Postpartum depression (PPD) is a complex mix of physical, emotional and behavioral changes that occur in some women after giving birth. According to the DSM-5, a manual used to diagnose mental disorders, PPD is a form of major depression that begins within 4 weeks of delivery.
Most new moms experience the “baby blues” after delivery. About 1 in every 10 of these women will develop more severe and longer-lasting depression after childbirth. About 1 in 1,000 women develop a more serious condition called postpartum psychosis.
Dad is not immune. Research shows that approximately 1 in 10 new fathers develop depression during their child’s birth year.
Postpartum depression is associated with the chemical, social and psychological changes that occur at the time of childbirth.
Chemical changes include a rapid drop in hormones after delivery. The actual link between this decline and depression is still unclear. But what is known is that levels of the female reproductive hormones estrogen and progesterone increase tenfold during pregnancy. Then, they drop off rapidly after delivery. By 3 days after a woman’s birth, levels of these hormones return to pre-pregnant levels.
In addition to these chemical changes, the social and psychological changes of having a baby increase the risk of depression.
Signs and symptoms
The symptoms of postpartum depression can be difficult to detect. Many women have these symptoms after delivery:
- insomnia
- change in appetite
- severe fatigue
- low libido
- frequent mood swings
As with PPD, these come with other symptoms of major depression, which are not typical after childbirth, and may include:
- Not taking interest in your child or feeling like you’re not bonding with him
- crying all the time, often for no reason
- depressed mood
- severe anger and hoarseness
- loss of pleasure
- Feelings of worthlessness, hopelessness and helplessness
- thoughts of death or suicide
- thoughts of hurting someone else
- trouble concentrating or making decisions
A new mom should seek professional help when:
- Symptoms persist for more than 2 weeks
- they can’t work normally
- They can’t cope with everyday situations
- they have thoughts of harming themselves or their baby
- They are feeling extremely anxious, scared and nervous throughout the day
causes and risk factors
If you have PPD, it’s not because you did something wrong. Experts agree that this happens for a variety of reasons, and they can be different for different people. Some things that can increase your chances of postpartum depression include:
- History of depression before becoming pregnant or during pregnancy
- Age at pregnancy (the younger you are, the higher the chances)
- ambiguity about pregnancy
- Children (the more you have, the more likely you are to be depressed in subsequent pregnancies)
- family history of mood disorders
- going through a highly stressful event, such as 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
- living alone
- marital conflict
types of postpartum depression
Three words are used to describe the mood swings that women experience after birth:
- The “baby blues” occur in up to 70% of women shortly 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 feel impatient, cranky, restless, anxious, lonely and sad. The baby blues can last only a few hours or 1 to 2 weeks after delivery. You usually do not need treatment from a health care provider for the baby blues. Often, joining a new moms support group or talking with other moms helps.
- Postpartum depression (PPD) can occur days or even months after the baby is born. PPD can occur after the birth of any child, not just the first child. You may have feelings like the baby blues – sadness, hopelessness, anxiety, hoarseness – but you feel them much more strongly. PPD often prevents you from doing the things you need to do every day. When your ability to function is affected, you need to see a health care provider such as your OB/GYN or primary care doctor. This doctor can examine you for symptoms of depression and design a treatment plan. If you don’t get PPD treated, symptoms can get worse. While PPD is a serious condition, it can be treated with medication and counseling.
- Postpartum psychosis is a very serious mental illness that can affect new mothers. The disease can occur quickly, often within the first 3 months after childbirth. Women may lose touch with reality, with auditory hallucinations (hearing things that are not actually happening, such as a person talking) and belief delusions (which are clearly irrational). Visual hallucinations (seeing things that are not there) are less common. Women who have postpartum psychosis require prompt treatment and almost always require medication. Sometimes women are kept in hospital because they are at risk of hurting themselves or someone else.
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.
If you’re breastfeeding, don’t think you can’t take medicine for depression, anxiety, or psychosis. Talk to your doctor. Many women take the drug under the supervision of a doctor during lactation. This is a decision to be made between you and your doctor.
Complications
Postpartum depression that is left untreated can undermine your ability to bond with your baby, and can affect the whole family:
- You. Postpartum depression that is left untreated can last for months or longer, even turning into a chronic depressive disorder.
- The child’s father. When a new mother has depression, the father may also be more likely to have depression.
- Children. Babies of mothers with postpartum depression are more likely to have problems sleeping and eating, crying more than usual, and delayed language development.
prevention of postpartum depression
If you have a history of depression, tell your doctor as soon as you know you are pregnant, or if you plan to become pregnant.
- during pregnancy. Your doctor can monitor you for symptoms. You can manage symptoms of mild depression with support groups, counseling, or other therapies. Your doctor may still prescribe medicines while you are pregnant.
- after the birth of your child. Your doctor may recommend early postpartum screening to look for signs of depression. The sooner you are diagnosed, the sooner you can start treatment. If you have a history of postpartum depression, your doctor may recommend treatment soon after the baby is born.
postpartum management
Here are some tips that can help you bring a newborn home:
- ask for help. Tell others how they can help you.
- Be realistic about your expectations for yourself and the baby.
- exercise, within the limits of any restrictions your doctor may impose on your activity level; Take a walk, and get out of the house for a rest.
- Expect some good days and some bad days.
- follow a sensible diet; Avoid alcohol and caffeine.
- Foster relationships with your partner – Take time for each other.
- Keep in touch with family and friends – don’t isolate yourself.
- Limit visitors when you first go home.
- screen phone call.
- Sleep or rest while your baby is sleeping.
Dr. Anita Rao, MBBS, MD (OBGYN), MRCOG and Laparoscopic Surgeon, Consultant – Obstetrics and Gynecology
MBBS, MD (OBGYN), MRCOG and Laparoscopic Surgeon,
Consultant – Obstetrics and Gynecology,
Birthright by Rainbow Hospitals, Rainbow Children’s Hospital, Hebbal, Bangalore