The Trap Of Postpartum Benzos

In February 2021, Grace Bagwell Adams, Ph.D., gave birth to her second child. It was the peak of the pre-vaccine COVID surge, and like so many who delivered babies during that intense chapter of the pandemic, Adams had carried fear and anxiety with her through her pregnancy. One week postpartum, she still didn’t feel right, so she returned to her OB/GYN. She told her doctor she was having “crippling” anxiety and she scored off the charts on the Edinburgh scale, the gold-standard screening tool for postpartum depression and anxiety.

“He said something along the lines of, ‘Well, it’s only been a week.’ And then he gave me a prescription for Klonopin,” she says.

Klonopin, the brand name for clonazepam, is a benzodiazepine—a class of fast-acting, short-term medications often prescribed for acute anxiety, panic, insomnia, and more. If you’ve heard of lorazepam (thank you, White Lotus), you’ve heard of a “benzo,” as the medications are called colloquially.

Adams had also been prescribed the opioid hydrocodone for pain. As a public health researcher, she knew the two medications could have dangerous, even deadly, interactions. Yet, overwhelmed and exhausted, she struggled to advocate for herself in the moment. When she got home, her husband called her doctor’s office and requested a prescription for Lexapro instead—a selective serotonin reuptake inhibitor (SSRI), widely considered part of a first-line treatment plan for postpartum anxiety. Adams never took the Klonopin; she started Lexapro the next day.

Her experience, though, led her to conduct a study on benzodiazepine prescribing patterns in the postpartum period. Published last June, Adams’ work found prescriptions for benzos rose by 17% during the pandemic. SSRI prescriptions, meanwhile, stayed flat.

Experts suggest that changes throughout the pandemic, including relaxed regulations on prescribing benzos and a lack of education around maternal mental health amongst providers, remain in place today, meaning prescription rates for the powerful drugs could still be elevated.

Make no mistake, benzodiazepines can play an important role in treating postpartum depression and anxiety, says reproductive psychiatrist and Mavida Health co-founder Sarah Oreck, M.D, particularly as a “bridge” to ease acute symptoms while waiting for longer-term treatments like SSRIs or therapy to take effect.

The problem? The pandemic pulled back the curtain on how often these medications aren’t being used or prescribed appropriately.

The rise of Rxs for benzos

The rise in benzo prescriptions during the pandemic comes as no surprise to Dr. Oreck: It’s well-documented that rates of postpartum depression, and especially postpartum anxiety, spiked during that time.

There are a few other things going on, too: First, in the context of pregnancy or postpartum care, she says that OB/GYNs are often the ones writing those prescriptions, as was the case with Adams. OB/GYNs sometimes serve as the first (and sometimes only) line of defense.

“I think this increase shows that OBs feel like they don’t have many tools in their toolbox,” says Dr. Oreck. “Benzodiazepines become a kind of reflexive option.”

Many physicians, OB/GYNs included, receive little training in mental health, even less in maternal mental health specifically. Despite maternal mental health conditions being the leading cause of death postpartum, OB/GYNs aren’t required to receive any formal training on the topic in medical school or residency.

Then, during COVID, benzos didn’t necessarily become more needed; they became more accessible, says Polina Teslyar, M.D., an instructor at Harvard Medical School and associate psychiatrist at Brigham and Women’s Hospital. “Before the pandemic, if you were prescribing a controlled substance—like a benzo, ADHD medication, or painkiller—you were legally required to see the patient in person.” During the pandemic, that rule was paused, which could have influenced prescribing patterns, she says. It’s a change still in effect today: The DEA is expected to issue final rules on how telemedicine prescribing of controlled substances will be handled long-term, but the details are still in flux.

And finally, a prescription isn’t proof that a medication was taken, reminds Dr. Teslyar—something that rings true in Adams’ case. Yet with the rapid expansion of telehealth and a workforce needing additional training, today’s medical system is more ripe for overprescribing.

The place of benzos in a postpartum mental health plan

While benzos aren’t a substitute for gold-standard, evidence-based care, like therapy, social support, and SSRIs, if taken and prescribed properly, they do have a place in a postpartum mental health plan—particularly for short-term panic or anxiety, especially when those symptoms are disrupting already fragile postpartum sleep, says Dr. Oreck. “They’re what we think of as a Band-Aid, not a cohesive treatment plan,” she adds.

Here’s one example of how benzos may fit into a treatment plan: If someone has started therapy or begun taking an SSRI to treat an underlying condition, but the SSRI may take 4 to 6 weeks to kick in, a benzo can help manage anxiety or panic in the meantime. Once the SSRI takes effect, you taper off the benzo, Dr. Oreck says.

That short-term relief was what Lauren Dana Ellman, a mom of twin 9-month-olds, needed. As soon as her OB/GYN walked into the room for her six-week postpartum follow-up, Ellman broke down in tears. She had been experiencing depression, anxiety, sleep deprivation, and hypervigilance about her babies.

“I told my doctor I didn’t want her to think I was going to do anything to myself or my babies, and she reassured me that she knew—but that nobody deserves to feel that way,” Ellman recalls. Her doctor referred her to a postpartum therapist and a psychiatric nurse practitioner, who prescribed the benzo lorazepam. “It was the only thing that helped me sleep when I was up worrying about when I’d have to wake up again for the babies, which prevented me from falling asleep in the first place,” Ellman says.

Although she was told she could take it nightly, Ellman found that didn’t work for her. “I hate feeling drowsy and having to work the next morning and function for the babies,” she explains. “I still take it sometimes, but on a very infrequent basis.”

Dr. Oreck says that’s typical. The postpartum population—especially those under medical care for anxiety or depression—tends to use benzos short-term and appropriately, particularly when combined with therapy or medications like SSRIs. These moms often don’t carry the same addiction risk profile seen in other populations, she says.

Still, even for new moms, daily use of benzos beyond two to four weeks can increase the risk of tolerance (needing more to get the same effect), dependence (physical adaptation), and withdrawal symptoms if the medication is stopped abruptly. Additionally, combined benzo and alcohol use can be “extremely dangerous” Dr. Tesylar says, as both are sedating.

When benzo prescriptions go awry

Dr. Oreck notes that there are “so many nuances” to prescribing psychiatric medications. She calls for more comprehensive psychiatric care postpartum—a gap her company, Mavida Health, is working to fill. One study of Adams’ found that among new mothers who filled a benzodiazepine prescription, over half (50.7%) also filled an opioid prescription, underscoring the need for clinicians to exercise enhanced caution.

Dr. Teslyar adds that while a benzo might help with sleep in the short term, “as a psychiatrist, I’m not going to start with a benzo.” She explains that these medications can actually disrupt long-term, deep, restorative sleep by altering the brain’s natural sleep architecture, or how you move through different cycles of sleep. “Who the patient is talking to matters,” she says, reiterating the idea that more access to specific maternal mental health psychiatric care in the postpartum period is critical.

Dr. Oreck also says that patients prescribed benzos often come to her questioning the vague frequency in dosage that Ellman experienced. What does ‘as needed’ even mean?

“We don’t want anyone to panic or have a day of anxiety where you can’t function. But these are not medications to be handed out flippantly. They are effective but require a lot of counseling and should be taken responsibly,” Dr. Oreck said.

Of course, one of the biggest issues, both agree, is that benzos are not designed to be used long-term as they cause physiological dependence and have long-term side effects such as memory loss, falls (mostly in older adults), and sleep disturbances. But, in some rare cases, long-term benzo use is unavoidable. “Some patients don’t find relief from anything else—but that’s the exception,” says Dr. Teslyar.

And always, there should be other tools in the toolbox. “The only time a benzo is appropriate as a solo treatment is when someone has a specific, infrequent phobia—like a fear of flying—and doesn’t travel often,” says Dr. Teslyar. “In that case, taking medication every day doesn’t make sense, but it might help to take something just before flying.”

Advocating for your mental health postpartum

It’s an unfortunate but urgent truth: “We have to be louder,” says Dr. Oreck. “We have to stand up as patients and ask questions.” It’s better to have an uncomfortable conversation with your doctor than to take a medication you don’t fully understand, she says, especially without support.

So if a provider offers a prescription, don’t hesitate to ask:

• Can you give me more instructions about this?
• What side effects should I watch for?
• What are the risks?
• Can I take this with other medications?
• What time of day should I take it?
• How long will I be on this?

“There’s a lot of qualitative work showing that this dismissal by providers—this not listening, not taking women seriously—is an endemic problem in maternal health care,” says Adams. “It’s linked to maternal morbidity and mortality.”

Both self-advocacy and collective advocacy matter. Organizations like Chamber of Mothers, March of Dimes, and Postpartum Support International push for better care, more resources, and accountability around maternal mental health in the U.S.

But above all, know this: Maternal mental health struggles are common and highly treatable. You don’t have to suffer in silence or navigate your journey alone. Reach out, ask questions, and demand the care you deserve. “My job as a physician is to let you know your options,” says Dr. Oreck. “It’s hard that this burden often falls on the patient. That’s a failing of the system—but together, we can change it.”