Postpartum depression (PPD) is a form of depression which affects women after childbirth. Symptoms include anxiety, sadness and episodes of crying. However, with treatment it can be overcome effectively.
What Is Postpartum Depression (PPD)?
Also known as postnatal depression, PPD is a type of mood disorder that mainly occurs in women after they give birth to a child. Although it is mostly observed in women, this type of depression can affect both men and women. As per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is a type of major depression that may occur within 4 to 6 weeks after childbirth. However, it may also take several months or even up to 1 year after delivery to appear. Diagnosis of this disorder is not only based on the time of onset but also the intensity of the depression. People affected by this condition experience intense sadness, anxiety, low energy, sleeping problems, despair and irritability which may affect their ability to take care of the infant and perform daily tasks. However, it should be remembered that postpartum depression (PPD) is very different from the baby blues that most women experience.
Globally, hundreds of millions of women are affected by PPD annually. According to the American Psychological Association (APA), about 1 in 7 women are affected by PPD. For almost 50% of women diagnosed with this disorder, PPD is their first experience with depression. In Asian countries, at least 65% of new mothers experience depression, according to a 2011 study 1. Moreover, about 10% of new fathers 2 are also affected by postpartum or prenatal depression, according to a 2010 study. It can not only affect first-time mothers and fathers, it can also affect parents who have not experienced PPD when their other children were born.
How PPD Affects Us
Postpartum depression is a complex combination of behavioural, emotional and physical changes. It can occur anytime within one year after childbirth. Giving birth to an infant may trigger a range of powerful and complicated emotions that may lead to depression. A recent 2020 scientific review 3 states “PPD occurs in about 6.5% to 20% of women. It occurs more commonly in adolescent females, mothers who deliver premature infants, and women living in urban areas.”
Although most new mothers go through “baby blues” within the initial 2-3 days after delivery, depression can be a lot more serious and long lasting. PPD is a serious mental disorder that affects your thoughts, behavior and health. It may result in extreme mood swings, hopelessness and exhaustion. Depression can be mild or severe and may make the mother feel detached from their child and feel empty inside. However, it doesn’t mean that the mother doesn’t love the infant.
PPD is not a weakness or character issue. It is a complication of childbirth that may affect the ability of the mother to take care of their child. This is why it is crucial to seek immediate treatment to relieve the symptoms and connect with the infant. If left untreated, depression in new mothers can lead to a severe mood disorder known as postpartum psychosis. The APA explains “PPD can affect any woman – women with easy pregnancies or problem pregnancies, first-time mothers and mothers with one or more children, women who are married and women who are not, and regardless of income, age, race or ethnicity, culture or education.”
Postpartum Depression vs Baby Blues
Most women tend to feel mildly sad, lonely, anxious, exhausted, tearful and experience mood swings after childbirth. This is known as baby blues. Around 70-80% of new mothers experience baby blues in the first 2-3 days after delivery. However, these feelings tend to resolve naturally within the next 2 weeks. But postpartum depression can be more intense and may last for a longer period of time. Even though both conditions occur after delivery and may have similar symptoms, these are separate and distinct from each other. According to the Centers for Disease Control and Prevention (CDC) explains “Feelings of postpartum depression are more intense and last longer than those of baby blues, a term used to describe the worry, sadness, and tiredness many women experience after having a baby.”
“Baby blues” is a term used to describe mild mood changes and feelings of worry, unhappiness, and exhaustion that many women sometimes experience in the first 2 weeks after having a baby. Babies require around-the-clock care, so it’s normal for mothers to feel tired or overwhelmed sometimes. If mood changes and feelings of anxiety or unhappiness are severe, or if they last longer than 2 weeks, a woman may have postpartum depression.
PPD feels a lot more serious and intense than the mild symptoms of baby blues. It may even affect the ability of the mother to care for the child or for themselves. As the symptoms of baby blues are not that severe, it generally doesn’t require treatment. PPD, however, may require therapy and medication to be treated successfully as it may lead to hallucinations or give rise to thoughts of hurting the baby or the sufferer themselves.
According to the National Institute of Mental Health (NIMH 4 ), “Babies require around-the-clock care, so it’s normal for mothers to feel tired or overwhelmed sometimes. If mood changes and feelings of anxiety or unhappiness are severe, or if they last longer than 2 weeks, a woman may have postpartum depression.” Women with postpartum depression generally will not get better unless they receive treatment.
Some new mothers may experience a more intense and extreme mood disorder, known as postpartum psychosis, after childbirth. According to the APA, this disorder may involve psychotic symptoms, such as hallucinations and delusions. It is generally a different disorder from PPD and is exceptionally rare. Data reveals that around 1-2 women out of 1,000 new mothers are affected by postpartum psychosis.
This rare and extremely serious mental illness can often co-occur with postpartum depression. One 2006 study 5 found that “postpartum psychosis is an overt presentation of bipolar disorder that is timed to coincide with tremendous hormonal shifts after delivery. The patient develops frank psychosis, cognitive impairment, and grossly disorganized behaviour.” Women with other mental health conditions, like schizoaffective disorder or bipolar disorder, are more likely to develop this extreme condition. The symptoms of this disorder are more severe and onset is observed within the first 2 weeks after delivery.
Some common symptoms of postpartum psychosis include –
- Delusions and hallucinations
- Rapid mood swings
- Insomnia or sleeping problems
- Constantly feeling confused & disoriented
- Restlessness or agitation
- Obsessive or fearful thoughts about child
- Intrusive thoughts of harming self or child
- Violent & erratic behavior
- Intense feelings of anger
- Meaningless chatter
- Suicidal thoughts or attempts
Postpartum psychosis is considered as a medical emergency. Women affected by it should seek immediate medical help and get treated.
Apart from this, women with PPD may also experience postpartum anxiety or postpartum OCD. Around 1 in 6 women 6 experience postpartum anxiety following childbirth, while 1 in 5 women who are first-time mothers have developed it. However, postpartum OCD is rare affecting only 1 to 3 in 100 7 childbearing women.
Postpartum Depression In Fathers
Although most new mothers struggle with PPD or postnatal depression, new fathers may also be affected by it. Men can also experience sadness, fatigue, anxiety, changes in appetite and sleeping patterns and feel overwhelmed after childbirth, just as a new mother. This is especially visible in young fathers who may have already experienced depression previously. Moreover, men with financial and relationship problems are more likely to develop this condition. This is generally known as paternal postpartum depression.
According to a 2010 study 8, around 4% of new fathers suffer from PPD in the first year after their baby’s birth. Another 2019 study 9 states that currently “there are no established criteria for PPD in men, although it could present over the course of a year, with symptoms of irritability, restricted emotions, and depression.” Moreover, fathers who experience extreme anxiety and stress due to parenthood, feel detached due to mother-infant bonding or lack of social support have higher chances of developing paternal PPD. However, with effective treatment, this condition can be treated both in mothers and fathers as well.
Symptoms Of Postpartum Depression
Postpartum depression can feel different for each individual. However, there are some common symptoms that can occur within the first few weeks after delivery. Here are some of the most common physical and emotional symptoms & indicators of PPD:
1. Physical symptoms:
- Severe anxiety & panic attacks
- Loss of energy, fatigue or exhaustion
- Frequent crying
- Loss of appetite or overeating
- Insomnia or sleeping too much
- Unexplained aches or pains
- Weight changes
- Digestive problems without any clear cause
2. Emotional & psychological symptoms:
- Intense feelings of sadness and misery
- Severe mood swings
- Feelings of hopelessness & helplessness
- Feeling detached or disconnected from the baby
- Social withdrawal
- Intense irritability and anger
- Feelings of guilt, shame & worthlessness
- Lack of interest in hobbies and enjoyable activities
- Doubts about not being a good mother
- Trouble concentrating, remembering, & making decisions
- Feelings of loss of control
- An intense need to escape
- Disinterest in the child
- Fear of being alone with the child
- Intrusive thoughts of harming self or child
- Suicidal thoughts
Causes Of Postpartum Depression
The exact cause for the development of PPD is not clearly known. However, it is believed that a combination of different factors lead to the development of this mood disorder. Some of the most prominent factors for developing this type of depression include the following:
1. Physical factors
Childbirth can lead to dramatic hormonal changes 10 in the body. Changes in hormones like progesterone and estrogen can often result in PPD. During pregnancy, these hormones can become higher than usual. However, within 24 hours after delivery, levels of estrogen and progesterone may drop down to their usual levels. Such an abrupt change in hormone levels can cause depression. Moreover, various hormones generated by the thyroid gland can also change substantially that may leave a new mother feeling depressed, fatigued and lethargic.
Here are some other physical factors that can contribute to the the development of PPD:
- Lack of nutritious diet
- Sleep deprivation
- Other mental health or conditions
- Alcohol or substance abuse
2. Genetic factors
Women with a history of a mood or anxiety disorder in the family have a higher risk of developing depression after delivery. Research 11 indicates that “genetic polymorphisms can be linked theoretically to an increased risk of PPD,” however, no specific gene has been identified yet. So if one or more family members have experienced PPD, then women from that family may also be affected by it. Moreover, women who have suffered from depression or anxiety previously, especially before or during pregnancy, are at a greater risk of developing this condition.
3. Emotional factors
Most people may have some doubt regarding pregnancy. However, if the pregnancy is unplanned or unwanted, then the woman may suffer from depression. On the other hand, parents who have properly planned the pregnancy may also have difficulty with adjusting to childbirth and having a new baby. Moreover, parents, who are affected by some medical condition or illness and are unable to care for their child, may feel intense sadness, guilt, shame and anger. Such negative emotions can greatly affect a new mother’s ability to cope with stress and their self-esteem.
Some new mothers may doubt their ability to care for their baby, have difficulty with self-identity, may feel unattractive, or feel a lack of control over their lives. They can also have a negative attitude toward the child or have difficulty accepting the child’s gender. These thoughts and feelings may also lead to postpartum depression. Moreover mothers who have experienced sexual abuse during childhood may also feel depressed after childbirth.
4. Lifestyle factors
Dramatic lifestyle changes that occur after the birth of a baby can also be a significant contributing factor. Caring for a child can profoundly change the existing lifestyle of new parents causing PPD in both mothers and fathers. While caring for the infant, parents are typically unable to get enough sleep, rest or time to care for their own health and well being. This can lead to sleep deprivation, changes in appetite, and exhaustion and limited physical activities. All these can combinedly result in the development of PPD.
5. Social factors
A lack of support from family members, friends and others may cause postpartum depression as well. Moreover, certain stressful experiences and life events like a family illness, loss of a loved one, domestic violence, physical, emotional or sexual abuse, or moving to a new location may also act as causative factors.
Apart from these, there may be some other risk factors for postpartum depression, such as:
- Difficulty getting pregnant
- Complicated pregnancy or childbirth
- Excessive worry about child
- Giving birth to twins, triplets or other multiple births
- A child with health issues or special needs
- Trouble breastfeeding
- Teenaged, young or older motherhood
- Relationship problems or marital conflict
- Financial problems or poverty
- Smoking or drinking during pregnancy
- Loneliness or single parenthood
- Previously diagnosed with bipolar disorder
Complications For People With PPD
This condition can adversely affect the mother-child bond and affect the mother’s ability to care for the infant. Moreover, this can also cause family issues and marital conflict.
1. Complications for mothers
Postpartum depression can persist for several months or even longer, if left untreated. Without professional help and care, PPD can lead to a chronic depressive disorder. However, it can also lead to higher risks of major depression in future, even when it is treated.
2. Complications for fathers
New fathers may experience emotional distress and strain due to a ripple effect of depression in mothers. PPD in mothers can greatly increase the risk of depression in fathers. Moreover, PPD can also affect fathers, irrespective of the condition in the mother.
3. Complications for children
When postpartum depression is left untreated in mothers, then the child has a higher risk of experiencing behavioural problems and emotional issues. These may include excessive crying, sleeping problems, eating disorders, shorter height 12, difficulties in language development and a higher risk of obesity 13 in preschoolers. Moreover, children may also have difficulties coping with stress and adjusting socially 14, especially in school during adolescence.
When To See A Doctor
Most new mothers are at risk of developing postpartum depression, peripartum depression and other mood disorders. If you think you or your partner or a loved one is suffering from PPD then it is important to consult an obstetrician–gynecologist (ob-gyn) or a mental health professional immediately. Typically, you should not delay visiting a doctor till the postpartum checkup.
Here are a few warning signs that you should immediately contact your doctor:
- Baby blues persist even after 2 weeks
- Symptoms of depression last for over 2 weeks
- PPD symptoms start within 1 year of childbirth
- Several symptoms of depression become increasingly intense
- Symptoms affect the sufferer’s ability to function or conduct daily regular tasks
- Affected parent is unable to care for the child
- Intrusive thoughts about harming self or child
- Suicidal thoughts or tendencies
Your doctor or healthcare provider will be able to help with treatment after asking a few questions to determine the presence and severity of depression.
Diagnosis Of Postpartum Depression
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies this condition as “depressive disorder with peripartum onset.” According to the American Psychiatric Association, peripartum depression is “depression occurring during pregnancy or after childbirth. The use of the term peripartum recognizes that depression associated with having a baby often begins during pregnancy.” This may be experienced either during pregnancy or within one month after childbirth.
As no distinction is made between depression experienced during pregnancy or after delivery, PPD is diagnosed as depression occurring anytime during the first year after childbirth. The criteria for diagnosing postpartum depression is similar to that of major depression or any other non-childbirth related depression. However, at least 5 symptoms from the following should be present within 2 weeks of onset:
- Feelings of intense sadness, hopelessness or emptiness almost every day, most of the time or depressive mood identified by others
- Loss of interest or lack of pleasure in activities
- Changes in sleep patterns
- Reduced appetite or weight loss
- Loss of energy
- Feelings of guilt or worthlessness
- Increased indecisiveness or loss of concentration
- Suicidal thoughts and tendencies
PPD can only be diagnosed by a healthcare professional. The doctor may conduct a depression-screening questionnaire to rule out other medical illnesses or even baby blues as a cause for the condition. The doctor may also conduct some examinations or diagnostic tests, like blood tests to find out if hormonal issues are causing the symptoms.
Treatment Of Postpartum Depression
If you have been diagnosed with PPD, then you must immediately seek treatment under the guidance of a doctor or mental health professional, like a psychiatrist or a psychologist. The treatment and recovery largely depend on the severity of the condition and the personal needs of the patient. Therapy and medication are the primary modes of treatment available for postpartum depression. Although the doctor may recommend either therapy or medication, utilizing both together can be more effective. Here are the available treatment options for PPD:
Talking to a psychologist, psychiatrist or other mental health professional can help you get access to counselling. Psychotherapy can help patients to cope with negative and destructive thoughts and enable you to better cope with them by developing effective strategies.This will help you manage your emotions, set realistic goals, resolve issues & problems and positively respond to challenges. Some of the most helpful forms of therapy for postpartum depression may include:
- Cognitive Behavioral Therapy (CBT)
- Interpersonal Therapy (IPT)
- Electroconvulsive therapy (ECT)
- Bright light therapy
- Nondirective counseling
- Peer and partner support
A 2010 study 15 states “existing research supports the use of both psychological treatments (specifically interpersonal therapy, cognitive-behavioral therapy, and psychodynamic psychotherapy), as well as psychosocial interventions, such as nondirective counseling,” for the treatment on PPD.
The doctor may recommend antidepressants for treating PPD. Antidepressants help to regulate mood and directly affect the brain. However, these medications take some time to work. So it may take several weeks before the patient can experience any benefits or potential side effects of antidepressants. In case you are breastfeeding, antidepressants may affect your breast milk. A scientific review 16 explains “Pharmacologic recommendations for women who are lactating should include discussing the benefits of breastfeeding, the risks of antidepressant use during lactation, and the risks of untreated illness.”
Apart from this, there may be some other side effects of using antidepressants, such as dizziness, fatigue, reduced libido etc. This is why it is crucial to consult with a doctor before taking any medication for PPD as medical professionals can help you understand the potential risks and devise an effective treatment plan. The doctor may also suggest hormone therapy if you have low estrogen levels or recommend repetitive transcranial magnetic stimulation (TMS) for women who breastfeed. One study 17 found that both cognitive behavioral therapy and the antidepressant fluoxetine “given as a course of therapy are effective treatments for non-psychotic depression in postnatal women.”
Continually maintain open communication with your doctor and talk to them about any side effect that you may experience. It may take some time to determine an effective treatment plan that will work for you.
Read more to know about : Treatment Of Postpartum Depression
Coping With Postpartum Depression
Apart from seeking medical treatment, it is also important that you make some healthy changes in your lifestyle and daily routine. Here are a few tips that can help you to cope with PPD, when used together with medical treatment and guidance from your doctor:
- Build a strong and secure emotional bond with your child as it will affect your relationship and communication with your baby throughout life.
- Maintain physical contact with your baby as skin-to-skin contact will help to make you both relaxed and strengthen your bond.
- Massage your baby frequently as studies 18 have found that infant massage improves the bonding process and reduces the intensity of postpartum depression symptoms in mothers.
- Eat omega-3 fatty acids found in oily fish like salmon and herring, especially during pregnancy, as it may reduce the risk of PPD.
- Get enough sleep as women with this condition tend to sleep less and take longer to fall asleep.
- Spend some time in the sun as exposure to sunlight and even fresh air helps to improve mood.
- Practice self-care and focus on your own needs and wants by asking a loved one to look after the baby for a while.
- Introduce exercise into your schedule as studies 19 have found that physical activity helps to overcome PPD.
- Build a support network and have positive interactions with your friends and family as emotional support can help to reduce stress. It is also important to avoid social isolation.
If your partner or a loved one is suffering from postpartum depression then you must encourage them to seek professional help and follow the medical treatment plan as instructed by the doctor.
Postpartum Depression Is A Treatable Condition
Anyone can be affected by depression. However, as new mothers experience a lot of mental, emotional and physical changes during childbirth, they are more prone to getting depressed during and after pregnancy. “Postpartum depression (PPD) is a significant public health problem which affects approximately 13% of women within a year of childbirth,” explains the World Health Organization (WHO) 20.
However, it can be effectively treated with timely identification, proper diagnosis and effective treatment under the supervision of a healthcare professional. So if PPD is affecting your ability to care for your child and yourself, consult a doctor immediately. With treatment, self-care and support from your partner, family and friends you can love and care for your baby the best way.References:
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