From the Guidelines
For immediate anxiety relief postpartum while breastfeeding, I strongly recommend starting with non-medication approaches like deep breathing exercises, progressive muscle relaxation, and mindfulness meditation. These approaches can be practiced in just 5-10 minutes and have been shown to be effective in reducing anxiety symptoms 1. It is also essential to reach out to your support network immediately and consider scheduling an urgent appointment with your healthcare provider. If medication is needed, selective serotonin reuptake inhibitors (SSRIs) like sertraline (starting at 25-50mg daily) or fluoxetine (10-20mg daily) are generally considered safe during breastfeeding, although the evidence on their safety during breastfeeding is limited 1. For very acute anxiety, your doctor might prescribe a limited course of lorazepam (0.5-1mg) or oxazepam, which have shorter half-lives and less accumulation in breast milk, as suggested by guidelines on anaesthesia and sedation in breastfeeding women 1. Cognitive behavioral therapy is highly effective and should be started as soon as possible, with sessions typically once weekly for 8-12 weeks. Some key points to consider when managing anxiety postpartum while breastfeeding include:
- Postpartum anxiety affects up to 20% of new mothers and addressing it promptly benefits both you and your baby, as maternal anxiety can impact infant development and bonding.
- Breast milk composition changes constantly, so nursing just before taking medication and waiting 2-4 hours before nursing again can minimize infant exposure to medication.
- Non-pharmacologic treatments like psychoeducation, self-management, or coaching, CBT, MBIs, and DBT can be effective in managing anxiety symptoms, and CBT has been shown to be the most effective 1. It is crucial to weigh the risks associated with anxiety medications in pregnancy against the risks associated with untreated or inadequately treated anxiety in pregnancy and to make decisions collaboratively with your healthcare provider 1.
From the Research
Treatment for Immediate Anxiety Relief Postpartum While Breastfeeding
- There is very low-certainty evidence that psychosocial breastfeeding interventions could reduce symptoms of anxiety immediately post-intervention as measured with the Zung Self-rating Anxiety Scale (SAS) 2.
- Relaxation interventions carefully tailored to address perinatal emotional distress may lead to important health benefits, including improvement in breastfeeding outcomes 3.
- Postpartum anxiety may be associated with reduced breast-feeding confidence and lactation performance, and awareness of this association may be helpful in identifying women at risk for lactation failure and targeting efforts to promote breast-feeding 4.
- Combination treatment with benzodiazepines and SSRIs for comorbid anxiety and depression may be effective, but it is essential to consider the potential risks and benefits, especially when breastfeeding 5.
Breastfeeding Interventions
- Psychosocial breastfeeding interventions may prevent postpartum depression in the short term and increase the duration of breastfeeding in the long-term, but the evidence is very uncertain about the effect of alternative breastfeeding interventions on postpartum depression or other outcomes 2.
- Breastfeeding support through psychotherapy is heterogeneous and scant, but there is some indication that psychotherapy support while breastfeeding may have more impact than routine counselling 3.
Anxiety and Breastfeeding
- High-anxiety mothers were less likely to practice full, exclusive breast-feeding and more likely to have terminated breastfeeding at 1 month, suggesting that postpartum anxiety may be associated with reduced breast-feeding confidence and lactation performance 4.
- State anxiety was measured among breast-feeding women by the State Trait Anxiety Inventory before hospital discharge and at 1 month postpartum, and predischarge anxiety correlated inversely with breast-feeding confidence 4.