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Postpartum Depression

A 35-year-old female gives birth to a healthy female child after trying to conceive for six years. Both parents and all the family members are overjoyed because of the newest addition to the family. The couple feels on the top of the world. Contrary to expectation, the mother, within few days, started feeling sad, didn`t experience attachment to the child, didn`t want to breastfeed, developed sleep issues, and was hopeless and frustrated with everything. She didn`t express this to anyone, because of the guilt and fear of being not understood. However, everything subsided, and she felt happy gradually with span of two weeks.

A 24-year-old female gives birth to 3.2 kg healthy baby boy after two years of marriage. Everything seemed to be normal till two weeks of delivery, following which she developed sleep disturbances, irritability, refused taking care of baby, and expressed suspiciousness that her family members would harm the child. These symptoms persisted for one week, following which she was taken to hospital and admitted. After start of treatment, she improved gradually and was discharged.

Childbirth is a blissful moment and celebrated with joy and happiness in every family. No one can imagine it could have any negative impact on anyone, especially the mother. Journey of pregnancy is different for every individual. A woman`s body undergoes a major transformation during pregnancy and postpartum (six weeks post-delivery) in terms of hormonal levels, bodily changes, added responsibilities, and adjustment in relationship. All these can trigger a cascade of powerful emotions, from excitement and joy to fear and anxiety. These can predispose an individual to some mental health issues.

Most new moms can experience varied psychological issues, ranging from postpartum blues and postpartum depression to psychosis. One of the important things is to understand that postpartum depression, or any mental health issue, isn`t a weakness, rather, a complication of childbirth. Postpartum depression is linked to chemical, social, and psychological changes that happen when having a baby. The term describes a range of physical and emotional changes that many new mothers experience. PPD can be treated with medication and counseling, so if you have any mental health issues during this period, prompt intervention can help you get better and aid in proper bonding with the baby.

The chemical changes involve a rapid drop in hormones after delivery. The actual link between this drop and depression is still not clear. But, what is known is that the levels of estrogen and progesterone, the female reproductive hormones, increase tenfold during pregnancy. Then, they drop sharply after delivery. By the third day after a woman gives birth, the levels of these hormones drop back to what they were before pregnancy. In addition to these chemical changes, the social and psychological changes of having a baby create an increased risk of depression.

Interesting finding is that, even new fathers aren’t immune. Research shows that about one in 10 new fathers get depression during the year their child is born.

Risk Factors of Postpartum Depression
No single factor is responsible for development of postpartum. The combination of biological, psychological, and social factors contributes to its development.
• A history of depression prior to becoming pregnant, or during pregnancy
• Age at time of pregnancy (the younger you are, the higher the chances)
• Unplanned/ unwanted pregnancy
• Children (the more you have, the more likely you are to be depressed in a later pregnancy)
• Family history of mood disorders
• Going through an extremely stressful event, like a job loss or health crisis
• Having a child with special needs or health problems
• Having twins or triplets
• Having a history of depression or premenstrual dysphoric disorder (PMDD)
• Limited social support or living alone
• Marital conflict

Causes of Postpartum Depression
There’s no single cause of postpartum depression, but physical and emotional issues may play a role.
• Physical changes. After childbirth, a massive drop in hormones (estrogen and progesterone) occurs, which may contribute to postpartum depression. Other hormones like thyroid also drop sharply, which can leave you feeling tired, sluggish, and depressed.
• Emotional issues. When you’re sleep deprived and overwhelmed, you may have trouble handling even minor problems. You may be anxious about your ability to care of a newborn. You may feel less attractive, struggle with your sense of identity, or feel that you’ve lost control over your life. Any of these issues can contribute to postpartum depression.

Types of Postpartum Depression
There are three terms used to describe the mood changes women can have after giving birth:
• “Baby blues” happen to as many as 70% of women in the days right after childbirth. You may have sudden mood swings, such as feeling very happy, and then feeling very sad. You may cry for no reason and can feel impatient, cranky, restless, anxious, lonely, and sad.
• The baby blues may last only a few hours, or as long as one to two weeks after delivery. Usually, you don’t need treatment for baby blues. The symptoms usually improve within span of one to two weeks on its own.

Postpartum Depression Symptoms
Postpartum depression may be mistaken for baby blues at first, but the signs and symptoms are more intense and last longer and may eventually interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin earlier—during pregnancy up to a year after birth.

Postpartum depression signs and symptoms may include:
• Depressed mood or severe mood swings
• Excessive crying
• Difficulty bonding with your baby
• Withdrawing from family and friends
• Loss of appetite or eating much more than usual
• Inability to sleep (insomnia) or sleeping too much
• Overwhelming fatigue or loss of energy
• Reduced interest and pleasure in activities you used to enjoy
• Intense irritability and anger
• Fear that you’re not a good mother
• Hopelessness
• Feelings of worthlessness, shame, guilt, or inadequacy
• Diminished ability to think clearly, concentrate or make decisions
• Restlessness, severe anxiety, and panic attacks
• Thoughts of harming self or baby
• Recurrent thoughts of death or suicide

Untreated, postpartum depression may last for many months, or longer.

Postpartum Psychosis
Postpartum psychosis is a rare condition that typically develops within the first week after delivery; the signs and symptoms are severe and include:
• Confusion and disorientation
• Obsessive thoughts about your baby
• Hallucinations and delusions
• Sleep disturbances
• Excessive energy and agitation
• Paranoia and attempts to harm self or baby
Postpartum psychosis may lead to life-threatening thoughts or behaviors and requires immediate treatment.

When to see a Doctor
It’s important to call your doctor as soon as possible if the signs and symptoms of depression have any of these features:
• Don’t fade after two weeks
• Are getting worse
• Make it hard for you to care for your baby
• Make it hard to complete everyday tasks
• Include thoughts of harming yourself or your baby

Postpartum Depression Prevention
If you have a history of depression, tell your doctor as soon as you find out you’re pregnant, or if you’re planning to become pregnant.
• During pregnancy: Monitor your symptoms. You can manage mild depression symptoms with support groups, counseling, or other therapies. Medications can be prescribed, even while pregnant, if required.
• After your baby is born: An early postpartum checkup to look for symptoms of depression. The earlier you’re diagnosed, the earlier you can begin treatment. If you have a history of postpartum depression, your doctor may recommend treatment as soon as you have the baby.

Managing after Childbirth
Here are some tips that can help you cope with bringing home a newborn:
• Ask for help. Let others know how they can help you.
• Be realistic about your expectations for yourself and baby.
• Exercise within the limits; take a walk and get out of the house for a break.
• Expect some good days and some bad days.
• Follow a sensible diet; avoid alcohol and caffeine.
• Foster the relationship with your partner, make time for each other.
• Keep in touch with family and friends, don’t isolate yourself.
• Sleep or rest when your baby sleeps.

Treatment
Postpartum depression is treated differently, depending on the type of symptoms and how severe they are. Treatment options include anti-anxiety or antidepressant medications, psychotherapy, and participation in a support group for emotional support and education. In the case of postpartum psychosis, drugs used to treat psychosis are usually added. Hospital admission is also often necessary.

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