Part One of a two-part series on postpartum depression.

When Anita Prakash* moved back to her hometown in India, after living in the UK for several years, she was overjoyed to discover that she was pregnant. She expected the next nine months to be stressful, of course, as she settled into a new home with her in-laws. But the pregnancy was a balm after a painful miscarriage just seven months before.

Her reality, however, was far worse than her expectations. As her pregnancy progressed, she was alarmed by her spiraling emotions and reactions to everyday situations.

“Blending into family life was not as easy or as pleasurable as I’d imagined it to be,” Anita says. “I had trouble interacting with my mother-in-law, who was the undisputed boss and caretaker of the home and was not able to handle a newcomer on her turf. Resentment, grief, loss, anger – there was plenty of that during the pregnancy.”

When the baby was born, Anita had trouble breastfeeding and her anxiety multiplied.

“Because we have several doctors in the family, the doctors at the hospital probably assumed [wrongly], that I was being looked after, so no one talked to me about any issues that I might be having,” she says.

Two months later, Anita says she was desperately unhappy and feeling terribly alone. She took to confining herself to her room for long stretches. After a fight with her husband, she came close to committing suicide. It was then she realized that she hadn’t been herself for quite a long time and needed help.

“I, who worked with a suicide helpline for years, felt so unsupported at that time that not even the thought of my two-month-old baby could have stopped me,” she says.

At the time, Anita’s family denied her troubles, viewing them as abnormalities. Now, they acknowledge she may have suffered from postpartum depression. Anita was never formally diagnosed, but her constant crying, sadness and general disinterest in the months after birth are typical symptoms of a very common yet very misunderstood condition.

A SILENT SORROW

Postpartum depression manifests in many different ways. For some, it may be mild irritability, sadness, or anxiety. For others, it may be more serious, causing severe mood swings, intense irritability, anger or guilt, and even suicidal thoughts. (For a complete list of symptoms, see the end of this article.)

It has no one cause; physical, emotional, and lifestyle factors all play a role. After childbirth, a woman experiences a sharp drop in various hormone levels and changes to her blood volume, blood pressure, immune system and metabolism—all of which can contribute to fatigue and mood swings. The sleep deprivation and responsibility inherent in caring for a newborn can cause negativity across the spectrum, from feelings of unattractiveness to struggles with identity.

While national figures on postpartum depression are unavailable, a 2012 study of 200 Gujarati women, published in India’s National Journal of Medical Research, found 12.5 percent of them experienced postpartum depression during the year after giving birth. Similar findings among new mothers in Goa and Tamil Nadu were published by two different 2002 studies in the American Journal of Psychology.

SYMPTOMS

Postpartum depression can range from mild blues that last for a couple of days to a couple of weeks. Or it can intensify into more serious, long-term feelings that interfere with a woman’s ability to care for her baby or perform daily tasks.

Symptoms of the “baby blues” include:

• Mood swings
• Anxiety
• Sadness
• Irritability
• Crying
• Decreased concentration
• Trouble sleeping

Symptoms of postpartum depression include:

• Loss of appetite
• Insomnia
• Intense irritability and anger
• Overwhelming fatigue
• Loss of interest in sex
• Lack of joy in life
• Feelings of shame, guilt or inadequacy
• Severe mood swings
• Difficulty bonding with your baby
• Withdrawal from family and friends
• Thoughts of harming yourself or your baby

If you or someone you love are experiencing these symptoms, consider meeting a psychiatrist or counsellor – especially if the feelings persist or worsen.

“Depression is contagious. Not medically, of course, but the sadness soon spreads to everyone in the house,” says Anita. “If you don’t ask for help, it can rob you of your sanity and peace of mind.”

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Part Two of this series, “A Cultural Conflict” addresses the Indian experience of postpartum depression, cultural risk factors, and ways to heal.

*Names have been changed to protect the identities of the women sharing personal experiences with this sensitive (and often taboo) topic.