? Thanks for your help!


A Worrywart

Dear A Worrywart,

For as long as there’ve been moms and babies, there’ve been the “baby blues.” While there’s a lot of excitement around the arrival of a little peanut, a rush of emotions — including sadness, irritability, and anxiety — is common among new mothers, regardless of mental health history. In fact, to some degree, it’s expected: you would’ve just spent nine months as a five-star hotel for this tiny being, and these little humans can shake up their moms’ worlds in big ways. Typically, these emotions subside in a few days. However, when severe baby blues drag on for weeks, it may actually be something called postpartum depression — a more serious condition that, if left untreated, may ultimately interfere with the mother’s ability to care for her baby. While women with a history of anxiety or depression do seem to have more mental health symptoms during pregnancy and after birth than those without, being proactive about your mental and physical health throughout this time can reduce the chance of post-partum depression.

Since you’re already thinking ahead, it could be good to know what to look out for when it comes to postpartum depression. The most common symptoms include intense irritability, loss of interest in sex or other formerly enjoyable activities, withdrawal from loved ones, and difficulty bonding with the baby, all of which can typically drag on for months. The intense combo of lack of sleep; physical changes (i.e. appearance), blood pressure, and immune function; and the sudden drop off of pregnancy hormones can all contribute to this condition.

A history of depression or anxiety can also be a risk factor for other mental health conditions during the course of the pregnancy — not just after the baby’s born. Those nine months of cookin’ your bun-in-the-oven can be exciting, but also stressful; you may find that an anxiety disorder that’s usually under control becomes exacerbated during this time. And, babies in utero don’t do so well when mama-to-be is experiencing stress or anxiety — they may get poor nutrition if the mom loses interest in eating, or they may be born preterm or with low birth weight due to the stress or depression, among other factors. There’s also research that suggests that babies whose moms had anxiety during pregnancy may exhibit more emotionality, sleep disturbance, or other signs of anxiety themselves.

Now, here’s some good news: if you work with your health care provider(s) to stay on top of your mental and physical health, you will likely have a good chance at a happy, healthy pregnancy. Because emotionality during pregnancy is often passed off as the regular effects of hormones, it’s advised that you keep your providers in the loop about your history with social anxiety disorder. Beyond this, there are many other ways you can maximize your mental health during and after pregnancy:

  • Planning ahead: Research shows that planning ahead for a baby can help to set you up for the smoothest pregnancy possible. This way, you’re able to minimize the chance of any surprises or hiccups along the way that could affect your anxiety levels.
  • Diet and nutrition: Consuming lots of sugar or caffeine might give you a quick energy fix, but when you’re pregnant, these items can actually lead to more extreme mood fluctuations. A well-balanced diet — full of protein, folic acid, omega-3s, and iron — can help you feel more emotionally stable (there’ll be fewer peaks and valleys than a high-sugar diet!) and get you and your baby all the good stuff you need.
  • Sleep: While this may be obvious, getting sufficient rest can greatly improve your mood and stave off symptoms of anxiety or depression. The hormonal ups and downs of pregnancy can mess with your sleep cycle, so investigating ways to improve sleep — such as bright light therapy or establishing and sticking to a bedtime routine once the baby is born — can be a good idea.
  • Coping strategies: It sounds like you’ve already got some anxiety management tricks up your sleeve, but developing plenty of coping strategies can be invaluable when you start to feel distressed, anxious, or depressed. Cognitive behavioral therapy, couple’s therapy, building up you social network, meditation, and exercise are a few ideas to explore.

You also mentioned that you were on a selective serotonin reuptake inhibitor (SSRI) previously, but aren’t anymore. If your anxiety disorder is under control without medication, health care providers usually do not recommend beginning or re-starting SSRIs during pregnancy. Some anxiety medications may not be safe for the baby, so it’s recommended that you tell your health care provider that you’re pregnant, and continue to talk to them throughout your pregnancy if you’re thinking about starting any anxiety medication.

Pregnancy is notorious for throwing curveballs and doing wacky things to some women’s health, so you’re on the right track by looking into ways to protect the health of both you and your future baby. Best of luck to you and your partner as you plan for that little twinkle in your eyes to become a little baby in your arms!

Originally published Aug 14, 2015