POST PARTUM DEPRESSION : Depression in mothers after Delivery

POST PARTUM DEPRESSION : Depression in mothers after Delivery

 The  arrival of a new baby is usually a happy time and time for celebrations. 

It can also be a stressful time during which a Mother or Father or Family have to make a lot of adjustments. 

Unfortunately, many women are not aware that mood changes are common after childbirth. These changes vary from mild to severe and can include postpartum depression. 

In fact, in the year after childbirth a woman is more likely to need help and care from family and may also need a psychiatrist or Family Doctor than at any other time in her life.

Types of POST-PARTUM MOOD Disorder

There are three recognized mood disorders in the period after birth.

Baby Blues : It affects about 80% of new mothers and occurring between the third and tenth day after birth. 

Symptoms include emotional crying, anxiety, mood fluctuations and irritability. 

The ‘blues’ are transient and will pass with understanding and support.

Post-Partum  Psychosis : This affects 1 in 500 mothers, usually in the first 3-4 weeks after delivery.

It is a serious condition. 

The mother herself might be unaware that she is ill, because her grasp on reality is affected.

 Symptoms include severe mood disturbance (either marked elation or depression or fluctuations from one to the other), disturbance in thought processes, bizarre thoughts, lack pr inability to sleep and inappropriate responses to the baby (like lying over the baby or not feeding the baby)

There is risk to the life of both mother and baby, if the problem is not recognized and treated. 

Post-partum psychosis requires a hospital admission, exclusive family support, handling of the baby by family members and counseling of the family.

 With appropriate treatment (anti-psychotic medicines may be needed), women suffering from post-patum psychosis recovers completely.

Post-Partum Depression : Between the ‘blues’ and psychosis lies post-partum depression. Most women find adjusting to life with a new baby very difficult. More than 15% of women and 10% of men develop post-partum depression.

It can occur unexpectedly after delivery and they typically blame themselves, their partners or their baby for the way they feel. Some try hard to get over it but there is no control over feelings.

It occurs in all cultures and all socioeconomic classes and can happen to child-bearing women of all ages.

 It appears with mild, moderate or severe symptoms. It can begin during pregnancy (antenatal depression), suddenly after birth, or gradually in the weeks or months following delivery. Symptoms can emerge at any time during the first year after birth. Most cases have their onset within the first four months.

It can happen after miscarriage, stillbirth, normal delivery or caesarean delivery. Pregnancy is the common factor.

It happens mostly after the first baby but can occur after any other pregnancy.

It can recur with a subsequent pregnancy. If a woman becomes pregnant again before recovering from it, the condition will continue through the pregnancy and can worsen. 

If a woman has been taking medication, it’s wise to wait at least a year after discontinuing medication before falling pregnant again.

Men can experience PND too.

What causes Post Partum Depression

It is caused by a combination of biological, psychological (spiritual) and social (cultural) factors. 

It results in a variety of symptoms and affects women’s lives severely.

It exists within families and communities, not with the woman alone. Assessment and intervention need to consider the significant other people in her family.

Biological factors

• Genetic predisposition to developing depression
• Sudden changes in pregnancy hormones following delivery
• Nutritional deficiencies and sleep deprivation
• Difficult pregnancy or childbirth experiences
• History of premenstrual tension
• Previous experience of Depression or family/personal history of mental health conditions

Psychological factors

• Infertility and use of IVF for conception
• Difficult or traumatic birth – for example, unexpected interventions in the birth or an emergency caesarean
• Problematic or unresolved relationship issues between the mother and her own mother
• Traumatic/abusive childhood (particularly sexual abuse)
• Unrealistic expectations of motherhood and of herself
• Certain personality types (perfectionist or controlling)
• Limited social and emotional skills (difficulties in effectively communicating)
• Past unresolved issues of grief and loss such as previous miscarriage

Social factors

• Lack of family and community support
• Difficult relationship with partner – for example, the woman’s partner might be removed emotionally, work long hours or travel a lot
• Intrusive or difficult family relationships
• Social isolation 
• Financial problems
• Lack of close friends, particularly families with children
• Being of a younger or older age
• Stressful life events, such as a death in the family or job loss

Symptoms of Post Partum Depression

Symptoms can begin anywhere from 24 hours to several months after delivery. Women are more likely to seek help early when onset is abrupt and symptoms are severe. Sometimes symptoms are harder to separate from normal changes after having a baby.

Sleep disturbance unrelated to baby’s sleep needs: most women with a young baby fall asleep as soon as they are able to. Women with post-partum depression often lie awake for hours feeling anxious while the baby sleeps. Sometimes they wake early in the morning. Others want to sleep all the time and have trouble getting up in the morning.

Appetite disturbance: women might feel totally uninterested in food. Sometimes they say, ‘I force myself to eat because I am breastfeeding, but I don’t taste anything’. Sometimes women overeat in an attempt to control their anxiety. Others feel sick at the thought of food.

Crying: a woman might feel sad and cry without apparent reason. Tears come easily day and night.  Some women say, ‘I want to cry but can’t. I am crying on the inside’.

Inability to cope: daily chores, caring for the baby or self-care might seem impossible. Small demands a woman previously coped with might completely overwhelm her. A woman might feel like running away. She might feel overwhelmingly exhausted and very heavy physically and emotionally. She might also wish it would all go away.

Irritability: a woman with PND might snap at her partner or other children without cause. Partners often say, ‘I can’t do anything right. If I fold nappies, she complains I do it the wrong way. If I don’t help, I’m being unsupportive’.

Anxiety: a woman might feel a ‘knot in the tummy’ most of the time and panic without cause. Some women experience heart palpitations so severe that a heart attack is feared. She might be anxious about her own health or her baby’s, even after reassurance that nothing is wrong. They deny being ‘depressed’. 

Negative obsessive thoughts: Small worries can consume her thought processes, interfering with her ability to listen, concentrate or remember. She might experience unrealistic fears, be afraid to let her partner go to work in case of a car accident, or be afraid to leave the baby with a friend in case something happens. No amount of reassurance or distraction can hold stop her thinking.

Fear of being alone: many women go out a lot or need their partner (or someone) at home with them at all times. This is because they’re afraid of being alone at home. The fear of something going wrong with the baby or a woman’s fear that she can’t cope with the baby on her own is overwhelming. Some feel incredibly lonely and go out to feel connected with other people. This takes an enormous amount of effort. 

Memory difficulties and loss of concentration: a woman might forget what she wanted to say mid-sentence. She might not be able to concentrate on simple tasks or take in new information. Organising herself and her family can become too difficult. Sometimes she doesn’t know where to start. Other times she might start everything at once. She might be unable to think creatively about her problems or find solutions – like reaching out to services that will help her.

Feeling guilty and inadequate: feeling guilty can be common for all mothers. Her thoughts and feelings constantly reinforce in her own mind that she is inadequate and a ‘bad mother’. She might be unable to take encouragement from the good things she has done or to feel affirmed by her relationship with her baby. Reassurance won’t stop her thinking and can discourage her from talking about how inadequate and guilty she feels.

Loss of confidence and self-esteem: a woman who enjoyed her job might panic at the thought of going back to it, no longer sure she’s able to do it. A woman who enjoyed entertaining might panic at the thought of visitors. She might feel unable to prepare a meal when she enjoyed doing so before the baby was born. Most women have very low self-esteem regardless of how well they seem.

Lack of sexual pleasure

Post Partum Depression is difficult to identify

It doesn’t usually resolve itself fully without treatment. If it is not identified or treated, it can severely affect the woman, her baby, partner, family and relationships.

With early identification and treatment, most women fully recover and have no long-term effects.

Management

• All women need emotional support from husband, family and relatives. Some women find psychological treatments helpful, especially if they have experienced traumatic events in their childhood or more recently.

• Antidepressant medication is a successful treatment for many women.Rather than ‘changing your personality’, this type of medication aims to correct chemical imbalances in the brain thought to be responsible for symptoms of depression and anxiety. Antidepressants are not addictive. Some can be safely taken while breastfeeding and pregnant.

Husband and Family support is very important in treating Post Partum Depression.

Always consult with your Family Physician regarding any of the problems.

                                                                                                                         Dr Mohit Bansal