What is Postpartum Depression?
Childbirth is a challenging and tiring event. A woman experiences numerous hormonal, physical, emotional, and psychological changes throughout her pregnancy, affecting her personal and family life. After giving birth, a mother might have a range of emotions from happiness and delight to sadness and periods of crying. These feelings, known as “baby blues,” often decrease within the first two weeks after delivery.
About 1 in 7 women might develop something more severe known as postpartum depression (PPD). While the “baby blues” tend to pass relatively quickly, PPD usually lasts longer and can seriously affect a woman’s return to normal everyday activities. It can disrupt not only the mother but also her relationship with her baby. PPD can affect a mother’s brain function and behavior. Unfortunately, many instances of PPD remain undiagnosed, as the new mother may feel uncomfortable sharing her feelings with family due to privacy concerns or fears of abandonment and lack of support, as noted by Beck in 2006.
What Causes Postpartum Depression?
PPD, or Postpartum Depression, can occur in pregnant women who experience depression and anxiety at any stage of their pregnancy.
Some factors may increase the risk of developing PPD. Psychological factors include a previous history of depression, anxiety, and premenstrual syndrome. A negative attitude towards the baby, reluctance about the baby’s gender, and past experiences of sexual abuse can also contribute to PPD. Obstetric factors, related to pregnancy and childbirth, can also increase the risk. These include emergency c-sections, hospitalization during pregnancy, complications like the baby’s first stool (meconium) passing in the womb or the umbilical cord slipping into the vagina before birth (cord prolapse). Additionally, having a preterm or low birth weight baby or low levels of hemoglobin can be linked to PPD.
Social factors can also play a role. Lack of social support and domestic violence – including sexual, physical, or verbal abuse from a spouse – are associated with the development of PPD. Smoking during pregnancy is another risk factor.
Lifestyle choices can also affect PPD: diet, sleep patterns, physical activities, and exercise may have an impact. For example, Vitamin B6, which helps convert tryptophan to serotonin – a mood-regulating brain chemical – is involved in PPD. The amount of sleep a person gets may also influence the risk of depression, with less sleep linked to PPD. Regular physical activity and exercise can help reduce depressive symptoms and improve self-esteem. Exercise stimulates the production of natural mood-boosting substances in the body (endorphins and opioids), which can improve mental health, self-confidence, problem-solving skills, and help individuals focus better on their surroundings.
Risk Factors and Frequency for Postpartum Depression
Postpartum depression (PPD) often shows up within six weeks following the birth of a child. This affects between 6.5% to 20% of women. It’s more common in young mothers, moms who’ve given birth prematurely, and women living in cities. Interestingly, African American and Hispanic mothers usually start showing symptoms within 2 weeks of giving birth. This is earlier than white mothers, who begin experiencing symptoms later according to a study.
Signs and Symptoms of Postpartum Depression
Postpartum depression (PPD) is diagnosed when a person shows five or more specific symptoms for a minimum of two weeks. These symptoms usually represent a change from the person’s normal behavior. Key to the diagnosis of PPD are symptoms of depression or anhedonia, which is a loss of interest in activities that were previously enjoyable. These symptoms should appear around the time of pregnancy or within four weeks of delivering a child.
These symptoms include:
- Feeling depressed most of the day
- Loss of interest or pleasure in most activities
- Insomnia or sleeping too much
- Slowing down of actions or agitation
- Feeling worthless or guilty
- Fatigue or loss of energy
- Suicidal thoughts, or frequent thoughts of death
- Difficulty in focusing or making decisions
- Change in weight or appetite (weight change of 5% or more in a month).
These symptoms should not be due to medication, substance use, or another medical condition. The symptoms should cause significant distress or interfere with daily life.
The International Statistical Classification of Diseases describes a depressive episode as the presence of a depressed mood, reduced activity and vitality, reduced capacity for enjoyment and concentration, feeling tired after minimum effort, disturbed sleep, reduced appetite, feelings of guilt or worthlessness, reduced self-esteem, and in some cases physical symptoms such as weight loss and loss of libido.
Postpartum depression symptoms are similar to those of regular depression, with the additional context of recent childbirth. Symptoms include a depressed mood, loss of interest, changes in sleep and appetite, feelings of worthlessness, trouble focusing, and thoughts of self-harm. There could also be anxiety and psychotic symptoms, such as delusions or hallucinations. This condition can lead to problems such as poor mother-child bonding, breastfeeding difficulties, negative parenting practices, marital issues, and developmental issues for the child.
Testing for Postpartum Depression
During the assessment, the doctor will consider information such as the patient’s history of drug and alcohol use, smoking habits, and current medications, including those purchased without a prescription. To check for symptoms of Postpartum Depression (PPD), a screening can be conducted anywhere from two to six months after giving birth.
Various tests are available for this purpose, and one of the most commonly used instruments is called the Edinburgh Postnatal Depression Scale. This is a simple, 10-question survey that the patient completes, which only takes a few minutes. If the patient’s score totals 13 or more, they might be at risk of developing PPD.
This screening test lays the groundwork for further medical assessments. The goal of these additional tests is to confirm the diagnosis, evaluate the risk of harmful actions towards oneself or others (specifically, harm to the newborn), and to make sure no other mental health conditions are present.
Treatment Options for Postpartum Depression
The initial treatment options for depression that occurs during or after pregnancy, known as peripartum depression, are psychological therapy and antidepressant medications. For women suffering from mild to moderate peripartum depression, therapy is typically the preferred option, especially when mothers are unsure about starting medication while breastfeeding their newborn. For severe cases, a combination of therapy and antidepressant drugs is often recommended. Selective serotonin reuptake inhibitors (antidepressants that increase serotonin levels) are usually the first choice of medication. If these don’t work, other types of antidepressants, such as serotonin-norepinephrine reuptake inhibitors or mirtazapine, might be considered. When an effective dose is found, treatment should continue for six months to a year to prevent a recurrence of symptoms.
For breastfeeding women, the implications of taking antidepressants, the benefits of breastfeeding, and the risks of untreated depression should all be discussed. Repetitive transcranial magnetic stimulation, a procedure that uses magnetic waves to stimulate and activate underactive nerve cells in those with major depression, may offer a therapeutic alternative for breastfeeding mothers who want to avoid medication. This treatment is usually carried out five times a week for a period of four to six weeks. The procedure is generally safe, but some side effects may include headaches, lightheadedness, scalp discomfort, and facial muscle twitching.
Severe peripartum depression may not respond to therapy and normal depression medications. In those instances, electroconvulsive therapy (ECT) is recommended. This treatment is particularly helpful for patients who contemplate suicide or cause harm to their baby, and for those who refuse to eat which can lead to malnutrition and dehydration. Some studies suggest ECT as a safer option for breastfeeding mothers as it has fewer side effects on both mother and baby.
For patients with severe peripartum depression who do not improve with ECT, a drug called brexanolone could be recommended. Brexanolone, approved by the FDA in 2019, is the first drug specifically designed for peripartum depression. Available only in certified healthcare facilities in the United States and administered intravenously over about 2.5 days, brexanolone usage requires continuous monitoring by a clinician for possible adverse effects. Although clinical trials show that brexanolone is usually well-tolerated and might provide rapid improvements for women with moderate to severe peripartum depression, more research is needed to further assess its long-term safety and effectiveness.
What else can Postpartum Depression be?
Baby Blues
This condition typically arises 2 to 5 days following childbirth and usually subsides within 10 to 14 days. Symptoms include crying spells, feeling of sadness, sleep disruptions, changes in appetite, confusion, fatigue, and a general feeling of anxiety or irritability. Importantly, it doesn’t prevent the mother from performing daily activities or caring for the newborn.
Thyroid Problems
Mood disorders can also stem from conditions linked with your thyroid, such as hyperthyroidism and hypothyroidism. To diagnose these, doctors check the levels of TSH (Thyroid-stimulating hormone) and free T4 in your blood.
Postpartum Psychosis
Postpartum psychosis is a severe mental health issue that requires immediate medical attention due to the risk of suicide or harm to the baby. Symptoms may include hallucinations, restlessness, abnormal behavior, delusions, and lack of sleep over multiple consecutive nights. These symptoms typically emerge quickly within the first few days or weeks after childbirth.
What to expect with Postpartum Depression
PPD, or postpartum depression, can hurt more than just the physical health of a child. Research shows that it can also harm the bond between a mother and her baby. Often, babies of mothers with PPD are treated negatively and this can greatly influence their growth and development.
Children born to mothers with PPD often show notable changes in behaviour, altered intellectual development, and early signs of depression. Importantly, these children are frequently obese and struggle with social interactions.
Possible Complications When Diagnosed with Postpartum Depression
Postpartum depression (PPD) influences not only the mother but also the father and the baby. Untreated PPD can have various impacts on the mother, father, and the baby. Here are the potential effects:
- Mother: If not treated promptly, PPD can turn into a chronic depression disorder. Even if treated, PPD could increase the risk of future episodes of major depression.
- Father: The father might also become depressed as postpartum depression is a stressful event for the whole family.
- Infant: Babies of mothers dealing with untreated depression may face behavioral and emotional problems. Common issues include delays in language development, sleeping and eating difficulties, excessive crying, and attention-deficit/hyperactivity disorder.
