Postpartum depression ( PPD) is a form of depression that affects some women following childbirth.
Symptoms include depression, shifts in habits of sleeping and eating, low energy levels, anxiety and irritability.
The condition typically develops within 4 to 6 weeks of giving birth, but it can sometimes take several months to show up.
It is not known why PPD occurs. Depression isn’t, however, a sign that you’re not enjoying your new arrival, as some mothers fear. It’s a psychiatric condition that can be handled successfully with the aid of support groups, therapy and treatment at times. Someone with symptoms should immediately see a doctor.
Not just mothers are affected by this type of depression. One research showed that postpartum or maternal depression is felt by about 10 percent of new fathers. After childbirth the highest levels can be found 3 to 6 months.
Symptoms
Postpartum depression may have different ways of influencing the parents. Below are some common signs and symptoms:
- a feeling of being overwhelmed and trapped, or that it is impossible to cope
- a low mood that lasts for longer than a week
- a sensation of being rejected
- crying a lot
- feeling guilty
- frequent irritability
- headaches, stomach aches, blurred vision
- lack of appetite
- loss of libido
- panic attacks
- persistent fatigue
- concentration problems
- reduced motivation
- sleeping problems
- the parent lacks interest in themselves
- a feeling of inadequacy
- an unexplained lack of interest in the new baby
- a lack of desire to meet up or stay in touch with friends
PPD is not the same as baby blues, affecting many new parents for a couple of days after they give birth. Nevertheless, if it greatly affects the ability to reassume everyday life due to low mood, it is a symptom of a longer-term depression.
A lot of PPD people don’t tell people how they feel. Partners, families , and friends who are willing to pick up early on the symptoms of postpartum depression will encourage them to seek medical help as soon as possible.
Some people with postpartum depression may have thought of harming their babies. They might also consider committing suicide or self-harm. For most cases, neither parents nor the child are affected, but having such thoughts can be disturbing and distressing.
Causes
PPD is possibly the product of a variety of factors. And the specific causes are not yet understood.
Generally depression is triggered by emotional, stressful events, a biological change that causes a brain chemicals imbalance, or both.
The following factors may contribute to PPD:
- the physical changes of pregnancy
- excessive worry about the baby and the responsibilities of being a parent
- a complicated or difficult labor and childbirth
- lack of family support
- worries about relationships
- financial difficulties
- loneliness, not having close friends and family around
- a history of mental health problems
- the health consequences of childbirth, including urinary incontinence, anemia, blood pressure changes, and alterations in metabolism.
- hormonal changes, due to a sudden and severe drop in estrogen and progesterone levels following birth
- changes to the sleep cycle
Breast-feeding problems may also be related to PPD. According to a report performed at the University of North Carolina at Chapel Hill, new mothers who encounter breast-feeding problems in the 2 weeks following the infant’s birth have a greater risk of PPD 2 months later.
Individuals with a family history of depression are at greater risk of experiencing it themselves. Nobody knows why this happens though.
An early diagnosis of bipolar disorder may also raise the risk of developing PPD relative to those with a new child.
Diagnosis
A doctor may want to rule out baby blues by asking the person with suspected PPD to complete a questionnaire for depression-screening.
In the past month, the doctor will also inquire whether they have experienced low morale, sadness or hopelessness. You would also ask whether the new parent still likes things that would generally make them happy.
The doctor may also ask if the patient has:
- sleeping problems
- problems making decisions and concentrating
- self-confidence problems
- changes in appetite
- anxiety
- fatigue, listlessness, or reluctance to be involved in any physical activity
- feelings of guilt
- become self-critical
- suicidal thoughts
A person who answers “yes” to three of the above-mentioned questions probably has mild depression. An individual with moderate PPD is still able to carry on with everyday activities. More “yes” answers indicate a deeper depression.
If the mother answers “yes” to the question of harming oneself or the baby, it is diagnosed automatically as severe PPD.
Many mothers who have no husband or close relatives to help out do not want to answer such questions directly because they are worried they will be diagnosed with postpartum depression and their baby will be taken away.
This would most rarely happen. In serious cases only an child is taken away. Also in extremely serious situations where the individual is to be treated in a mental health facility, they are usually accompanied by the child. When a new parent has extreme depression, they will have considerable difficulties in coping at all, they will not be able to function at all, and a dedicated mental health team will require comprehensive help.
The doctor may also prescribe other medical tests, such as blood tests, to determine whether hormone complications, such as those caused by an underactive thyroid gland, or anemia, are present.
Treatment
Recent parents who believe they show signs of PPD should contact their doctor. While it may often take several months to heal, and in some cases much longer, it is treatable.
Recognition of the problem is the most critical phase on the path to managing and healing from PPD. Family, partners, and close friends support can have a significant effect on a quicker recovery.
Rather than repressing emotions, it is better for the person with PPD to express how she feels to people she can trust. There is a chance of feeling shut off from friends or other loved ones which may lead to problems in relationships that contribute to the PPD.
Self-help programs are helpful. They have access not only to helpful advice, but also to other parents with similar issues, worries and symptoms. It will lessen the sense of isolation.
Medications
In people with serious PPD the doctor can prescribe an antidepressant. Such help balance the chemicals which affect mood in the brain.
Antidepressants can help with irritability, hopelessness, a feeling of being unable to cope, concentration, and insomnia. Such medications can also help dealing with baby bonding but can take a few weeks to become successful.
The drawback is that antidepressant chemicals may be transferred by breast milk to babies, although there is no proof of the long-term effects. Tricyclic antidepressants, such as imipramine and nortriptyline, are most likely to be the easiest to take when breast-feeding a baby according to several small studies.
TCAs are not appropriate for individuals with a history of heart disease, epilepsy or repeated suicidal thoughts with extreme depression.
A selective serotonin reuptake inhibitor (SSRI), including paroxetine or sertraline, may be administered to those who can not take TCAs. The amount of paroxetine or sertraline ending up in breast milk is minimal.
A mother with PPD will explore feeding choices with her doctor so she and the child are able to select the best medication, which could include an antidepressant.
In postnatal psychosis, where the mother can have hallucinations, suicidal thoughts, and irrational behavior, tranquilizers may be prescribed. The drugs should be used for a limited period, however, in these situations. Side effects comprise:
- loss of balance
- memory loss
- lightheadedness
- drowsiness
- confusion
Psychological therapies
Studies have shown that cognitive behavioral therapy ( CBT) can be successful in moderate PPD cases.
In some people too, cognitive therapy is effective. This type of therapy is based on the principle that depression can cause the thoughts. The person is taught how the relationship between her thoughts and state of mind can be better controlled. The aim is to change the patterns of thought to make them more optimistic.
Talking therapies alone are less successful for those with severe depression, where motivation is poor. Most researchers conclude that a combination of psychotherapy and medicine provides the best outcomes.
Electroconvulsive therapy
When the symptoms are so severe that they don’t respond to other therapies, electroconvulsive therapy ( ECT) can be helpful. It only indicated, however, when all other solutions, such as medication, were not effective.
ECT is used under general anesthetic and with relaxant muscles. For cases with extremely serious depression ECT is typically extremely successful. But the gains can be short-lived.
Side effects include headaches and short-term memory loss which is typically, but not always.
Treating severe postpartum depression
The individual with extreme PPD may be referred to a specialist team, including psychiatrists , psychologists, occupational therapists and specialist nurses. When the doctors suspect the patient is at risk of hurting her or her child, she could be admitted to hospital in a mental health facility.
In some situations, while the person with PPD is being handled, the parent or a family member may care for the child.
Lifestyle tips
The more a physician learns about medical and family history during or just before a child, the better the likelihood of avoiding PPD.
The following changes may help:
- Follow a well-balanced, healthy diet.
- Eat frequently to maintain blood sugar levels.
- Get at least 7 to 8 hours good-quality sleep each night.
- Make lists and be organized to reduce stress.
- Be open in talking to close friends, partners, and family members about feelings and concerns.
Contact local self-help groups.
Statistics
To JAMA Psychiatry, Northwestern Medicine researchers estimated that postpartum depression affects about 1 in every 7 new mothers.
Researchers also found in their study, involving more than 10,000 women, that about 22 per cent of them had been depressed when they were followed up 12 months after giving birth.
The team also discovered that:
- More than 19 percent of the women who had been screened for depression had considered hurting themselves.
- A large proportion of mothers who had been diagnosed with postpartum depression were previously diagnosed with another type of depression or anxiety disorder.
A Canadian analysis revealed that, in urban areas, postpartum depression is much more severe. They found a 10% risk of postpartum depression among women living in urban areas, compared to a 6% risk to those living in rural areas.
