What is Postpartum Rage? How Do I Know if I Have it?

While we all know about postpartum depression (PPD) or anxiety, have you ever heard of 'postpartum rage'? It's a real issue that many mothers struggle with after giving birth and can be just as debilitating. According to information from The Cleveland Clinic, signs of postpartum rage range from anger to frustration to irritability to constantly feeling on edge.

To better understand the causes and susceptibility to this condition, we spoke with Sara Lyon, a childbirth educator, doula, licensed massage therapist, and rhythm expert, and Patricia A. Evans, a nurse practitioner and certified nurse midwife. They provide insights into all aspects of postpartum rage, from its diagnosis to its treatment.

What is postpartum rage?

Postpartum rage, a type of postpartum mood and anxiety disorder, is defined by feeling intense anger, irritability, and aggression, unlike the extreme sadness and guilt associated with postpartum depression. Lyon explains that the main causes of postpartum anger are hormone changes, severe drops in estrogen and progesterone levels, lifestyle changes, body changes, relationship changes, lack of sleep, and added parenting responsibilities.

Women who have a history of anxiety and depression, adolescent mothers, and those who deliver prematurely are also more likely to experience postpartum rage. Lyon adds, "Having a family history of depression postpartum depression or anxiety, including postpartum rage, also predisposes you. Additionally, up to 40 percent of individuals with a family history of depression may inherit this condition."

Why am I angry all the time after having a baby?

Experiencing postpartum mood disorders is affected by the way hormones change during and after pregnancy. Lyon says these hormones are different for each stage of having a baby, from getting pregnant to being a mom. She explains, "You might be dealing with big hormone changes during childbirth and after, which can mess with your serotonin and norepinephrine levels." Lyon also says that sleep deprivation and feeling super tired from taking care of a newborn can make postpartum rage worse.

Because so many changes happen within the first weeks of postpartum, Evan says that it is really important to be open and honest about how you're doing with your healthcare provider. "If you ever feel like you might hurt yourself, your baby, or someone else, don't hesitate to call 911 for help right away," she tells Today's Parent.

What is the 5-5-5 rule of postpartum?

Lyon says that the 5-5-5 postpartum activity framework, supported by traditional birth practitioners and healthcare systems globally, suggests spending the first five days in bed, the next five days on the bed, and the last five days around the bed. "In other words, it's about not pushing yourself too hard and allowing your body the rest it needs to recover, whether you've given birth vaginally or through surgery," she says.

How long does it take for your body to return to normal after birth?

Pregnancy lasts about nine months, so it's important to realize that getting back to how you felt before will take time, says Evans. She explains, "Your body and mind need time to bounce back.  The first two weeks are usually the toughest as your hormones are all over the place, and you're getting used to having a new baby around. Around six weeks, things start to get more normal, and by three months, you should be feeling a lot better."

FAQs

How common is postpartum rage?

According to Evans, postpartum mental health issues are widespread, with as many as one in four women experiencing some form of postpartum depression and/or rage. While postpartum depression is more prevalent than postpartum rage, postpartum rage is frequently disregarded as a distinct symptom.

How is postpartum rage different from postpartum depression?

Postpartum depression and postpartum rage can both occur in the postpartum period, but they have different symptoms. According to Lyon, postpartum rage is characterized by aggression and anger, while postpartum depression can involve these moods along with sadness, anxiety, worry, and despair.

Evans suggests that it's possible to experience postpartum rage without developing postpartum depression, and having postpartum rage doesn't guarantee you'll develop it. However, it's still important to get professional screening to successfully treat any clinical psychiatric imbalance.

How is postpartum rage diagnosed?

While postpartum rage is not an established mental disorder diagnosis in the most recent Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), it is commonly seen as a symptom of postpartum depression and anxiety disorders, according to Evans. To diagnose postpartum rage, your pregnancy care provider will ask you specific questions and usually use the Edinburgh Postnatal Depression Scale (EPDS) to gauge the level of depression and/or rage you might be going through.

How do you treat postpartum rage?

While the symptoms of postpartum rage can be overwhelming for many new mothers, there are various treatment options available to help them cope with this challenging phase. According to Evans, "specific antidepressants (serotonin reuptake inhibitors SSRIs) and anti-anxiety medications can help reduce the anger and give more control over one's thoughts. Additionally, seeking therapy from a professional specializing in pregnancy and postpartum issues is crucial for new moms to learn effective strategies to manage and recover from postpartum depression and/or postpartum rage."

Evans emphasizes the importance of being part of support groups with other parents to validate feelings and promote well-being. She also talks about the importance of taking a break without feeling guilty. "For example, letting family members or babysitters look after the baby for a few hours so the mom can rest or have some time for herself."

How long does postpartum rage typically last?

Low-grade postpartum rage usually doesn't last long and often subsides within the first eight weeks, as Lyon explains. In the meantime, she emphasizes the importance of making sure you're getting enough sleep, taking care of your body, and gaining confidence in looking after your new baby to help manage your mood. If you're still concerned about postpartum rage, Lyon advises speaking with your ob-gyn and other health professionals to make sure you're staying on track.

Experts

• Sara Lyon, childbirth educator, doula, licensed massage therapist, and rhythm expert.
• Patricia A. Evans, NP, CNM, nurse practitioner, and certified nurse midwife