The Lowdown on Postpartum Depression

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Mar 30, 2016

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After all of the challenges of pregnancy and childbirth, it’s no wonder a woman’s body and mind need time to re-calibrate. That’s what postpartum conditions are: a period of adjustment when a natural decline in estrogen and progesterone levels and other hormonal changes affect the brain’s neurotransmitters, which are responsible for regulating mood. As a result, it’s quite common for women to experience some degree of post-delivery mood fluctuation, ranging from mild to severe. In fact, a whopping 85% of new moms experience one of the following:

  • Postpartum blues, which is the mildest and most common
  • Postpartum depression, moderate and also fairly common
  • Postpartum psychosis, which is most severe and least common

These mood changes are common medical conditions caused by birth-related changes in the body. They are in no way a reflection on any mother’s dedication or willingness to care for her child.

While postpartum conditions can affect any woman, you may be more at-risk if you have: previously experience with one of these postpartum conditions, experience with recent stressful life events, inadequate support from family members, martial disharmony, a history of sexual abuse, a history of depression during or outside of pregnancy, or a history of bipolar disorder.

Postpartum Blues

Also known as the ‘Baby Blues,’ this is the most common postpartum condition. Most women will experience a relatively low period following childbirth, as their bodies heal and hormones stabilize. Symptoms could include: tearfulness, mood fluctuations, anxiety, overwhelmed feelings, and irritability. These symptoms can fluctuate day to day and typically do not usually last more than a few weeks; they eventually fade on their own.

If you experience any of these symptoms, follow the self-care suggestions below. If the blues persist for more than two weeks, it would be a good idea to consult your physician about whether additional support would be helpful.

Self-care strategies:

  • Sleep whenever you can
  • Take guilt-free time for yourself
  • Ask for help and accept it without guilt
  • Eat regular and healthy meals
  • Exercise and stay active
  • Stay connected with friends and family
  • Connect to other new mothers for support
  • Focus on what you have achieved, not on what you haven’t yet done

How your partner/family can support you:

  • Understand the new mother’s feelings are natural and her condition is not a choice
  • Offer help
  • Avoid criticism
  • Encourage her and listen when she shares her feelings
  • Make sure she is taking time for herself
  • Be patient if she is not ready for sex
  • Do things together as a couple or with the baby

Postpartum Depression

Postpartum depression (PPD) refers to the overwhelming feelings of sadness or mood changes that can emerge during pregnancy or within the first few months after childbirth. Postpartum depression is usually more intense and longer-lasting than postpartum blues and does not usually fade spontaneously or shortly. But like the blues, PPD is not a choice.

Postpartum depression symptoms fall on a range. Moderate symptoms include:

  • Disturbed sleep (unrelated to posture or need to go to the bathroom) and/or an inability to fall back asleep due to worry
  • Unusual irritability or shortness of temper
  • Panic attacks, anxiety or increased fearfulness/worry
  • Avoidance of routine activities or difficulty completing daily tasks
  • Low mood
  • Inability to enjoy usual pleasures
  • Tearfulness

More severe symptoms are also possible and common:

  • Inability to feel excitement or interest in the pregnancy or baby
  • Loss of appetite and weight (without any medical cause)
  • Withdrawal from friends and family
  • Feelings of failure, worthlessness, low self-esteem or guilt
  • Feelings of hopelessness
  • Suicidal thoughts or plans
  • Frequent negative thoughts (postpartum only)
  • Feelings of guilt that follow negative thoughts in a vicious cycle (postpartum only)
  • Anger toward the baby or persistent difficulty bonding with the baby (postpartum only)
  • Thoughts of harming the baby (postpartum only) (While the incidence of physically harmful behavior is low, thoughts of this nature need to be addressed right away.)

If you or your family or friends notice any of these symptoms, addressing these feelings right away is critical, as postpartum depression can inhibit bonding between the mother and child; a mother struggling with feelings of depression may have difficulty responding to the baby’s cues and feel unable to comfort him or her adequately. This can lead to delays in the child’s social, emotional and behavioral development.

The first step is visiting your physician and consulting your team (any midwife or lactation consultant you may be working with) for support and referrals for treatment. Your physician should first rule out any other medical causes of mood disorders such as anemia or thyroid disturbances. Once these possibilities are eliminated, your physician can provide referrals to a psychiatrist and/or a therapist who specializes in postpartum depression. There are two kinds of treatment that are typically most effective when combined.

  • Pharmaceutical intervention (medication) with a psychiatrist. This treatment consists of medication to adjust neurotransmitter levels, generally for a short period of time and before being gradually reduced under the supervision of the treating clinician. If breastfeeding, it is possible to take one of several anti-depressants that have shown negligible levels in breast milk; ask your physician and psychiatrist for details.
  • Psychotherapy with a therapist. Therapy or counseling can help you talk through your concerns and find better ways to cope with your feelings, solve problems, set realistic goals and respond to challenging situations. Sometimes, family or relationship therapy can also help.

The good news is the blues and PPD are treatable and temporary if you seek the right support. Prompt treatment can allow you to better enjoy your baby and feel like yourself again, usually within six months to one year. However, if left untreated, PPD can turn into longer-term depression.

Postpartum psychosis

Postpartum Psychosis is rare. It affects 1 to 2 women in 1000 after childbirth. It typically presents quickly and dramatically, within 48 to 72 hours of delivery. Symptoms include restlessness, irritability, confusion, disorganized or erratic behavior, and auditory hallucinations to harm one’s self or the infant. In the unlikely event that you or your family members notice these symptoms, seek immediate help as this can be very harmful to mother and/or child and longer lasting than the blues or PPD.

For any type of postpartum condition, timely identification, assessment, and treatment is key!

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Written By Dr. Pervin Dadachanji

Dr. Pervin Dadachanji is a practicing psychiatrist with a special interest in child and adolescent psychiatry. She completed her MBBS and M.D. (Psychiatry) from Seth G.S. Medical College and K.E.M. Hospital, Mumbai. She has also done a stint in the Child and Adolescent Psychiatry Department at The Royal Free Hospital, London. She has been in private practice since the past 20 years. She conducts parenting workshops for various parent groups, schools and nurseries in Mumbai. She also does workshops for children and adolescents on sexuality and body science. She has written a book called Recipes for Parenting and is consultant psychiatrist at Ummeed, a Child Development Centre in Mumbai.

See all articles by Dr. Pervin

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