Definition
The kind of depression that certain women experience following a child birth is known as postpartum depression (PPD). It may occur soon after delivery or up to a year later, most of the time it occurs within the first three months after delivery. Birth of a baby can trigger some powerful emotions from excitement and joy to fear and anxiety. It can also result in depression.
It is considered a complication of giving birth. It was not known exactly why this postpartum depression occurs. It was seen that this PPD doesn’t always affect women it can even occur in men also (father). This was mostly observed 3-6 months following childbirth. One study has shown that 10% of men will experience this postpartum depression.
A young father (who married early) with a history of depression or experiencing relationship problems, or having financial struggles are mostly at the risk of PPD. This PPD fathers sometimes called paternal Postpartum depression.
Baby blue symptoms
Signs and symptoms of baby blues may last for a few days to one or two weeks after the baby is born.
These include mood swings, anxiety, irritability, sadness, crying, reduced concentration, appetite problems, and sleeping troubles.
Postpartum psychosis
Sometimes new mothers experience extreme mood disorder called postpartum psychosis after childbirth.
Indicators of postpartum psychosis include
Obsessive thoughts about baby, disorientation, confusion, hallucinations, delusions, agitation, sleep disturbances, attempts of harming herself or her baby, it may lead to life-threatening thoughts or behavior so immediate treatment is essential.
Postpartum depression
The signs and symptoms of postpartum depression are almost similar to baby blue symptoms but here the Symptoms are very intensive and lasts longer, and also interfere with daily activities and handling other tasks.
Symptoms usually develop within the first few weeks after giving birth, but may begin earlier during pregnancy or later up to a year after birth.
Postpartum depression signs and symptoms include
Sadness, weeping, regretting about something, unable to tolerate the feeling of rejected by someone, difficulty in bonding with baby, changes in sleeping patterns, severe anxiety, irritability, low energy, changes in eating patterns(loss of appetite or eating much more than usual), mood swings, excess crying, feeling guilty, reduced concentration, sleeping troubles, headache, stomach ache, blurred vision appetite problems, Not showing interest in newborn baby, fear that you are not a good mother, reduced motivation, persistent fatigue, panic attacks, restlessness, loss of libido, and recurrent thoughts of suicide or death.
If this is left Untreated these symptoms may last for many months or longer. Several people suffering from postpartum depression don’t tell others about these symptoms. Partner, family members or friends may identify these changes and bring them to notice. certain people suffering from PPD can go through thoughts of hurting their newborn baby. They even try to harm themselves or committing suicide. They may not do it surely but they get these frequently.
Causes
Postpartum depression is caused by multiple factors. But specific reasons are not known. There is no single cause for postpartum depression but physical and emotional issues, stressful events may play a role. Imbalance of chemicals in the brain plays a role here.
Physical changes
Following childbirth, the sudden drop in hormone levels(estrogen and progesterone) in your body might give rise to postpartum depression. Other hormones produced by the thyroid gland may also drop sharply which can make you feel tired, sluggish and depressed.
Emotional issues
- When you are deprived of sleep.
- Unable to balance the tasks of a caretaker.
- Gave birth to a new child.
- Not having People backup.
- Problems in the relationship.
- Financial problems.
- Being alone, Parents and close friends are not around when you need them.
- Diagnosed with other illnesses in the past.
- changes in blood pressure, and metabolic changes.
- Changes in sleep patterns.
- People with a family history of depression are at higher risk.
- The previous history of the diagnosis of bipolar disorder also increases the chances of diagnosing with Postpartum Depression.
Chances of depression are more if the age of women is less than 25 based on a research conducted at the University of North Carolina at Chapel Hill, it was seen that difficulties in breastfeeding are also linked to postpartum depression. A new mother’s who experience breastfeeding difficulties in the two weeks following the birth of a baby has the chances of increasing postpartum depression in two months.
Diagnosis
Your physician will diagnose the baby blues by asking the patient with suspected PPD as a part of a depression screening questionnaire.
A doctor may ask the following questions whether there are any changes in sleeping patterns or any problems in concentrating in making decisions, not being self-confident, alterations in hunger, feeling nervous all the time, regret about something, any kind of suicidal thoughts, being self-critical, fatigue, and loss of interest in physical activity.
If the patient says yes to any 3 of the above symptoms it may indicate probably that she had mild depression. Patients with this mild PPD can continue their daily activities.
If the mother has feelings of harming the baby or harming herself it means that she is suffering from a severe kind of PPD.
Statistics
Researches in northwestern medicine reported in JAMA Psychiatry that approximately 1 in every 7 new mothers was affected by postpartum depression.
In their study involving over 10,000 mothers, they found that nearly 22% of them experienced postpartum depression when they are followed twelve months following birth.
- It was observed that women who developed this postpartum depression are previously diagnosed with another type of depression or anxiety disorder.
- A Canadian study found that postpartum depression is much more common in urban areas.
- Women living in urban areas have a 10% risk of developing postpartum depression. Women in rural areas have a 6% risk of developing PPD.
In moderate cases of PPD cognitive-behavioral therapy (CBT) is ideal. It is based on a principle that thoughts can trigger depression. CBT is successful in a moderate case of Postpartum depression. Here the individual is taught how to manage the relationship between her thoughts and state of mind.
Complications
- Untreated PPD can last for months or years and can become a chronic depressive disorder.
- Children of a mother with PPD are more prone to have behavioral and emotional problems such as difficulties in sleeping, excessive crying, eating problems, delayed talking, and delay in language development.
Treatment
Recovery of PPD may take time, it may take one to two months or may even be longer but it is healable. Support of family members, partners, and people who are close to you can have a huge effect on speedy recovery.
Medications
They have prescribed antidepressants in severe cases. These will assist in offsetting the elements in the brain that influence the mood.
Anti-depressants assist with irritation, negative thoughts, problems in concentrating, insomnia. It may take a few weeks for it affects to be seen. It may even help in creating a bond between the mother and the baby.
The main side effects associated with it are through breastfeeding there is a chance that anti-depressants chemicals may pass to the infant from the mother.
Based on certain studies during breastfeeding, it is better to take Tricyclic anti-depressants such as imipramine, Nortriptyline, as these are safe.
Tricyclic anti-depressants are contraindicated in patients with a history of heart disease, epilepsy, or severe depression with frequent suicidal thoughts. These patients are advised to take selective serotonin reuptake inhibitors (SSRI’s) such as Paroxetine or sertraline. Very minimal amounts of them can get into breast milk.
A woman with Postpartum Depression should take advice from the doctor in order to avoid risks of breastfeeding to her baby.
In the condition with postnatal psychosis, tranquilizers are prescribed where the mother may have hallucinations, suicidal thoughts, and irrational behavior. However, Medication should be used only for a short time in such cases.
Side effects are Loss of balance, light-headedness, drowsiness, confusion, loss of memory.
Psychological Therapies:
Studies have shown that certain therapies are there to treat this PPD.
Cognitive-behavioral therapy (CBT):
In moderate cases of Postpartum depression, cognitive-behavioral therapy (CBT) can be successful.
In case of severe PPD where motivation is low talking therapies alone are less effective. From the combination of this psychotherapy and Medication, the best results can be obtained.
Electroconvulsive therapy (ECT):
In case of severe symptoms if they don’t react to any other treatments then this electroconvulsive treatment may be helpful. This is applied along with general anesthesia and with muscle relaxants. This is helpful in a severe case of PPD. Side effects associated with it are headache, memory loss.
Severe PPD: The person can be referred to physicians, psychiatrists, psychologists, occupational therapists, and specialized nurses. If the physician observed that there are chances of hurting herself or her baby then the physician will immediately admit her into his clinic and start treatment.
Management
- Taking a healthy and balanced diet.
- Maintaining blood sugar levels by eating at small intervals frequently.
- Proper sleep is adequate at least 6-8 hours a day.
- Being open with family members, life partner or friends by talking freely regarding their problems.
Sirisha B