I am now over a year postpartum, which is crazy to me. It still feels like I gave birth a few weeks ago! Thankfully not in a physical or emotional sense, just in a nostalgic way.

I am going to do a full update on being one year postpartum and my fitness journey like I did last time (full warning: it has been much harder this second time around to balance my time!) but I wanted to do a separate post on my mental health journey – specifically talking about my recent experience with postpartum anxiety, because I know it’s incredibly common but still remains somewhat taboo despite our best efforts to make it a more discussed topic.

Disclaimer: this is not medical advice nor should it be interpreted as such. This blog is for informational purposes only. Please seek medical advice from your healthcare provider.

My Anxiety History

I’ll start off by saying that I do normally have anxiety to some degree, even before I had babies. However, I was usually able to manage it with CBT (Cognitive Behavioral Therapy) taught coping techniques – it wasn’t perfect, but it seemed to be ok for me. I didn’t really think anything could be much different.

I did have a time where I went through more severe anxiety. It was mostly situational – what is called performance anxiety. I would have “episodes” during exams in nursing school – extreme dry mouth, thirst, a feeling of panic, upset stomach, nausea, racing heart… this only started happening during my second undergraduate degree during exams.

I was somehow able to complete my exams but I’d have to bring water and gum to try and distract myself throughout. I’d often finish my exams first simply because I had to think that fast to get out of there as soon as possible. It was not an enjoyable experience. A few exams in I realized I couldn’t keep it up. I sought help from my primary care provider.

We decided given the nature of this particular type of anxiety I was having, that a medication was the best option. I really only needed it for exams and dealing with those hour to two hour time spans. I didn’t want to feel like I had to escape the whole time – even though it didn’t impact my grades, I was worried it might start to. I was prescribed a very low dose of lorazepam.

Now – I had never taken medications for anxiety or anything like that before. All I had to compare was pain killers I had for my wrist surgery and dental (wisdom tooth) surgeries. I’m not someone who takes a lot of medication unless I feel I cannot deal (it’s not that I am against it, I just didn’t find I needed it). But I knew I needed to take something, and the low dose was definitely powerful the first time but I adjusted after 1-2 exam periods. It helped immensely. I was able to sit and take my exams and focus. It can cause some brain fog but I didn’t have that experience. I just felt relaxed enough to complete my exam at a more leisurely pace. I was still always one of the first people done (definitely remembered for that in school haha!) but without the feeling of utter panic I felt much better.

I also requested accommodations for exams to take the mental pressure off – I got extra time (never used it but it was nice to know it was there if I needed it) and got to write in a quieter space for the most part. It was nice and I highly recommend that to anyone who struggles with similar types of anxiety around testing.

My general anxiety was always around certain situations (going places where I couldn’t locate a bathroom because IBS…), but I also spent a lot of time ruminating and worrying. Constantly. But I really truly thought that was just “who I was” and that I had to deal with it. Even with my knowledge of mental health through schooling (a minor in psychology and then nursing), I really felt it was a character flaw I had to learn to live with.

I didn’t realize until this second postpartum experience that it was something that wasn’t a part of who I actually was…

(I will mention here as an aside, that I do also have a history of disordered eating that has since been managed – to the degree that it can be of course. It’s still a history and still plays a part in my life, but not so much from an anxiety side).

My Second Pregnancy

My first year ever being postpartum, after I had Maggie, I honestly felt great. I was able to keep up with working out, pursue some interests, spend a lot of time with our new family (especially because of COVID) and I honestly had minimal situational anxiety (since I didn’t go out as much) and/or IBS symptoms (which is definitely a precursor or trigger for my anxiety).

I was still worrying though but it was the same degree as normal except certain times of the month where it seemed my hormones would play a role in amplifying it (just a hypothesis). My worry often focuses around my health or the health of my loved ones, and I think that ever looming presence of the pandemic was definitely amplifying that a bit. Also – the nature of my work as I thought about going back closer to a year, a lot of time spent with people who have medical conditions, did seem to cause increased anxiety.

I applied for a new job and was successful, and was able to step away from a role I absolutely loved but that I suddenly felt worried about (again, pandemic related I thought). My new job still was patient-facing but a little less involved; more high-level case management. I felt good when I went back to work until I got pregnant again.

My pregnancy, if you remember, started off great but had about a 6 week long “rough patch” if you will. Thinking back, I have a lot of thoughts on my whole experience.. but I’ll save those for another post. In the end, everything was totally fine but it was a very high stress time. I definitely felt an immense amount of anxiety during those 6 weeks, probably more than I had ever experienced. I had to keep keeping on because I was still working and had a daughter to take care of. My husband was an amazing support, but it felt heavy.

When we got the “all good” from the doctors at Mount Sinai in October of 2021, I felt a weight lifted but the residual effects of the stress and anxiety were still present. My body was very sore and achy and suffering from pelvic issues; I was fatigued and anxious. I ended up taking medical leave a bit early due to physical reasons that both my pelvic physiotherapist and I were convinced were related to stress but that weren’t getting better with lesser work duties.

Being off helped me immensely, I definitely felt an additional weight lift.. and then James arrived in February and I was overjoyed! We had such an amazing birth experience and he was just perfect. SO much anxiety from the previous months was just gone. I felt much more at peace and busy with a newborn…

The Rise of Postpartum Anxiety

It wasn’t until a few months into James life that I started to feel my anxiety creep back. I was having a lot of IBS symptoms which compared to my last postpartum experience was weird. I hadn’t had any after Maggie or during either of my pregnancies! This time I was almost immediately having struggles.

At first, managing two kids flowed really well. When James was really little, I found it pretty smooth to get Maggie to daycare and have the day with him. We were able to do much more out and about as the pandemic was not just beginning like it had been with Maggie. We could join in-person mom groups (masked at first but this stopped after awhile) and actually walk around the mall without me feeling worried we would absolutely catch something. It was good.

I don’t know exactly when things changed, but at some point I started to feel what I can only describe as overwhelmed. I had an amazing support in my husband, but some days my fuse was so short I didn’t know why. I felt frustrated easily. I worried about random things again. My usual techniques for management were not working. I started asking myself the Edinburgh scale questions wondering if I had depression, but it wasn’t quite lining up.

At some point I realized that it was probably anxiety. The IBS, the worry, the feeling of having too much going on at once.. that’s what it was. I felt like I was a waitress and I was carrying too many plates on top of each other and they were all about to come crashing down around me. That made me want to be both angry and upset at the same time. It made me want to blame someone for having so much but there wasn’t really anyone that needed to be blamed? I just felt like a lot was going on for me to worry about and I got to a point where, even though I didn’t feel that way everyday, those moments where I did I just hated it. I said to my husband “I want to be happy to be around my kids and not feel like this internally during it!”.

So I decided to see my primary care provider once again and he agreed that it sounded like anxiety and not depression. We talked about options – I had done the counselling thing before and said that nothing I had previously learned was really helping. It was a bit different than normal with the frustrated edge. We decided to go the medication route, but obviously my previous prescription (which I had stopped after I wrote my NCLEX) was no longer the appropriate choice.

Trying Zoloft

We trialled Zoloft, which is usually the first drug that gets prescribed for most people with postpartum anxiety. It is safe for breastfeeding (my biggest concern) and generally doesn’t have many side effects.

Unfortunately for me – I was a rare case who did have side effects. The first week was smooth. It made me a bit tired, but I took it before bedtime and it was alright (some people do get insomnia with it, so you may have to trial and error when it is best to take it). However by the second week I started having a very weird and less common side effect – jaw clenching and facial muscle flexing. I was like subconsciously frowning at times or at least flexing those muscles. It was very weird and it took me a few days to realize and pinpoint that it was the medication. The jaw clenching was particularly troublesome as it was causing me TMJ discomfort, so I could not deal with it anymore.

I called my office and had my prescription changed. I started on escitalopram (Lexapro) a few days later.

Fun or not so fun fact: my pharmacy messed up my first prescription, and gave me trazodone which is also an antidepressant but it is not zoloft (sertraline). Luckily, my nurse habits remain and I always double check my bottles and doses before taking anything. I caught it and let my pharmacy know. They apologized profusely and said they would be letting the manager know as well. I hope that actually happened to prevent this or worse errors happening to anyone else! Human errors happen – and I was okay, but it could have been more disastrous. Always check your bottles and make sure you have the right medication! Even if you’ve been prescribed it many times!

My Lexapro Journey…

I’ve been on Lexapro for many months now and I’ve had no side effects, including weight gain (many people ask about this one and I’ll admit I asked my doctor as well before being prescribed it).

I take it before bed and it’s just a part of my day now.

I will say – I have not been worrying. It’s like, all that time spent worrying is just a distant memory now. I mean sure, I still worry about things I should worry about, but I don’t spend my time thinking over things or worrying anymore. Things don’t feel as urgent or as overwhelming. I’d say my low dose works just well enough. If I had known years ago I could have spent less time doing all that just by taking a medication… I would have done it sooner.

Coping techniques are still a part of my day – but with the addition of the medication they work much better. No longer just a bandaid that feels like it could be ripped off at any moment. It’s pretty awesome.

I do sometimes feel “overwhelmed” but I am a parent of two children. To a certain extent, that is expected. But I am here to remind you that: you don’t just have to live with it when it’s more than expected. It’s not just a part of motherhood when it feels like too much. If you don’t feel like something is right, please seek help. Whether that be with your provider, your village (if you’re lucky enough to have one) or whoever you can.

I see a lot of patient blaming or person blaming on Instagram lately. Oh, try these supplements, eat better and workout and your anxiety will be gone. That is blaming the person for their condition. Well if you just took care of yourself… no. That’s not ok and that is not how we approach healthcare.

These feelings are not your fault. You are a good mother or a good parent. Sometimes we need a little extra help – that could be therapy, medication or a combination of the two. That’s ok. By realizing that and seeking help, you are being an amazing parent.

And if you’re on a medication and it’s not for you – talking to your prescriber is a good first step. There are options. Pleas be careful adding any supplements to your regimen without discussing it with a pharmacist or your prescribe too; interactions can happen.

Stay safe and be well everyone. Thank you for reading if you got this far, and if you ever are looking for resources in the Peel region or Greater Toronto Area, please feel free to contact me.