Postpartum depression

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Types
Symptoms
Causes And Risk Factors
Prevention
Diagnosis
Treatment
Lifestyle/management
Prognosis And Complications
Alternative Treatments

Around 13 per cent of women suffer from Postpartum depression within one year of childbirth. It can remain undiagnosed or untreated for years due to a lack of awareness. According to a study, more than 65% of mothers in Asian countries suffered from Postpartum depression. These statistics are even higher if we include cases of stillbirths and miscarriages and even unreported cases. The condition is accompanied by debilitating symptoms similar to clinical depression. It is found that 50% of women start experiencing symptoms of Postpartum depression during pregnancy. Postpartum depression may affect the mother’s abilities and skills to engage in delicate interaction with the child. It begins as insecurity, usually within 30 days of the baby’s birth, and rapidly expands to other symptoms that typically include sadness or anxiousness throughout the day that often worsens in the evening. [1]

Types

Postpartum depression’s classification is based on the severity:

Postpartum Blues – It is also known as Baby Blues. Around 85% of all women are found to experience Postpartum Blues. It is the most common and mildest type of Postpartum depression. If symptoms persist for more than two weeks, it is advisable to seek psychiatric help.

Postpartum Anxiety – It is another common form of Postpartum depression. It mostly remains undiagnosed as it has symptoms of constant worrying, fearfulness and stress which are not generally considered a disorder.

Postpartum Post Traumatic Stress Disorder (PTSD) – Over 9% of women have Postpartum PTSD. The symptoms are similar to general PTSD. It occurs following situations like unplanned C-sections, unhealthy infants, and other childbirth complications.

Postpartum Panic Disorder – This is found to occur in about 10% of women after childbirth. Symptoms include tightness in the chest, palpitations, and shortness of breath, and are more common in women with severe anxiety, panic attacks, and even thyroid dysfunctions.

Postpartum Obsessive-Compulsive Disorder (OCD) – In a cohort study, around 11% of women were found to have symptoms of OCD after childbirth, with no previous history of the condition.

Postpartum Psychosis – It is the most severe form of Postpartum depression, and has a low prevalence. It can begin within 2-3 days after childbirth with mild symptoms like sleeplessness and irritation. However, it can lead to delusions, disorientation, erratic behaviours and auditory hallucinations that can harm the subject or the infant. [2,3]

Symptoms

The symptoms of Postpartum depression can be so generic that they often remain unnoticed as a medical condition.

Following are the common symptoms of Postpartum depression:

Feeling irritable

Suffer from lack of concentration

Abnormal sleeping pattern

Feeling exhausted and fatigued

Lack of motivation to take care of your child

Irritation and restlessness

Feeling hopeless or numb

Physical symptoms like muscle ache and headache

Fear of harming oneself or the infant

In certain types of Postpartum depression, such as Postpartum Anxiety, OCD, PTSD, panic disorder and psychosis, the symptoms can become more alarming.

Following are the severe symptoms of Postpartum depression:

Repetitive actions like bathing the infant or changing his/her clothes several times

Panic attacks

Breathing difficulty

Hallucinations, mostly auditory, where the mother perceives commands to cause harm to herself or the baby

Delusions and disorientation

Suicidal thoughts; in worse conditions, suicidal attempts

Postpartum psychosis has the most severe signs and is considered a medical emergency. It is a type of Postpartum depression that has the highest rates of suicide and infanticide. [4,5]

Causes And Risk Factors

Causes

Though experts have not been able to pinpoint a single cause of Postpartum depression, it is believed that a combination of factors like hormonal, biochemical, physiological, environmental and genetics work in conjunction to make one prone to Postpartum depression.

The following conditions have been found to cause Postpartum depression:

Sudden drop in hormonal levels: Levels of hormones like progesterone and oestrogen can increase up to tenfold during pregnancy. The hormone levels come back to normal soon after Postpartum. This can lead to some behavioural changes.

Physical changes: Changes in the body after childbirth, like weight gain, stretchmarks or physical pain after delivery, can be a cause of Postpartum depression.

Prolonged pregnancy blues: This is the mildest form of the condition and is known to last for a short time, usually undiagnosed and untreated. However, in some cases, it can last longer and become severe.

Early pregnancy: If one isn’t in a stable mind and good health to embrace pregnancy, it could set a stage for the blues to set in and stay longer post-childbirth and delivery.

Multiple pregnancies: If you had a painful delivery and labour coupled with anxiety and panic attacks during pregnancy, you are bound to face bouts of depression. A subsequent pregnancy will only add to the stress and increase the chances of the condition haunting you.

Stress [6]

Risk Factors

Following are the risk factors that can lead to Postpartum depression:

Medical history- Personal or family history of depression increases the likelihood of Postpartum depression.

Marital conflicts

Lack of social support

Low self-esteem

Maternal neuroticism

Unplanned or unwanted pregnancy

Being a single parent

Complications during or after pregnancy

Low socioeconomic status

Environmental factors – A study found that women in metropolitan cities, towns and suburbs are more likely to experience Postpartum depression. [7,8]

Prevention

There is no known way of preventing or avoiding Postpartum depression. However, sleep-promoting and self-care can result in a lower occurrence of Postpartum depression. Some efforts to be taken during pregnancy include eating healthy food, exercise, yoga and meditation. It is also recommended to avoid caffeine sources like tea and coffee as well as alcoholic beverages immediately after childbirth. It is important to break down the stigma of depression and seek medical support whenever needed. [9]

Diagnosis

If all symptoms of Postpartum depression are evident, the primary healthcare provider may suggest you visit a specialist. Following are some of the methods of diagnosing Postpartum depression:

Noting the signs and symptoms, along with their frequency

Testing for other mental illness

Depression screening – This usually involves the use of a questionnaire to rate the mental state of the individual. A commonly used depression screening method for Postpartum depression is the Edinburgh Postnatal Depression Scale (EPDS). This involves a 10-item questionnaire in which the subject is asked to rate the state of their condition in the range of 0 to 3. An EPDS>= 13 is considered normal.

Other screening methods include:

– The Centre for Epidemiologic Studies of Depression instrument (CES-D) consists of 20 questions, and scores greater than or equal to 16 indicate chances of Postpartum depression.

– Patient Health Questionnaire (PHQ-9)

– The Postpartum Depression Screening Scale (PDSS) – This method is widely used when diagnosis has to be done over the telephone.

Laboratory testing – Hypothyroidism is also a proposed cause of depression, especially in Postpartum panic disorder. Therefore, thyroid levels are tested. [10,11]

Treatment

The following is the recommended treatment for Postpartum depression:

Therapy – Therapy with a psychologist or psychiatrist to plan a strategy against Postpartum depression.

Marriage counselling – Difficulties in marital life can affect the mental health of the mother, thereby increasing the chances of Postpartum depression,

Medications

– Antidepressants: Conventional medications are antidepressants like fluvoxamine, fluoxetine, Sertraline, and venlafaxine. Apart from this, drugs that act as Specific Serotonin Reuptake Inhibitors are useful as they do not cause sedation and are well-tolerated. Tricyclic antidepressants (TCA) are effective but can cause sedation. Many women choose non-pharmacological treatment while they are breastfeeding.

– Hormonal therapy- The sudden changes in hormonal levels can be a cause of Postpartum Blues. Oestrogen replacement therapy is used along with antidepressants.

Electroconvulsive therapy (ECT) – This is used for severe conditions like Postpartum Psychosis. Patients with Postpartum Psychosis require inpatient treatment.

Self-care for Postpartum depression:

Exercising – If exercise is not a viable option, take a small stroll with your baby outdoors. A gush of fresh air and a change of environment can go a long way in helping one recover from the blues

Meditation

Rest and sleep – Whether your labour went according to your plan or you needed an emergency medical intervention, don’t fret about it now. Sleep with your baby whenever possible to give your body proper rest to recuperate from the strains of labour and fight the blues.

Make time for yourself – Remember, coping with the demands of a newborn can go haywire, so go slow on yourself. It’s okay if your house is a mess if you have piles of laundry to do, your culinary skills have gone for a toss, and you have lost sense of night and day

Getting outdoor

Sought for medical help – People are generally reluctant to take medication for depression Postpartum, but one should know that the symptoms of the depression are more harmful to the baby than medications for depression. [6,12,13]

Lifestyle/management

It is important to not feel embarrassed, guilty or overwhelmed by your condition. Following are the ways of managing your lifestyle that will be helpful for your speedy recovery:

Make it a priority to find time for yourself and indulge in your hobbies. You can try reading, meditation, or exercise in any form you are comfortable with. Even a 15-minute walk can make you feel better.

Talk to people, get in touch with people and institutions that can support you.

Maintain a journal or diary.

Do not hesitate to talk about how you feel to your spouse, doctor or family. [9]

Prognosis And Complications

Prognosis

Generally, the prognosis is good and most women are found to recover. However, Postpartum Psychosis may have chances of contracting other mental illnesses in the future. Treatment of Postpartum depression is successful in 80% of all cases. As with any other disorder, early detection and treatment ensure a faster recovery. [1]

Complications

Contrary to popular belief, Postpartum depression doesn’t interfere with mother-child bonding. If a mother doesn’t want to take care of the baby, it doesn’t mean she isn’t in love with her child. But the symptoms of depression are so overpowering that they can overshadow durable maternal love. Hence, if the feeling of blues escalates, it can be an alarming situation. A child, who faces the consequences of maternal depression, can have delayed development of vocal skills, be more restless, and cranky and may be more prone to anxiety disorder in future. So, even if not for oneself, it makes sense to get treated for Postpartum depression for the sake of the child.

Alternative Treatments

Although there are not enough studies to claim the benefits of alternative treatments, some women find acupuncture, meditation, cognitive behavioural therapy and psychological therapy useful. [11]

References

1. Carberg, J. (2021). Statistics on Postpartum Depression - Postpartum Depression Resources. Retrieved 22 June 2021, from https://www.Postpartumdepression.org/resources/statistics/

2. Health, M. (2021). Postpartum Psychiatric Disorders - MGH Center for Women's Mental Health. Retrieved 22 June 2021, from https://womensmentalhealth.org/specialty-clinics/Postpartum-psychiatric-disorders/

3. Carberg, J. (2021). Postpartum Depression Types – Psychosis OCD, PTSD, Anxiety and Panic. Retrieved 22 June 2021, from https://www.Postpartumdepression.org/Postpartum-depression/types/

4. Carberg, J. (2021). Symptoms of Postpartum Depression - Common Symptoms To Watch For. Retrieved 23 June 2021, from https://www.Postpartumdepression.org/Postpartum-depression/symptoms/

5. Postpartum Mood Disorders: What New Moms Need to Know. (2021). Retrieved 23 June 2021, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/Postpartum-mood-disorders-what-new-moms-need-to-know

6. Postpartum Depression and the Baby Blues - HelpGuide.org. (2021). Retrieved 23 June 2021, from https://www.helpguide.org/articles/depression/Postpartum-depression-and-the-baby-blues.htm#

7. Carberg, J. (2021). Causes of Postpartum Depression - Understanding Postpartum Depression. Retrieved 23 June 2021, from https://www.Postpartumdepression.org/Postpartum-depression/causes/

8. Postpartum Depression: Types, Symptoms, Treatment & Prevention. (2021). Retrieved 23 June 2021, from https://my.clevelandclinic.org/health/diseases/9312-Postpartum-depression

9. Staff, f. (2021). Postpartum Depression: Diagnosis, Symptoms, Treatment. Retrieved 23 June 2021, from https://familydoctor.org/condition/Postpartum-depression/

10. Sit, D. K., & Wisner, K. L. (2009). Identification of Postpartum depression. Clinical obstetrics and gynecology, 52(3), 456–468. https://doi.org/10.1097/GRF.0b013e3181b5a57c

11. Hirst, K., & Moutier, C. (2021). Postpartum Major Depression. Retrieved 23 June 2021, from https://www.aafp.org/afp/2010/1015/p926.html

12. Health, M. (2021). Postpartum Psychiatric Disorders - MGH Center for Women's Mental Health. Retrieved 23 June 2021, from https://womensmentalhealth.org/specialty-clinics/Postpartum-psychiatric-disorders/

13. (2021). Retrieved 23 June 2021, from https://www.womenshealth.gov/mental-health/mental-health-conditions/Postpartum-depression