Postpartum Depression – Causes, Symptoms and Treatment

The birth of a child marks the beginning of a new journey in the life of the parents, especially the mother. While the event is bound to bring joy and delight to the mother, it can sometimes be confusing to see the opposite happen. It is estimated that more than 40% new mothers experience baby blues, an emotional state characterised by worry, unhappiness, fatigue and self-doubt. Baby blues usually disappear after a few days or a week, but if the feeling is prolonged and lasts for more than two weeks, it can be a case of postpartum depression.

What is Postpartum Depression?

Postpartum depression is the state of depression which may start during pregnancy or up to a year from the birth of the child. Depression is a mental illness which negatively affects the way you feel, think or act. It is hard to tell the difference between postpartum depression and the usual stress and exhaustion that is experienced due to new parenthood. It is not unusual to experience feelings of exhaustion, sadness or despair during or after pregnancy, but if the feelings prevent you from doing your daily tasks, then it could be an indication of postpartum depression.

Causes of Postpartum Depression

There are a number of reasons that can lead to postpartum depression in new mothers. Women with a history of mental health conditions or depression are typically at a higher risk. The following reasons can also increase the possibility of postpartum depression:

• Emotional fatigue which could be caused due to stress from pregnancy, illness, financial constraints, social isolation, or health problems in the newborn baby.

• The hormonal changes experienced during pregnancy or after the childbirth. At the time of pregnancy, the levels of the hormones progesterone and oestrogen are higher than usual. The levels fall back to normal after delivery. This abrupt change may lead to depression.

• Physical factors such as inadequate diet, sleep deprivation, alcohol or drug abuse and low thyroid hormone levels can also lead to postpartum depression.

• History of mental health illness in the family.

Women who are healthy and have had a normal delivery can also face this condition. Since the chances of postpartum depression affecting women with previous history of depression are higher, do inform your doctor if you have previously suffered from anxiety or depression in the past.

Sign & Symptoms of Depression After Pregnancy

The signs and symptoms of depression after pregnancy are severe and can interfere with your ability to perform day to day activities. The symptoms can vary from person to person and from time to time. Here are some signs and symptoms to watch out for:

• Being irritable or angry without any reason
• Extreme mood swings
• Difficulty in concentrating on any work
• Loss of interest in doing work and lack of enjoyment in pursuing your hobbies
• Unexplained aches, pains or illness
• Loss of appetite or uncontrolled eating leading to sudden fluctuations in the body weight
• Feeling of worthlessness and lack of self- control
• Excessive crying without reason
• Sleeplessness even after being tired and exhausted
• Avoiding people around you, even friends and family
• Worrying excessively about your baby or being uninterested in caring for the baby
• Experiencing feelings of guilt along with self- pity
• Severe anxiety accompanied by panic attacks

A doctor should be consulted if these symptoms recur or continue for a long time. The symptoms might surface within a few weeks of delivery, and if not treated, can stay for a long period causing damage to the mental health of the mother.

Postpartum Psychosis

Postpartum psychosis is a rare psychiatric condition which usually develops in the first week of delivery. The signs and symptoms of postpartum psychosis are more severe than those of depression and include:

• Paranoia
• Delusions and hallucinations
• Confusion and disorientation
• Sleeplessness and sleep disturbances
• Feeling of extreme obsession towards the baby

Postpartum psychosis is a serious condition which could lead to life-threatening behaviour and thoughts. It must receive medical attention immediately.

Difference Between Depression and Postpartum Depression

While the end result of both the conditions is same, there is a difference between depression and postpartum depression. Unlike depression, postpartum depression is linked to pregnancy and is a result of various factors such as hormonal changes, changes in the environment, emotional changes and genetic changes. Women with a history of depression or mental health illness are at a higher risk of suffering from postpartum depression.

Difference Between Postpartum Depression and “Baby Blues”

Here are some of the main differences between the two conditions:

• Baby blues last for a shorter period (about two weeks after giving birth), whereas, postpartum depression can last even up to a year after giving birth.
• The symptoms of postpartum depression are much more severe than those of baby blues. Baby blues are characterised by a feeling of sadness, and vulnerability whereas postpartum depression is accompanied by anxiety, irritability, sadness, lack of interest in the baby, and a feeling of incompetence.
• Baby blues appear after the child’s birth and disappear a week or two from the birth of the baby, whereas postpartum depression may emerge anytime during the pregnancy and will last longer, taking a toll on the physical and mental health of the mother.
• Baby blues disappear after ample rest, settlement of the birth-related anxiety, and comforting from the family members. However, postpartum depression will need continued professional counselling to overcome the depressed state of mind.

Complications of Postpartum Depression

Depression is a chronic condition marked by cycles of recurrence and improvements. Depression has a severe impact on mental health of the affected individual leading to complications which can last for life.

To mothers

Unattended postpartum depression in mothers can last for months or even longer in mothers and turn into chronic depressive disorder. Possible complications from postpartum depression to mothers include:

• Effect on mental health: Depression is mentally taxing and takes a toll on the mental health of the patient. The trauma associated with depression can lead to negative changes in the lifestyle of the mother and make her more averse to the surroundings. Postpartum depression can lead to future episodes of major depression and unrest from which the mother might never be able to recover.
• Effect on physical health: Depression can lead to adverse physical health conditions and increase the risk of obesity, heart attack and chronic illness in the patient. This is due to a disturbed lifestyle caused by the mental trauma.
• Risk of suicide: Depression is known to cause up to two-thirds of all suicides due to changes in normal lifestyle, withdrawal from the society, regular irritability, and changes in the daily routine activities.

To Fathers

Postpartum depression has a ripple effect which can cause emotional stigma to everyone close to the mother and the child. The father is at particular risk of postpartum depression due to the emotional strain and negativity caused by being in the proximity of a person affected by depression. New fathers are at an increased risk of depression irrespective of whether their partners are affected or not.

To Children

Children who have mothers suffering from untreated postpartum depression are likely to have emotional and behavioural problems due to negligence by the mother. Such children can develop attention-deficit/ hyperactivity disorder (ADHD) and be prone to problems like excessive crying, sleeping, eating difficulties, and delay in language development.

Diagnosis & Test for Depression After Pregnancy Depression

Diagnosis of after- pregnancy depression is based on symptoms meeting specific traits and criteria. Individuals who face the symptoms of depression or have a family history of depression should seek the help of their doctor and get screened for depression if necessary.

The doctor will try to determine whether the postpartum baby blues are temporary or have the potential of leading to severe depression. Doctors can recommend blood tests to find out if hormonal changes and an underactive thyroid are contributing to signs and symptoms of depression.

Health professionals may also make use of psychological screening tests such as the Beck Depression Inventory or the Hamilton Rating Scale to assess an individual for depression.

How Long Does After-Pregnancy Depression Last?

There is no defined period for which after-pregnancy depression lasts, and it depends on how early the condition is detected and the kind of treatment which is given to the patient. Postpartum depression sets in during pregnancy or 2-3 weeks after childbirth. In women who receive timely clinical treatment, the symptoms of depression can last up to or more than one year. However, for women not receiving any clinical treatment, the postpartum depression duration can extend beyond 3 years as well.

Postpartum Depression Treatment

Depending on the severity of depression, the treatment time and method will vary. There are several ways of dealing with postpartum depression such as psychotherapy, counselling, medication, and various other therapies.

Psychotherapy

Psychotherapy is considered to be one of the most effective therapy modes for treating PPD. Psychotherapy involves sharing your concerns with a psychiatrist or a psychologist. The mental health providers suggest ways to cope up with and come out of the depression. Through therapy, one can find better ways to solve problems, control mood swings, set realistic goals, and respond to situations in a positive way. Described below are the most commonly used therapies for the treatment of postpartum depression.

Counseling

Counselling is a way of treating depression by direct interaction between the affected individual and the counsellor or psychiatrist. Counseling can help you to feel better if you are suffering from mild depression. There are different kinds of talk therapies, but the ones most commonly used to treat depression are cognitive behavioural therapy and interpersonal therapy.

1. Cognitive Behavioral Therapy (CBT)

Cognitive behavioural therapy is focused on changing the way you think and behave and is known for its effectiveness in treating anxiety, obsessive-compulsive disorder, depression, and other mental health-related problems. CBT is based on the premise that thoughts, feelings, physical actions and sensations are interconnected, and negative thoughts can trap you in the vicious circle of depression. CBT looks to break down problems into smaller parts and transform negative thoughts into positive ones. CBT is designed to provide practical solutions to improve your thought process on a daily basis.

2. Interpersonal Therapy (IPT)

Interpersonal therapy is a direct interaction between the therapist and the person affected with by depression, where the therapists focus on four key problem areas of the patient, namely grief, role transitions, interpersonal disputes and interpersonal deficits. Interpersonal therapy has proven to be one of the most valuable and effective therapies to treat PPD.

Antidepressants

Antidepressants are drugs are used to treat major depressive disorders including postpartum depression. Antidepressants balance out the brain chemicals which are responsible for regulating moods and making you feel better. However, antidepressants have side-effects and may also enter your breast milk. Hence, antidepressants should be consumed only on a doctor’s prescription.

Medication

In case of severe depression, a combination of medication such as antidepressants, mood stabilizers and antipsychotic medications can be used to control the signs and symptoms of depression. Medicine for postpartum depression should be taken only on the prescription of a doctor.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy is recommended when the postpartum depression is severe and does not respond to medication. ECT introduces small amounts of electrical current to the brain to produce waves which are similar to those which are generated during a seizure. The chemical changes in the brain can help to reduce symptoms of depression.

Home Remedies and Lifestyle

Postpartum depression is generally not a condition which can be treated at home; however, a change in lifestyle will build on the treatment plan and help a speedy recovery.

• Inculcate healthy lifestyle choices: Including physical activities such as going on a walk with the baby in your daily routine will help to keep stress at bay. It is important to get adequate rest, eat healthy food, and avoid smoking or consumption of alcohol.
• Avoid isolation and share your feelings: Discuss your feelings or concerns with your friends, family or partner. Sharing your feelings will help you get perspective on how others have handled the situation.
• Give time to yourself: Pampering yourself once in a while can make you feel a lot better. Get a relaxing bath, put on your best clothes, and take some time out with a friend or your partner. Pursue your hobbies or eat your favourite food. Breaking free from routine activities will freshen you up.
• Slow down, set realistic expectations: Resist the temptation to do all the work by yourself. Set realistic expectations and do not burden yourself with office and household work in addition to looking after the baby.
• Ask for help and support: Do not hesitate to ask for help or support. Let your partner or family members know if you need any help in handling the baby or performing daily chores.

How to Prevent Postnatal Depression?

With a little precaution and controlled lifestyle, you can prevent postnatal depression. If you have had a history of depression, especially postnatal, inform your doctor about the same as soon as you are pregnant or if you plan to get pregnant.

Here are tips to prevent postnatal depression:

• During pregnancy: Avoid anything that will lead to stress. Follow a healthy diet and a simple routine which involves light physical exercise. If you feel depressed, consult the doctor. Mild depression can be managed with the help of support groups or therapies. Antidepressants may also be recommended in some situations during pregnancy.
• After the birth of a baby: If you have had a history of depression in the family, the doctor may recommend a postpartum checkup to identify any signs and symptoms of postpartum depression immediately after your baby is born. Post pregnancy, do not overburden yourself with too much work and take baby steps to get back to routine life.

Early detection of the signs and symptoms of depression can go a long way in avoiding escalation of the condition.

What Can Happen if Postpartum Depression Remains Untreated

If postpartum depression is not treated on time or remains untreated, it can develop into chronic depression and interfere with the mother-child bond and affect the entire family. Severe depression can lead to other chronic diseases and suicide in worst cases. Postpartum depression in the mother will also have a negative impact on the upbringing and overall development of the child.

Postpartum depression is a serious disorder which should not be ignored. Early detection of the condition and immediate treatment can prevent the symptoms from turning into a chronic depression. It is important to talk about the situation to family, friends and your doctor, instead of facing it alone.