Postpartum—or postnatal—depression (PPD) is a type of depression that affects some women after having a baby.
Typically, it develops within 4-6 weeks after giving birth, but it can sometimes take several months to appear.
The exact cause is unclear, but some risk factors have been linked to it. Usually, there is no clear reason. However, there is absolutely no link between postpartum depression and not loving the baby.
PPD is a clinical illness and not a character weakness. Anyone with symptoms should see their doctor immediately.
Effective treatment is possible with the help of support groups and counseling, and sometimes medication.
PPD can affect fathers, too. One study found that around 10 percent of fathers experience postpartum or prenatal depression. The highest rates are 3-6 months after childbirth.
The exact causes of postpartum depression are still not known.
Postpartum depression can affect mothers in several different ways. Below are some common signs and symptoms:
- a feeling of being overwhelmed
- a feeling of being trapped
- a feeling that it is impossible to cope
- low mood that lasts for longer than a week
- a sensation of being rejected
- crying a lot
- feeling guilty
- frequent irritability
- headaches, stomachaches, blurred vision - signs of tension
- lack of appetite
- loss of libido
- panic attacks
- persistent fatigue
- problems concentrating or focusing on things
- reduced motivation
- sleeping problems
- the mother lacks interest in herself
- a feeling of inadequacy
- unexplained lack of interest in the new baby
- lack of desire to meet up or stay in touch with friends
Postpartum depression is not the same as baby blues, which affects many women for a few days after giving birth. However, if the woman's ability to go about her day-to-day life is significantly undermined, it is more likely she has postpartum depression.
A significant proportion of mothers with postpartum depression do not tell people how they feel. Partners, family, and friends who are able to pick up on the signs of postpartum depression at an early stage should encourage them to get medical help as soon as possible.
Scary thoughts - some mothers with postpartum depression may have thoughts about harming their child. The mother may also think about ending her life or harming herself. The mother and/or baby are very rarely harmed; but, having these thoughts is frightening and distressing.
Experts believe postpartum depression is probably the result of multiple factors. However, its exact causes are still not known.
Depression is usually caused by either emotional and stressful events or some biological factor which leads to an imbalance of brain chemicals (neurotransmitters), or both.
The following factors may contribute to PPD:
- Depression develops during pregnancy.
- Excessive worry about the baby and the responsibilities of being a parent.
- Complicated or difficult labor and childbirth.
- Lack of family support.
- Worries about relationships.
- Financial difficulties.
- Loneliness, not having close friends and family around.
- A history of mental health problems, such as depression, or a previous postpartum depression.
- Health consequences following childbirth, such as urinary incontinence, anemia, changes in blood pressure, and alterations in metabolism.
- Hormonal changes - after giving birth, estrogen and progesterone (hormones) levels may drop considerably, as may other hormones produced by the thyroid gland.
- Lack of sleep following birth.
Breast-feeding difficulties - new mothers with breast-feeding difficulties in the first 2 weeks after the baby is born have a higher risk of postpartum depression 2 months later, according to a study carried out at the University of North Carolina at Chapel Hill.
A person with a family history of depression has a higher risk of developing it themselves. However, nobody knows why this occurs.
Women who have bipolar disorder have a higher risk of developing postpartum depression compared with other mothers.
A doctor may ask the patient to complete a depression-screening questionnaire. The aim here is to rule out baby blues.
The doctor will often ask whether the patient has felt down, depressed, or hopeless during the past month; or whether they take little or no pleasure in activities that would usually make them happy.
The doctor may also ask if the patient has:
- sleeping problems
- problems making decisions and concentrating
- self-confidence problems
- changes in appetite - this could be a lack of appetite or eating more than usual (comfort eating)
- fatigue, listlessness, reluctance to be involved in any physical activity
- feelings of guilt
- become self-critical
- suicidal thoughts
A patient who answers "yes" to three of the questions above probably has mild depression. In cases of mild depression, the mother is still able to go about her normal activities. The more "yes" answers there are, the higher the severity of depression.
If the mother answers "yes" to the question of harming themselves or the baby, it is automatically considered severe depression.
Some mothers with no partner or close relatives to help out might not want to answer these questions openly because they fear they will be diagnosed with postpartum depression and will have their baby taken away from them.
This is most unlikely to happen. A baby is only taken away in very exceptional situations. Even in very severe cases where the mother has to be hospitalized in a mental health clinic, she will usually have her baby next to her.
A mother with moderate depression will find normal activities hard to do - but with the right help will probably cope. If she has severe depression, she will not be able to function at all and will need extensive help from a dedicated mental health team.
The doctor may also order some diagnostic tests, such as blood tests, to determine whether there are any hormonal problems, such as those caused by an underactive thyroid gland, or anemia.
Postpartum depression is treatable.
Mothers who wonder whether they might have postpartum depression symptoms should get in touch with their doctor. Although recovery may sometimes take several months, and in some cases even longer, it is treatable.
The mother's most important step on the road to treatment and recovery is to acknowledge the problem. Family, partner, and close friends' support can have a major impact on a faster recovery.
Experts say it is better for the mother to express how she feels to people she can trust, rather than bottling everything up inside. There is a risk that partners or other loved ones may feel shut out, which can complicate things.
Self-help groups are beneficial because not only will the mother have access to useful data, she will also meet other mothers who share similar problems and symptoms. This may help her feel less isolated.
In moderate or severe postpartum depression, the doctor may prescribe an antidepressant. These help balance the chemicals in the brain that affect mood.
Antidepressants may help with irritability, hopelessness, a feeling of not being able to cope, concentration, and sleeplessness. These medications tend to have good results and help the mother cope better and bond with her baby, but can take a few weeks to kick in.
Antidepressants can be passed on to babies through breast milk. Nobody knows what the long-term risks are for the baby. According to some small studies, TCAs (tricyclic antidepressants), such as imipramine and nortriptyline are most likely the safest to take while breast-feeding a baby. If the mother has a history of heart disease, epilepsy, or severe depression with frequent suicidal thoughts, she should not be prescribed TCAs.
Those who cannot take TCAs may be prescribed an SSRI (selective serotonin reuptake inhibitor), such as paroxetine or sertraline. The amount of paroxetine or sertraline that eventually gets into breast milk is minimal.
The mother should discuss feeding options with her doctor so that selecting the right treatment, which may include an antidepressant, is an informed choice decision.
Tranquilizers may be prescribed in cases of postnatal psychosis, where the mother may have hallucinations, suicidal thoughts, and irrational behavior. However, in such cases, the medications should be used for a short time. Side effects include:
- loss of balance
- memory loss
Cognitive therapy is also effective for some people - this type of therapy is based on the principle that a person's thoughts can trigger depression. The patient is shown (taught) how her thoughts can have a harmful impact on her state of mind. The aim is to alter the patient's thought patterns so that they become more positive For those with severe depression, where motivation is low, talking therapies alone are much less effective. Most studies agree that the best results come from a combination of talking therapies with medication.
If the mother's symptoms are very severe and do not respond to other treatment, she might benefit from electroconvulsive therapy (ECT). However, this is always a treatment of last resort - when all other options, such as medication and talking therapies, have failed.
ECT is applied under general anesthetic and with muscle relaxants. ECT is usually very effective in cases of very severe depression; however, benefits may be short-lived.
Side effects include headaches and memory loss (usually short term, but not always).
Treating severe postpartum depression
A patient with severe postpartum depression may be referred to a team of specialists, including psychiatrists, psychologists, occupational therapists, and specialized nurses. If the doctor(s) feels that the patient is at risk of harming herself or her child, she may be hospitalized in a mental health clinic.
In some cases, the baby may be cared for by the partner or a family member while the mother is being treated.
The more a doctor knows during or even before a pregnancy about the patient's medical and family history, the higher the chances are of preventing postpartum depression.
According to the National Health Service (United Kingdom), the following may help:
Stay physically fit - do regular exercise. Many women have reported benefits from exercise. However, a study published in The Lancet found only a moderate effect of exercise in reducing symptoms of postpartum depression; although some difference was noted, it was not statistically significant.
- Follow a well-balanced, healthy diet.
- Rest - get at least 7-8 hours good quality sleep each night.
- Maintain blood sugar levels by eating frequently.
- Make lists -be organized to avoid rushing around and becoming frustrated at not achieving much.
- Be open - talk to close friends, partners, and family members about how you feel, and things you are worried about.
- Get in touch with local help groups.
Remember that postpartum depression affects millions of women every year. It is not your fault.
Researchers from Northwestern Medicine reported in JAMA Psychiatry that postpartum depression affects approximately 1 in every 7 new mothers.
In their study, involving over 10,000 mothers, they also found that close to 22 percent of them had been depressed when they were followed up 12 months after giving birth.
The team also discovered that:
- More than 19 percent of the women who had been screened for depression had considered hurting themselves.
- A sizeable proportion of mothers who had been diagnosed with postpartum depression had previously had another type of depression or an anxiety disorder.
A Canadian study found that postpartum depression is much more common in urban areas. They found a 10 percent risk of postpartum depression among women living in urban areas compared with a 6 percent risk for those in rural areas.