Medically reviewed by Dr Imaeka Ukpe
Postpartum depression (PPD), also known as postnatal depression is a depressive symptom that lasts more than 2 weeks after delivery and interfers with activities of daily living. Put simply, it refers to a form of deep sadness, anxiety and moodiness that occurs after childbirth.
It is quite different from “baby blues” because even though symptoms are similar, baby blues are mostly temporary and often require no treatment. On the other hand, postpartum depression, when left untreated, can lead to more damage to the mental health of new mothers making them want to harm themselves or their babies.
Postpartum depression is real. So, if you have experienced it or still in the limbo of it, you are not alone. For any consolation, statistics show that postpartum depression occurs in 10-15% of mothers and the risk of recurrence ranges from 25-50%. Sadly, in Africa, many women who go through this do not know that they are depressed, and the few ones that are aware of their situation do not seek the requisite help that they deserve.
The question on your mind will likely be along the lines of: How come postpartum depression awareness is not often talked about in this part of the globe?
The fact is that, in many developing countries like Nigeria, childbearing has a vital societal value and is often regarded as what makes a woman complete, thus they are expected to appreciate the gift of a child and focus only on the joys of motherhood. Birthing a child is welcomed with ecstasy, making it almost impossible to talk about the mixed feelings (and postpartum depression) some new mothers experience.
Causes of Postpartum Depression
Medically, the exact cause of postpartum depression is not known. However, it has been noted that the following could trigger postpartum depression in new mothers:
prior depression or mood disorders: Studies show that most women who have had depression in the past or battled with mental health and mood disorders usually experience postnatal depression.
hormonal changes: The entire nine months of pregnancy is not an easy journey for a lot of mothers especially in terms of hormonal changes. For example, the levels of progesterone and estrogen go up during pregnancy, then drops down almost immediately after child delivery. This sudden change can send mixed signals to the brain, making the new mother depressed.
sleep deprivation that often comes with tending to a newborn: The excitement is finally over. Usually, a week to two weeks after childbirth, some women get over the euphoria that comes with bringing a child to the world as they now have to pay more attention to caring for the newborn at every point in time, including midnights. Not having enough sleep, coupled with the transition from pregnancy to motherhood can be nerve cracking to the woman, leading to postpartum depression.
genetic susceptibility: If the new mother has a family history of depression or mood disorders, the gene can likely cause her to experience postpartum depression.
significant life stressors: Emotional stress emanating from life situation of the new mother can lead to postpartum depression. Juggling the care of a newborn by battling emotionally threatening issues like marital conflict, unemployment, poverty, physical changes in the body like stretch marks, big tummy, painful breasts, dull complexion, etc
Other likely causes also include psychological adjustment, lack of social support from partner or family members, unwanted pregnancy, sick infant, prior or current poor obstetric outcomes (like previous miscarriage, preterm delivery, infant with congenital malformation, baby blues ( such as rapid mood swings , irritability, anxiety, decreased concentration, insomnia, crying spells).
Signs and symptoms of postpartum depression
The most noticeable symptoms of postpartum depression, just like those of major depression may include:
Anxiety or panic attacks
Insomnia or increased sleep
Unrealistic worries and hopelessness
Disinterest in the baby
Loss of appetite or overeating
In worse case scenarios, one may experience;
Irritability, violence or anger
Fear of harming the baby
Typically, these symptoms may affect the new mother for 2 – 6 months but can last up to 1 year when untreated. In cases where the symptoms are serious, immediate medical help is needed. If you notice some of these symptoms in yourself or a new mother around, Speak to a Doctor for immediate assistance.
Diagnosing Postpartum Depression
A diagnosis of postpartum depression is based on clinical evaluation for symptoms or sometimes formal depression scales. Because of ignorance, as well as cultural and social factors in Africa, many women may not voluntarily seek professional help when they experience signs of postpartum depression. So, it is imperative that health care providers follow new mothers up on their feelings and psychological states before and after delivery. Screening new mothers during postpartum clinical visits using a validated screening tool such as Edinburg Postnatal Screening Tool and postpartum depression screening scale will help a great deal in curbing the prevalence of postpartum depression.
The Edinburg Postnatal Depression Scale is a 10 -item, self-rated questionnaire used extensively for detection of postpartum depression. A score of 10 or more or an affirmative answer on question 10 (presence of suicidal thoughts) requires more thorough evaluation. We have provided in this article, the DSM-IV criteria for detecting major depressive episode to help you self-evaluate yours symptoms and know when to Talk to a Doctor:
Greater than or equal to 5 of the following symptoms have been present during the same 2 weeks period;
- Experiencing depressed mood everyday
- Markedly diminished interest or pleasure in all or almost all activities most of the day
- Significant weight loss when not dieting or weight gain or increased appetite nearly everyday
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly everyday
- Feelings of worthlessness or excessive inappropriate guilt nearly everyday
- Diminished ability to think or concentrate or indecisiveness nearly every day
- Recurrent thoughts of death (not just fear of dying)
- Recurrent suicidal ideation without a specific plan or a suicidal attempt or a specific plan for committing suicide.
Like earlier stated, if a new mother experiences 5 and above of the symptoms listed above and is not under the influence of drugs or substance abuse nor is she bereaved, then the best point of call is to Speak to a Healthcare Professional.
Dealing with Postpartum Depression
It can be difficult for a new mum to admit that she is passing through postpartum depression either because of ignorance or the fear of being judged. However, acknowledging that one is depressed and truly needs help is the first step to effectively dealing with postpartum depression.
Being surrounded by loved ones and an understanding partner as social and emotional support systems at this vulnerable time can go a long way to help treat symptoms of postpartum depression.
Depending on whether symptoms are mild, moderate or severe, the doctor can recommend appropriate treatment options for the new mother. Some of these treatments may include but not limited to:
Psychotherapy (speaking to a therapist): For mild to moderate depressive symptoms, individual or group psychotherapy like cognitive behavioral and interpersonal therapy are effective. Other helpful psychotherapies are getting involved in psychoeducational or support groups.
Pharmacotherapy (using antidepressants): If a woman has significant anxiety she may be treated with anxiolytics like clonazepam. Selective serotonin reuptake inhibitors are first line agents (e.g fluoxetine, sertraline). Others include serotonin/nor epinephrine reuptake inhibitors, tricyclic antidepressants, and brexanolone. Pharmacologic strategies are indicated for moderate to severe depressive symptoms or when a woman’s condition does not respond to non-pharmacologic treatment.
Electroconvulsive therapy (applying electric current to the brain to quickly reverse symptoms of severe depression): Inpatient hospitalization may be necessary for severe postpartum depression. A consideration is electroconvulsive therapy which is rapid, safe and effective for women with severe postpartum depression especially those with active suicidal ideation.
Exercise therapy, light therapy, massage therapy, acupuncture, and omega 3 fatty acid supplementation have also shown to improve the symptoms of postpartum depression and are beneficial in effective treatments.
Why Everyone should be Involved:
As a condition, postpartum depression is not to be taken for granted as its effects are not only on the mother but also the child and the father. For the new mum, postpartum depression negatively interferes with her ability to care for herself and the baby adequately. New mothers may not properly bond with their infant, resulting in emotional, social and cognitive problems in the life of the child in the future.
It is important that prompt treatment is given to the new mother as allowing the symptoms to persist may further impact on the development of the child development, resulting in increased risk of cognitive delay, insecure attachment, and behavioral disorders. The fathers are not exempted. If left untreated, postpartum depression can affect the father’s psychological and emotional health. Fathers are at increased risk of depression and marital stress. Treatment of mother improves outcome for everyone, especially the innocent child who is solely dependent on mother–child interaction to develop well.
Postpartum depression is not a weakness but a real medical condition, and it should be treated as such. You are not a bad mother for feeling the way you do, and it does not mean that you hate your baby. You simply need the right care and help to go through the phase. Getting prompt medical attention is the best step to take to manage symptoms and faster recovery.
Did you find this article helpful? Feel free to drop your thoughts in the comment section. This is a safe place to talk about how you feel with no judgment.
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