WHAT IS POSTPARTUM DEPRESSION? CAUSES, SYMPTOMS, AND TREATMENT

Medically Reviewed by Dr. Sony Sherpa, (MBBS) - August 28, 2024

Childbirth brings joy to parents and families, especially when the pregnancy is planned. Nevertheless, it could also come with other strong emotions like anxiety and fear. These emotions are normal to be felt as humans. However, the problem starts when they intensify and become extreme, resulting in a medical condition called postpartum depression. It is a kind of depression that requires urgent and long-term medical attention.

Just as women experience many body changes during pregnancy and delivery, their mental states could also change. This article will discuss what postpartum depression is all about, its symptoms, and how it can and should be treated.

What Is Postpartum Depression?

It is a mental health disorder that affects women after giving birth. Postpartum depression is mainly characterized by anxiety, tiredness, and sadness for an extended period. Although, in some cases, it usually starts during pregnancy (perinatal) and continues till after delivery. Some extreme cases have shown that the symptoms can persist even after a year has passed.

Other Types of Postpartum Mood Disorders

There are other types of mood disorders that occur postpartum and should not be confused with postpartum depression; they are:

Postpartum Baby Blues

It is the most common, as nearly all women experience it after childbirth. Postpartum blues comes with frequent crying for no reason, anxiety, and you might feel sad a few days after delivery. Symptoms usually disappear over a few days without need for any treatment.

Postpartum Psychosis

This, on the other hand, is a severe psychiatric condition that can occur in the days or weeks following childbirth. It is very rare and affects just 1 out of 1,000 women post-delivery. Its symptoms come almost immediately after delivery and could last for many months. Postpartum psychosis comes with confusion, hopelessness, insomnia, paranoia, delusions, hallucinations, severe agitation, hyperactivity, and manic episodes. Women already suffering from obsessive-compulsive disorder (OCD), anxiety disorders, bipolar disorder, or schizophrenia are prone to it.

Causes and Risk Factors for Postpartum Depression

No one can single out the causes of postpartum depression, but we can classify them into biological, physical, psychological, and social causes.

Biological Causes

• Family history: If any of your family members has suffered from depression, the gene could be passed. Only this time, it comes postpartum.
• Hormonal changes: Postpartum depression can be attributed to the rapid changes in hormonal levels during pregnancy and after pregnancy. Imagine the body having to regulate itself as these hormones return to normal after nine months. Most women can relate to the changes in mood and emotion during their menstrual cycles.

Physical Changes

• Body dysmorphia: The changes in the body that come with pregnancy can be very drastic. It can be insignificant in some women, but others could have to deal with increased body weight and sagging of certain parts. These could contribute to body dysmorphia, especially during pregnancy and even after.
• Altered body chemistry: A change in routine due to caring for the newborn could result in insomnia, which predisposes the body to mood disorders.

Psychological Causes

It can be mentally draining thinking of how to care for your baby until they are old and independent. This could particularly bring about fear and anxiety during pregnancy. These feelings could intensify, leading to postpartum depression, especially after the baby is out in real time.

Social Causes

Postpartum depression is more common in cases of single parenthood, or when the pregnancy was unplanned. Also, parenting without guidance or strong support can have one starting on the wrong foot.

Besides the causes described above, some factors can put you at risk of developing postpartum depression. These factors include:

• Pregnancy complications such as prolonged labor, gestational diabetes, and premature birth.
• History of pregnancy loss
• Giving birth to a baby with congenital or genetic disabilities
• Having a baby that cries often or refuses to sleep
• Trouble bonding with the baby
• Personal medical history of depression
• Age of the mother
• Victims of domestic violence
• History of physical or sexual assault
• Lack of family or social support
• Conflict in marriage or relationship
• Underlying stress from the way of life or events around the time of pregnancy
• History of drug or alcohol abuse which could lead to withdrawal symptoms

Symptoms of Postpartum Depression

There are several symptoms that a person with postpartum depression will exhibit. As they are frequently subtle and could be mistaken for other things, it is crucial to pay great attention to them. At times, the victim might not even admit to anything wrong. Some of these symptoms are:

• Feeling depressed most of the day for several days in the week
• Feelings of anxiety, helplessness, shame, guilt, fear, panic, or worthlessness
• Extreme mood swings
• Trouble sleeping or sleeping for longer periods
• Reduced level of participation in everyday activities
• Finding it difficult to think, make decisions, or concentrate
• Lack of appetite
• Chronic aches in different parts of the body
• Neglecting self-care and childcare
• Thoughts of hurting yourself or your baby

Postpartum Depression in the Other Parent

You probably did not know that this condition happens not only in the birthing parent but even in the other parent, the father. Also, surrogates and adoptive parents could experience it, so it is not necessarily due to biological relations to the newborn, nor is it limited to only women who have given birth.

In cases where the father is affected, it is referred to as paternal postnatal depression. There are fewer reports of men who have suffered this, but it is estimated that about 8 to 10% of new fathers experience it. This condition comes with depression and anxiety in the first year after childbirth. A history of depression, financial problems, or a bad relationship could contribute to the development of depressive symptoms in a new father. If the mother has the symptoms, the partner is likely to develop them too.

How Long Does Postpartum Depression Last?

The duration of this condition depends on how early it is treated. If ignored, postpartum depression can last several months or even worse years. This is why as soon as the symptoms persist for more than two weeks, you should seek treatment so it reduces over time. Even with treatment, some women might still experience some symptoms of postpartum depression until after a year of onset.

Does Postpartum Depression Affect the Baby?

In the long run, this condition affects the baby indirectly in many ways. Firstly, a woman suffering from this condition will find it challenging to connect with her baby, which could impair the baby’s social skills with time.

Also, the baby will probably miss important postnatal appointments with pediatricians, which are vital to their development. It will also have an impact on the parent's capacity to care for the child. Important factors, such as whether the baby has been fed well or slept well might not be noticed. Neglect could also result in long-term effects such as obesity and behavioral, developmental, and learning disorders.

How Can You Prevent Postpartum Depression?

You can prevent postpartum depression mainly through therapy during pregnancy. Talking about your feelings to a qualified therapist can help you find ways to prepare and cope with changes that come after delivery. If you have ever had depression or began experiencing symptoms of perinatal depression, it is imperative to get started right away. There are two forms of therapy you can decide to opt for which are discussed below.

Interpersonal Therapy

This form of therapy helps you point out and manage the problems in your personal life. They could be work-related, family, relationships, losses, or even a medical condition. Interpersonal therapy uses questions and role-playing and observes how you communicate as well as make decisions in a controlled setting.

Cognitive Behavioral Therapy

This is designed to aid in combating negative feelings by changing your thought process and how you act. The therapist helps you set goals that help you identify those negative thoughts so you can start thinking and acting differently.

Treatment of Postpartum Depression

Diagnosis

No precise test has been designed to diagnose postpartum depression effectively. However, a depression screening can be done. It can be diagnosed through evaluation by your healthcare provider. You will be asked questions regarding your health and how you have felt since your baby was delivered. The doctor also carries out physical examinations and other tests to rule out the causes of the symptoms.

Treatment Options

There are two common ways to treat postpartum depression, psychotherapy and medication (antidepressants). In most cases, both are done concurrently. The kinds of therapy you can go for have been described earlier. Another treatment option is transcranial magnetic stimulation, which employs magnetic waves for simulating and activating nerve cells. A session is done about five times weekly for 4 to 6 weeks.

Common Medications

Antidepressants are a group of drugs that help reduce the symptoms of depression, and are administered to treat postpartum depression too. However, it could take up to 8 weeks of consistent use before you begin to notice changes which is why strict adherence to the dosage is essential. You should also not self-medicate but meet with your healthcare provider to prescribe the most suitable and effective medication.

There are different kinds of antidepressants listed below, with examples of drugs under them:

• Selective Serotonin Reuptake Inhibitors (SSRIs). These are the most commonly administered antidepressants because they have fewer side effects. Examples are Sertraline, Paxil, and Fluoxetine.
• Atypical antidepressants. When symptoms do not respond to SSRIs, atypical antidepressants are prescribed.

Other Coping Mechanisms and Self-care Tips

After taking all the prescribed medications and going for counseling, following a home routine is also essential. There are some helpful tips and mechanisms that you should try to speed up recovery, as they also help maintain overall health and wellness. Some of them are as follows:

• Eat healthy foods, especially meals rich in omega-3 fatty acids
• Start a regular workout routine which can begin with short walks
• Stay active for at least 20 minutes daily
• Get as much rest and sleep as possible, especially when your baby is asleep
• Put in efforts to connect with your baby through skin-to-skin contact and smiles
• Avoid alcohol or drugs
• Make some alone time for yourself to carry out activities you enjoy
• Regularly communicate with your family and friends
• Accept help with the baby from those you trust
• Try to reduce additional stressors, like secular work and bad relationships
• Join support groups, such as a parenting group if available in your area, to reduce isolation and loneliness

Complications of Postpartum Depression

The symptoms of postpartum depression, with time, can worsen and lead to thoughts of harming yourself or others. It could also lead to other forms of mental disorders, such as anxiety disorders and obsessive-compulsive disorders. Untreated postpartum depression could also lead to ill-health due to a prolonged lack of self-care.

When to Seek Medical Intervention for Postpartum Depression Symptoms

If five or more of the symptoms mentioned above are present and last longer than two weeks, you should seek medical intervention. Also, in cases where signs begin to show during pregnancy, it is best to seek medical advice before delivery so it does not worsen.

In summary, no one should be judged for having this condition. You should not overlook the warning signs and seek help from your healthcare provider as soon as possible. It might mean being on drugs for a very long while. Nevertheless, it will do you and your newborn a lot of good in the long run.

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References:

• Depression Among Women
• What is Peripartum Depression (formerly Postpartum)?
• Postpartum Depression
• Postpartum depression: Causes, symptoms, risk factors, and treatment options
• Postpartum Depression
• Depression During and After Pregnancy

 

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