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Postpartum Depression

Anxiety Attacks or PPD
By Karen Kleiman, MSW
Karen KleimanQ. My son is nearly six months old, and since the time that he was about six weeks old, I've been having frequent anxiety attacks. I usually get them at night, and even on nights that I don't have a full blown panic attack, I end up having a hard time sleeping.

I'm breastfeeding my son, so I really don't want to take any medication until he weans. Do you have any thoughts/ideas? I've cut out coffee, and am trying to get some exercise every day (although some days I'm more successful than others).

A. I'm sorry you continue to feel this way. First of all, let me tell you and others that I feel VERY strongly about this particular issue. I worry about women who continue to function fairly well, but feel less than their "normal" and continue this way, with symptoms, for a very long time. Sometimes, it's because they're ashamed or embarrassed. Sometimes, it's because they hope it will get better or go away on its own. Sometimes, it's because they aren't certain what the next step should be. So I'm glad you asked this question. Women shouldn't "settle" for feeling this way. It's not okay to continue to live with anxiety attacks for an extended period of time.

THEREFORE... yes, medication is an option, but not for everyone, particularly if you're breastfeeding (antidepressants are compatible with breastfeeding, but that's another long story). Cutting out caffeine is excellent. This means, NO caffeine. Even small amounts can interfere and exacerbate anxiety. No chocolate (what?!) too.

Exercise helps a great deal. The only caution is that sometimes, very aerobic exercise can agitate things and make you feel more anxious, so be careful about pushing it.

Are you in therapy? That can be extremely helpful. The support is beneficial and there are tools you can learn, some cognitive-behavioral tools, that are particularly useful when coping with anxiety. I would also recommend a very sweet, old book called Hope and Help for your Nerves by Claire Weeks (awful title, isn't it?) If you can get past the constant reference to "nervous suffering" and replace it with our more contemporary label of anxiety attack or panic, it is a wonderfully soothing and important book. I think you'll find it helpful; she can walk you through the rough spots.

Journaling also helps. And if you're in therapy, it's a great way to keep a record of your thoughts and feelings and perhaps make connections regarding why you are feeling this way so you can break patterns.

And a final note. Remember that anxiety is a nasty beast. We don't always understand why it's here at some points and not at others. It can come out of nowhere, as you know, and not make "sense." Try your best not to "make sense" out of it. Accepting that it's there is a huge step. Try not to be afraid of it. Nothing bad will happen, it just *feels* awful. Understand that it will get better and it will get worse. (rating it 1-10 can help, how bad is it today? Oh, it's only a 4, that's much better than last night when it felt like a 7!!) Know what I mean?

Keep these cognitive-behavioral points in mind: (don't remember the reference for this, but its a very familiar CB intervention)

1. Expect, allow, and accept that fear will arise.
2. When fear comes, stop, wait, and let it be.
3. Focus on and do manageable things in the present.
4. Label your level of fear from 0 to 10. Watch it go up and down.
5. Function with fear. Appreciate your achievement.
6. Expect, allow, and accept that fear will reappear.

I hope this helps.

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