Postpartum Depression - Discussion and Overview

Definition

Postpartum depression is a disorder which afflicts new mothers immediately in the postpartum period. It is a condition which frequently goes undiagnosed and unrecognized and is sometimes devastating in its repercussions.

When this condition is unrecognized and untreated, a seriously afflicted mother with postpartum blues can think about harming herself and / or the child. Even in mild cases, she can seriously impair the developing bond between mother and child.

Hence, the key to successfully handling this ailment is by early identification of the problem via diagnostic tests and intervention via supportive and pharmacologic means. This would be an effective two-pronged method of managing postpartum depression and considerably reduces the impact of the disease.

As always, our stand when it comes to pharmaceutical drug medications is that they should only be used as a last resort - this applies to all types of depression.

Some of the terms used to describe this condition include postpartum blues, baby blues, perinatal depression, peripartum depression, maternity blues, postpartum anxiety disorder, postpartum psychosis, puerperal psychosis, etc. Post natal depression is also sometimes used. Common misspellings include "post pardum depression" and "post pardom depression".

Information on postpartum depression – Overview

Though the common myth and belief is that a new mother is necessarily in a state of exalted bliss, this seldom is true with many women post delivery. Hence, a woman who is experiencing low moods or general lack of pleasure in activities need not feel guilty to express such emotions, since she is not alone.

As per statistics currently available, 80% of women experience some amount of mood disturbance post pregnancy in the postpartum period. The feelings are associated with the emotions of loneliness, fear, guilt from feeling unloving or not maternal towards the baby, as well as overall guilt for experiencing negative emotions, when their conditioning and general expectations around them is that they should be feeling ecstatically happy.

In most case, postpartum blues is mild and disappears without necessitating treatment. However, a small percentage of 10 – 20% of women with postpartum blues develop exacerbated symptoms, leading to full blown postpartum depression.

The mild form of postpartum depression, called “baby blues”, is a transient state of heightened emotions which occurs in about 50% of women immediately after delivery. This state is marked by a peak which is felt from day 3 to day 5 post delivery and lasts for a couple of weeks. There is a marked increase in crying spells, insomnia, sadness, fatigue, irritability, inability to concentrate and a general state of “being on an emotional precipice”.

The ability of a woman to care for the newborn is not impaired due to her experiencing mild postpartum blues. It is a common occurrence and not considered to be an illness, unless it develops into postpartum depression.

The risk factors that may predispose the condition of postpartum blues can include previous episodes of major depression, psychological stress, social stress, lack of support, previous menstrual syndrome, etc.

When postpartum blues continue for an inordinately extended period, this can be accompanied by a marked increase in intensity of the symptoms. This condition then crosses over from a case of mild postpartum blues to full-blown post partum depression.

An individual suffering from such depression will worry constantly about the baby’s health and will also experience negative thoughts about the baby. Though she may occasionally harbor thoughts of harming the baby, she will seldom act on such thoughts.

Unlike postpartum blues, post partum depression will clearly impair the new mother’s ability to care for her child. Severe postpartum depression can lead a woman to become suicidal or think of killing her children, not with the intention to harm them, but to protect them from abandonment.

Postpartum Puerperal Psychosis

A more severe state of disorder to that of postpartum depression is a condition called postpartum puerperal psychosis. Though this condition is rare, if identified, it requires immediate attention and treatment.

The symptoms of this condition are experienced in the 3-week period post delivery, and may include hallucinations, delusions, etc. The serious related conditions associated with this ailment are bipolar disorder, mood disorder, or psychosis. The symptoms generally include insomnia, extreme agitation and sudden mood swings.

The point to look out for is that a woman seriously ill with this condition can fool caregivers and health professionals into thinking that she is cured, when she is in fact seriously depressed and ill. The likelihood that women will act on thoughts of harming their newborn is higher when the woman is suffering from postpartum puerperal psychosis.

Causes of post partum depression

The age of the mother and the number of children she has previously had does not relate to her likelihood of developing or not developing postpartum depression. Although there is no specific cause that has been known to cause post partum depression, the following are some of the likely factors that play a role in the onset of the condition:

• Hormonal imbalance: The levels of certain hormones, such as estrogen, cortisol, and progesterone, fall rapidly in the 48-hour period post delivery. Though not all women experience noticeable changes when the hormone levels dip, some women may be more sensitive to the dramatic fall in these hormones, leading to a depressive state.
  
  
• Other risk factors: If the individual has a history of mental illness prior to pregnancy; if there is a family history of mental illness, including postpartum blues, in the family; if there is stress due to conflict in the marriage; if there is loss of employment; or if there is a lack of social support.
  
  
• Miscarriage: The chances of depression are high if the woman has had a miscarriage and is childless. This is a factor that can prevail even when a woman is generally unhappy about being pregnant.
  
  
• Changes associated with Childbirth: The physical and emotional changes that occur with pregnancy and childbirth, and the woman’s’ ability to cope with these rapid changes, can contribute to being depressed.

  Physical changes include loss of muscle tone and the challenges of losing weight in the post delivery period. Due to the increased level of activity and the loss of sleep due to feeding and taking care of baby, new mothers are often fatigued and stressed, and these can lead to depression. The physical pain or soreness in the perineal area during the post recovery period after a caesarean section can also lead to depression.

  The emotional changes associated with childbirth include: a feeling of being trapped to the confines of home and attending to baby’s needs constantly; a feeling of loss of self and identity; being overwhelmed by responsibilities of parenthood; sudden changes to routine, causing stress; lack of sleep; and feeling sexually and physically unattractive.
  
  

More information on postpartum depression is discussed in the other related pages and articles.

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Useful Depression Resources