Jill Krause called her doctor, certain that she had cancer. It was about five months after she gave birth to her second baby five years ago, and Krause, a well-known blogger, noticed "a weird ridge" on her thigh she convinced herself was a tumor, rubbing it over and over until she bruised. A few days later -- before her doctor could get her in for an appointment -- she had what she believed was a stroke. Her body went numb, she felt dizzy and her heart raced. Perhaps the cancer had spread, she worried, and her body was shutting down.
Her doctor had a different diagnosis. The "tumor" on her leg was a bit of cellulite, and the "stroke" was a panic attack. Krause, 35, had developed a postpartum anxiety disorder, and it was pulling her under.
"I had these obsessive thoughts that centered around death," Krause said. "Me dying, my kids dying. My thoughts were always racing ... and I had so much anger. I was mad all the time."
As alarming as Krause's symptoms might sound, a new study out of Canada suggests they are not at all uncommon among pregnant and postpartum women. Perinatal anxiety -- a condition that can cause women to feel a constant, paralyzing sense of worry and make them unable to eat or sleep -- could, in fact, be even more prevalent than postpartum depression (PPD), the researchers believe, and yet public awareness about the mood disorder remains relatively scarce.
The study, published in the Journal of Affective Disorders, included a group of 310 pregnant Canadian women whom researchers screened for anxiety. They also conducted in-depth follow-up interviews with any women who met the diagnostic criteria for the disorder around three months after they gave birth.
Nearly 16 percent of the mothers in the study had anxiety and anxiety-related disorders during pregnancy, while 17 percent experienced significant anxiety in the early postpartum period.
Rates of depression, on the other hand, were lower: 4 percent of pregnant women and nearly 5 percent of postpartum mothers were found to be depressed. Nichole Fairbrother, an assistant professor of psychiatry with the University of British Columbia and an author on the study, told The Huffington Post she believes those numbers are likely low and limited by the study's small sample size. (Other estimates put the rates of PPD among women in the United States at closer to 15 percent of postpartum women.)
Fairbrother also clarified that the purpose of her study is not to take away from how common or debilitating depression is. Rather, it is to help spread the message that anxiety -- which affects more than 40 million adults and children in the U.S., making it the most common mental disorder -- may also be affecting new mothers in far greater numbers than women or their healthcare providers realize.
"We're doing a better job with postpartum depression in terms of public campaigns. Women are more comfortable talking about it now, and there's more discourse around it," Fairbrother said. "We screen for it. We ask about it. But unless a woman volunteers that she's also experiencing anxiety -- and she might not even be aware that she is -- [care providers] may not ask."
“"It never occurred to me that what I’m experiencing was anything other than me really sucking at motherhood."”
- Jill Krause
No one asked Krause, who realized only in hindsight that she'd grappled with a more mild bout of anxiety after the birth of her first child that went undiagnosed.
"When I left the hospital after both of my kids were born with those pamphlets on postpartum depression, I don’t remember seeing anything about anxiety," she writes. "At my six-week appointment, my midwife asked if I was suicidal, if I cried a lot, if I felt depressed. I didn’t. I still don’t. It never occurred to me that what I’m experiencing was anything other than me really sucking at motherhood." Even Katherine Stone, founder of the blog and non-profit Postpartum Progress, which has done an enormous amount of outreach to spread awareness about perinatal mood disorders, has argued that the term postpartum depression can sometimes do "a disservice" to those women who struggle after having a baby, but don't reach out for help because they think sadness is the only hallmark of a mental health problem.
Even mothers who don't fall entirely through the cracks, treatment-wise, can have their anxiety mis-diagnosed as depression. Certainly, some mothers experience both (a little over 4 percent of the women in the Canadian study had both anxiety and depression.) And many of the medications used to help manage anxiety and depression are the same. But the conditions are distinct and the types of therapy used to help treat them are different.
Ultimately, as researchers work to do a better job capturing the true rates of postpartum depression and anxiety disorders, the key to getting mothers the help they need is to educate them about the simple fact that postpartum anxiety exists. And to do a better job of screening and treating them.
After seeing her doctor, Krause went on an antidepressant, which quickly helped even her out, then went off it before she got pregnant with her third child. She felt good, but knew to be watchful for symptoms of anxiety. Sure enough, five or six months after her third child was born, Krause recognized the same crippling worry beginning to creep back in and immediately went back on her medication.
Krause is now pregnant with her fourth and is not currently being treated for anxiety, but she is fully prepared with a prescription and a game-plan should it recur. In a way, she is lucky, she says. At least she won't be caught off guard by anxiety again.
"Since I first wrote about anxiety [in 2011], I'd say I've heard from at least one woman a week on average saying, 'Thank you for writing about this. I had no idea,'" Krause said. "I 100-percent think there is a huge, gaping lack of information and knowledge about postpartum anxiety."
"If you don't know to look for help," she continued, "if it doesn't come across your newsfeed, you have no idea."