Postpartum Depression and Anxiety Prevention

Postpartum mood and anxiety disorders are getting a lot more attention these days, and it is great that people are aware of them, but the fear of developing symptoms can bring about anxiety of its own.

In light of this, it's important to empower birthing people to understand how to mitigate the risks and to do everything they can to keep themselves healthy. There are many evidence-based strategies we can recommend to help people to lower their risks.

Major risk factors include: Major risk factors for perinatal mood and anxiety disorders (PMADs) include a history of depression or anxiety, trauma, socioeconomic stress, relationship stress, and limited social support. It is also important to recognize that Black, Indigenous, and People of Color (BIPOC) individuals experience higher rates of PMADs and often face additional barriers to accessing timely, culturally responsive care. To learn more, read our recent blog post.

Prevention strategies:

Therapy: There have been many studies suggesting that proactive therapy can be helpful for postpartum outcomes. If your patient has risk factors for developing postpartum symptoms, it is a great investment to establish a therapist ahead of time. The therapist can support coping with symptoms, but also to help monitor for symptoms that require a higher level of support.  Medical, mental health, and community providers including, but not limited to, home visitors and doulas can call VTCPAP to assist with finding therapists who take your patient's insurance and have openings.

Sleep: There are many studies that link mental health outcomes to sleep. Poor sleep is associated with increased anxiety, depression, ADHD symptoms, panic attacks, as well as, in rare cases, postpartum psychosis. Sleep is the most important modifiable variable, but it can take extensive problem-solving to preserve it. Some patients have no support, and some struggle to ask for support.

Tips include:

• If there is a partner involved, plan ahead to split the night into two shifts. The birthing person may have to breastfeed through the night, but at least for half the night, the diaper changing and soothing is not their responsibility. It is more successful to plan division of labor ahead, than to wait to get too tired to ask for help. 

• If there are people involved in helping- line up times for naps. If they feel unnecessary in the moment, they can be used for other preventative strategies.

• Sleep hygiene- avoid using screens at night if there is any difficulty falling asleep. This can be the source of stimulation. Invest in some good magazines, novels, or listen to podcasts/audio books.

• Don't overschedule the early days- it's great to get out or have company, but sleep may need to happen around the clock.

Community: There are clearly established connections between social support and lowered risk of postpartum depression and anxiety. It can be beneficial to schedule time with friends/family in advance, so there are points of connection to combat potential isolation in the postpartum period. Other options include Parent-Child Community Centers or playgroups, as well as online resources, such as Postpartum Support International support groups and peer mentors. Yoga has a growing evidence base for decreasing postpartum depression, and some centers offer classes where people can bring their baby.

Medication: There is not sufficient data to recommend starting a medication prophylactically based on risk factors alone. However, if there has been a medication that has been beneficial in the past, it could help to have a low threshold for restarting it postpartum. Very few psychiatric medications are contraindicated in breastfeeding. Most of the common medications we use have a relative infant dose under 10 (see Lactmed or call VTCPAP as a resource). We mostly only avoid medications that cause enough drowsiness to interfere with waking at night to feed, if that is the birthing person's responsibility. 

Individual time: Self care is an overused, confusing term. It suggests spa days and manicures, but "self care" is very individualized and can require thought. For some people it is playing video games and eating ice cream. For others it is simply eating breakfast. I like to ask people to think about moments they enjoyed most before having kids. What were you doing? Connecting with friends? Hiking? Shopping? Whatever it is- that's probably not happening much after a first or subsequent baby arrives. Often, self-care becomes a moment to scroll or put laundry away. Social media is a natural way to connect to the outside world, but it isn't typically associated with increased mental health or a sense of contentment. 

Acceptance: Finally, it's helpful if people can avoid judging their own experience. Social media can cast an idealized version of what postpartum looks like: clean, calm and in love. For most of us who have had babies, there are few moments that encapsulate these qualities, and many more moments of overwhelm, sour milk smells, and questioning if we are cut out for the tasks at hand.  Mindfulness practices locally (call VTCPAP), and online can all support self-compassion and acceptance, as can social support and therapy.

Refrences

1. US Preventive Services Task Force. Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;321(6):580–587. [DOI] [PubMed] [Google Scholar][Ref list]
2. Leistikow N, Smith MH. The role of sleep protection in preventing and treating postpartum depression. Semin Perinatol. 2024 Oct;48(6):151947. doi: 10.1016/j.semperi.2024.151947. Epub 2024 Jul 14. PMID: 39048415.
3. Cho H, Lee K, Choi E, Cho HN, Park B, Suh M, Rhee Y, Choi KS. Association between social support and postpartum depression. Sci Rep. 2022 Feb 24;12(1):3128. doi: 10.1038/s41598-022-07248-7. Erratum in: Sci Rep. 2022 Mar 4;12(1):3899. doi: 10.1038/s41598-022-08119-x. PMID: 35210553; PMCID: PMC8873474.
4. Pan WL, Lin LC, Kuo LY, Chiu MJ, Ling PY. Effects of a prenatal mindfulness program on longitudinal changes in stress, anxiety, depression, and mother-infant bonding of women with a tendency to perinatal mood and anxiety disorder: a randomized controlled trial. BMC Pregnancy Childbirth. 2023 Jul 31;23(1):547. doi: 10.1186/s12884-023-05873-2. PMID: 37525110; PMCID: PMC10388457.