If you've realized you have postpartum anxiety, the next question is what actually helps. The good news is that postpartum anxiety responds well to treatment, and you have real options. Here is what treatment looks like: therapy, medication, what to do about panic attacks, and the everyday things that make a difference.
Therapy for postpartum anxiety
For most moms, therapy is where treatment starts, and for mild to moderate anxiety it's often enough on its own. It also leaves you with skills you keep after you feel better.
In my practice, therapy for postpartum anxiety usually draws on a few approaches together:
- Cognitive behavioral therapy (CBT) works on the loop between anxious thoughts, your body, and what you do. You learn to catch the "what if" thoughts and check them against what is actually happening. Just as important, you slowly start doing the things anxiety has told you to avoid: letting someone else hold the baby, leaving the house, sleeping while your partner is on duty. Avoiding brings relief in the moment and makes anxiety stronger over time. Facing things in small steps does the opposite.
- Interpersonal therapy (IPT) focuses on the huge role change you just went through and the relationships under strain because of it. A lot of postpartum anxiety is tied up with feeling alone, unsupported, or unsure who you are now, and IPT works on exactly that.
- Psychodynamic work helps when becoming a mom has stirred up older things: how you were mothered, past losses, or patterns you don't want to repeat. Understanding where a pattern comes from is often how you get to choose a new one.
- For intrusive thoughts and checking, standard CBT isn't enough on its own. Exposure and response prevention and inference-based CBT are made for that, and I use both. Here is more on postpartum OCD and how it's treated.
We usually meet weekly for the first eight to twelve weeks, then every other week or monthly as you feel better. Most moms notice real change within the first several weeks and feel substantially like themselves within a few months. Video sessions work well for this and mean the baby can come too. Here is what a first session is like.
Medication for postpartum anxiety
Medication can help a lot, especially when anxiety is severe, panic attacks are frequent, sleep and appetite are wrecked, or depression is part of the picture too. For moderate to severe anxiety, therapy and medication together tend to work best.
The medications most often used for postpartum anxiety are antidepressants called SSRIs. Sertraline (Zoloft) is the one prescribed most often after birth, partly because it has the most research in breastfeeding moms. They usually take a few weeks to start working. Sometimes a prescriber adds something short-term for severe anxiety or panic while an SSRI starts to work.
I don't prescribe, so the decision about which medication, if any, belongs with your OB, your primary care doctor, or a psychiatrist who knows perinatal care. I work alongside them, and you can start with therapy, start with medication, or do both. I wrote about the medication questions moms ask most, including what the research says about breastfeeding.
Managing panic attacks
A panic attack is a sudden rush of fear with a pounding heart, short breath, shaking, dizziness, or a feeling that something terrible is happening. They are frightening, but a panic attack itself isn't dangerous, and it usually peaks within about ten minutes and then passes.
One important note first: if you have chest pain, trouble breathing, or a racing heart for the first time, especially in the weeks after birth, get checked by a doctor before assuming it's anxiety. Heart and lung problems after birth are rare, but they're real, and ruling them out is part of good care.
When you know it's panic:
- Exhale for longer than you inhale. Breathe in for four, out for six or eight. A long exhale slows your heart down.
- Name it. "This is a panic attack. It feels awful, and it will pass." Fighting it tends to make it bigger.
- Ground yourself. Five things you can see, four you can hear, three you can touch.
- Let it crest. Stay where you are if you can, and let the wave peak and fall without running from it.
Over time, therapy helps with the fear of the next attack, which is often what keeps panic going. Medication can lower how often attacks happen.
What helps every day
None of these replace treatment, but they all make it work better:
- Protect one block of sleep. Trade nights with your partner so each of you gets one real stretch. Sleep loss makes anxiety louder.
- One hour a day that is yours. Time to recharge with nobody needing anything from you. A nap, a walk, a shower, a book.
- Eat regularly. Running on empty can feel a lot like anxiety in your body.
- Go easy on caffeine. It's tempting when you're exhausted, but it can make a racing heart and racing thoughts worse.
- Move a little. A walk outside with the stroller counts.
- Tell someone. A partner, a friend, or other moms going through it. Here are support groups in Austin, and Postpartum Support International runs free online groups.
Does postpartum anxiety go away on its own?
Sometimes mild anxiety eases as sleep improves and the early weeks pass. But anxiety that has lasted more than two weeks, is getting worse, or is running your days usually doesn't go away by waiting, and it can turn into longer-term anxiety if it's left alone. Treatment works faster than waiting, and you don't have to be at a breaking point to start. Here are the signs that it's time to talk to someone.
If you want to work on this on your own
I made a self-paced course, Anxiety Management for New Moms, for moms who want real tools they can use in the middle of the day. It teaches calming techniques that work even during a feed or a 3 a.m. wake-up, how to catch the anxious thoughts that fuel the spiral and check them against the facts, and how to keep worry from taking over your whole day. Each module comes with a printable workbook, and you can go at your own pace and come back whenever you need it.
Working with me
I'm a licensed clinical psychologist, a certified perinatal mental health specialist, and postpartum anxiety is a big part of my work. I use CBT, interpersonal therapy, and psychodynamic work, plus ERP and I-CBT when intrusive thoughts are part of it, and I'm happy to coordinate with your OB or prescriber. I see moms in Austin or on video, and babies are always welcome in my office.
You don't have to be "bad enough" to benefit from support. Many of the moms I work with aren't clinically depressed at all. They're dealing with the everyday stress of becoming a mom, and therapy helps with that just as much as it helps with depression or anxiety.
The first step is a free 15-minute call. Tell me what has been going on, and I will tell you honestly what I think would help.
Frequently asked questions
- What is the best treatment for postpartum anxiety?
- For mild to moderate anxiety, therapy is often enough on its own and leaves you with skills you keep. For moderate to severe anxiety, therapy and medication together tend to work best. When intrusive thoughts and checking are part of it, exposure and response prevention and inference-based CBT are the specific treatments.
- Should I try therapy or medication first?
- Either is a reasonable start, and you can add the other later. Therapy is a good first step for mild to moderate anxiety. If anxiety is severe, panic attacks are frequent, or sleep and appetite are wrecked, talk with your OB or a prescriber about medication too.
- Can I take anxiety medication while breastfeeding?
- Often, yes. The medications most often used, SSRIs, are generally considered compatible with breastfeeding, and sertraline has the most research in breastfeeding moms. The choice belongs with your prescriber, who can weigh your history and your baby's needs.
- How do I stop a postpartum panic attack?
- Breathe out longer than you breathe in, name it as panic, ground yourself in what you can see and hear, and let it peak and pass, usually within about ten minutes. If you have chest pain, trouble breathing, or a racing heart for the first time after birth, get checked by a doctor first.
- Can postpartum anxiety go away on its own?
- Mild anxiety sometimes eases as sleep improves. But anxiety that lasts more than two weeks, gets worse, or runs your days usually doesn't go away by waiting, and treatment works faster. You don't have to be at a breaking point to start.
Dr. Jana Rundle
Licensed Clinical Psychologist
