Postpartum depression/ Perinatal depression

Postpartum depression (PPD) is depression that occurs to a mother after a childbirth. PPD is defined as an episode of non-psychotic depression with onset within 1 year of childbirth. PPD can happen any time after childbirth. It often starts within 1 to 3 weeks after a childbirth and may last for weeks or months at a time.

The word "postpartum" means "after birth," so "postpartum depression" is talking only about depression after the baby is born. For many women, this term is correct: they start feeling depression sometime within the first year after they have the baby. But some women start to feel depression while they're still pregnant and the term "perinatal depression" is used to describe this situation. The word "perinatal" describes the time during pregnancy or just after birth. Researchers believe that depression is one of the most common problems women experience during and after pregnancy. Perinatal depression affects as many as one in seven women.

This type of depression does not only affect mothers. Sometimes new fathers also experience postpartum or prenatal depression.

Feelings of postpartum depression are more intense and last longer than those of “baby blues”. It is a term used to describe the worry, sadness, and tiredness many women experience after having a baby. “Baby blues” symptoms typically resolve on their own within a few days.

Mothers with postpartum depression experience feelings of extreme sadness, anxiety, and exhaustion that may make it difficult for them to complete daily care activities for themselves or for others.

Postpartum depression is a common complication of childbearing and as such represents a considerable public health problem affecting women and their families and make it an important medical condition to diagnose, treat and prevent.

References-

www.marchofdimes.org/pregnancy/postpartum-depression.aspx

www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml

www.acog.org/Patients/FAQs/Postpartum-Depression?IsMobileSet=false

www.cdc.gov/reproductivehealth/depression/index.htm

The patterns of symptoms in women with postpartum depression are similar to those in women who have depression unrelated to childbirth, apart from the fact that the content may focus on the delivery or baby.

Some of the more common symptoms a woman may experience include:

• Feeling sad, hopeless, empty, or overwhelmed
• Crying more often than usual or for no apparent reason
• Worrying or feeling overly anxious
• Feeling moody, irritable, or restless
• Oversleeping, or being unable to sleep even when her baby is asleep
• Having trouble concentrating, remembering details, and making decisions
• Experiencing anger or rage
• Losing interest in activities that are usually enjoyable
• Suffering from physical aches and pains, including frequent headaches, stomach problems, and muscle pain
• Eating too little or too much
• Withdrawing from or avoiding friends and family
• Having trouble bonding or forming an emotional attachment with her baby
• Persistently doubting her ability to care for her baby
• Thinking about harming herself or her baby.

Postpartum depression is different from the baby blues-

• The “baby blues” is a term used to describe the feelings of worry, unhappiness, and fatigue that many women experience after having a baby. Babies require a lot of care, so it’s normal for mothers to be worried about, or tired from, providing that care. Baby blues, which affects up to 80 percent of mothers, includes feelings that are somewhat mild, last a week or two, and go away on their own.
• With postpartum depression, feelings of sadness and anxiety can be extreme and might interfere with a woman’s ability to care for herself or her family. Because of the severity of the symptoms, postpartum depression usually requires treatment. The condition may begin shortly before or any time after childbirth, but commonly begins between a week and a month after delivery.

References-

www.cdc.gov/features/maternal-depression/index.html

www.who.int/mental_health/prevention/suicide/lit_review_postpartum_depression.pdf

Postpartum depression probably is caused by a combination of factors. These factors include the following:

• Changes in hormone levels just after childbirth: levels of estrogen and progesterone decrease just after child birth and these changes may trigger depression in the same way as smaller changes in hormone levels before menstrual periods trigger mood swings and tension.

• History of depression: Women who have had depression at any time-before, during, or after pregnancy, or who currently are being treated for depression have an increased risk of developing postpartum depression.

• Emotional factors: If the pregnancy is not planned or is not wanted, this can affect the way a woman feels about her pregnancy and her unborn baby. Even when a pregnancy is planned, it can take a long time to adjust for having a new baby. Parents of babies who are sick or who need to stay in the hospital may feel sad, angry, or guilty. These emotions can affect a woman’s self-esteem and how she deals with stress.

• Fatigue: Many women feel very tired after giving birth. It can take weeks for a woman to regain her normal strength and energy. For women who have had their babies by cesarean section, it may take a longer time.

• Lifestyle factors: Lack of support from family members and stressful life events, such as a recent death of a loved one, a family illness, or moving to a new city, can greatly increase the risk of postpartum depression.

Other risk factors may be-

• Family history of depression
• A difficult pregnancy or birth experience
• Giving birth to twins or other multiples
• Experiencing problems in your relationship with your partner
• Experiencing financial problems
• Being a teen mother
• Preterm (before 37 weeks) labor and delivery.
• Pregnancy with birth complications.
• Smoking, drinking alcohol, and use of harmful drugs
• Negative thoughts and feelings about being a mother, these include
  • Having doubts that you can be a good mother
  • Putting pressure on yourself to be a perfect mother
  • Feeling that you’re no longer the person you were before you had your baby
  • Feeling that you’re less attractive after having your baby
  • Having no free time for yourself
  • Feeling tired and moody because you aren’t sleeping well or getting enough sleep

References-

www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml

www.acog.org/Patients/FAQs/Postpartum-Depression?IsMobileSet=false

www.marchofdimes.org/pregnancy/postpartum-depression.aspx

www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml

www1.nichd.nih.gov/ncmhep/initiatives/moms-mental-health-matters/moms/Pages/default.aspx

A health care provider can diagnose a woman with postpartum depression. Because symptoms of this condition are broad and may vary between women, a health care provider can help a woman figure out whether the symptoms she is feeling are due to postpartum depression or something else. A woman who experiences any of these symptoms should see a health care provider right away.

Your doctor will usually talk with you about your feelings, thoughts and mental health to distinguish between a short-term case of postpartum baby blues and a more severe form of depression. Don't be embarrassed, share your symptoms with your doctor so that a useful treatment plan can be created for you.

As part of your evaluation, doctor may:

• Do a depression screening that may include having to fill out a questionnaire.
• Advice blood tests to determine thyroid functions, and
• other tests, to rule out other causes for symptoms.

Reference 

www.cdc.gov/features/maternal-depression/index.html

Many options are there for managing PPD during pregnancy or after birth. Some women may participate in counseling (talk therapy); and others may need medication. There is no single treatment that works for everyone.

Treatment can include:

Counseling/Talk Therapy:

Woman with PPD may have one-on-one therapy with just she and the therapist (a counselor, therapist, psychologist, psychiatrist, or social worker) or group therapy where she meets with a therapist and other people with problems similar to her.

Another option is family or couple’s therapy, in which she and her family members or her partner may work with a therapist. Sometimes, therapy is needed for only a few weeks, but it may be needed for a few months or longer.

Counseling can be done with two ways:

• Cognitive behavioral therapy (CBT), which helps people recognize and change their negative thoughts and behaviors.

• Interpersonal therapy (IPT), which helps people understand and work through problematic personal relationships.

Support groups: These are groups of people who meet together or go online to share their feelings and experiences about certain topics. Counselor can suggest the support group to help.

Medicine: PPD often is treated with medicine. Several medications can treat depression effectively and are safe for pregnant women and for breastfeeding mothers and their babies.

• Antidepressants. These are medicines used to treat many kinds of depression, including PPD. Some medicines are not safe to take during breastfeeding. Talk to your health care provider to find out about these medicines to decide which one is right for you.

• Estrogen. This hormone plays an important role in menstrual cycle and pregnancy. During childbirth, the amount of estrogen in the body drops quickly.

In addition to treatment following things can be advised to new mothers to manage PPD:

Stay healthy and fit:

• Do something active every day. Go for a walk or get back to the gym.
• Eat healthy foods. These include fruits, vegetables, whole-grain breads and lean meats. Try to eat fewer sweets and salty snacks.
• Get as much rest as you can. Try to sleep when your baby sleeps. 
• Don’t drink alcohol. Alcohol is a depressant, and also can interact with the medicine given for PPD. You can pass alcohol to your baby through your breast milk.

Ask for and accept help:

• Be with others: Keep in touch with people who care about you and share your feelings.
• Make time for yourself: Do something for you, like getting out of the house, if a family member or your partner can look after the baby.
• Be realistic: You don't have to do everything. You don't have to have the "perfect" home. Just do what you can and leave the rest.
• Ask for help: Don't be afraid to ask for help from family and friends, whether it's caring for the baby or doing household chores.    
• Rest when the baby rests: Sleep is just as important for you as it is for the baby. Sleep when the baby sleeps, during naps and at night.
• Reduce your stress:

• Do the things that used to make you feel good about yourself before you got pregnant.
• Do not make any major changes in your life right after having your baby.

Family members and friends may be the first to recognize symptoms of postpartum depression in a new mother. They can encourage her to talk with a health care provider, offer emotional support, and assist with daily tasks such as caring for the baby or the home.

Without treatment, postpartum depression can last for months or years. In addition to affecting the mother’s health, it can interfere with her ability to connect with and care for her baby and may cause the baby to have problems with sleeping, eating, and behavior as he or she grows.

References-

www.marchofdimes.org/pregnancy/postpartum-depression.aspx

www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml

www1.nichd.nih.gov/ncmhep/initiatives/moms-mental-health-matters/moms/Pages/default.aspx

Certain kinds of counseling can prevent perinatal/postpartum depression (PPD) in women at increased risk of depression. Counseling by a counselor or therapist helps the woman to solve problems and cope with things in her everyday life.   

Counseling can be recommended for women with one or more of these risk factors:

• Current signs and symptoms of depression
• A history of depression or other mental health condition
• Being pregnant as a teenager or being a single mom
• Having stressful life circumstances, like low income
• Being a victim of intimate partner violence (IPV)

Two types of counseling can be recommended to prevent PPD for women at increased risk: 

• Cognitive behavioral therapy (CBT), which helps people recognize and change their negative thoughts and behaviors.

• Interpersonal therapy (IPT), which helps people understand and work through problematic personal relationships.

Support groups: These are groups of people who meet together or go online to share their feelings and experiences about certain topics. Counselor can suggest the support group to help.

Optimal postpartum care provides an opportunity to promote the overall health and well-being of women. Timely recognition of maternal distress, both physical and psychological, during the course of pregnancy and in the postpartum period should be important concerns for her family members and health care professionals.

References-

www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml

www.acog.org/Patients/FAQs/Postpartum-Depression?IsMobileSet=false