Mental HealthPregnancy and Newborn Health

Postpartum depression (PPD): All You Need To Know

Giving birth is usually a big change in the lives of parents. New mothers may showcase signs of postpartum depression, which can be fatal but is often brushed aside as normal, unfortunately. 

What is postpartum depression?

Postpartum depression refers to a persistently low mood and feelings of extreme sadness/indifference/anxiety observed in new mothers after delivery. More than half of the new mothers experience ‘baby blues’, which involves crying for no reason, irritability, restlessness, and anxiety. However, baby blues differ from postpartum depression as they last only a week or two, whereas PPD lasts much longer.

According to a report by the Office on Women’s Health, PPD affects 1 in 9 new mothers. The symptoms may arise within a month or sometimes, after a year of delivery, and usually peak at three to six months after childbirth.

Unfortunately, most new mothers believe that anxiety and depression are a part of the pregnancy process and ignore such feelings. But PPD is a serious mental health condition and if left untreated, can transform into other mental health disorders such as paranoia, panic anxiety, psychosis, and a feeling of distrust in others. However, it can be resolved by treatment. If symptoms of depression last 2 weeks or longer within the first year of giving birth, the mother should consult a doctor.

What are the causes of postpartum depression?

The exact cause of PPD is unknown. According to sources, the causes may include:

  • a history of previous trauma,
  • hormonal fluctuations,
  • previous diagnosis or family history of bipolar disorders or clinical depression,
  • the physical and emotional stress of delivery and childcare,
  • increased stress at the workplace or at home,
  • difficulty sleeping,
  • feeling overwhelmed,
  • feeling unattractive,
  • not having any spare time,
  • pain after labor or other complications such as urinary incontinence,
  • breastfeeding difficulties,
  • substance use disorders,
  • having a baby with special needs,
  • unwanted pregnancy,
  • financial worries
  • a lack of support from family and friends.

Other causes include complications during delivery, delivering babies preterm or having low birthweight babies, and having unrealistic expectations of acquiring mothering skills rapidly after childbirth.

When should you suspect PPD?

New mothers often experience frequent mood swings due to ruminating intrusive thoughts that create instant fear and anxiety. These can occur in the form of images, visuals, or voices that can pop up anytime.

PPD mothers may demonstrate tension and anxiety, restlessness, irritability, poor memory, poor decision-making skills, frequently complain of body pains and illnesses, and an isolating tendency of distancing away from family and friends.

Other signs may include lack of interest in hobbies, loss of sense of time, change in appetite, lack of concentration, feeling unworthy, feeling of suffocation, and difficulty bonding with the baby. Anxiety and panic attacks are often accompanied by a rapid heart rate and increased sweating. In severe forms, the mother may lose interest in her baby.

Treating postpartum depression

PPD is a distressing condition and requires utmost support and care from the family members during recovery. Some of the treatment approaches for PPD include:

  • Psychotherapy and counseling

These techniques are the first line of approach for treating mild PPD. They involve self-help advice offered during counseling sessions or interpersonal psychotherapy which aims to improve communication skills and help develop social networks. Cognitive-behavioral therapy (CBT) may resolve moderate PPD and aims to alter behavior by altering thoughts. CBT focuses on day-to-day obstacles that give rise to negative thoughts and attitudes that give rise to self-destructive behavior.

Mothers can avoid intrusive thoughts by distracting their attention. When such thoughts arise, listening to music, and engaging in puzzles or other mind-related games help to ward off such thoughts.

  • Medications

Moderate-to-severe PPD is usually treated with antidepressants such as selective serotonin reuptake inhibitors (fluoxetine, citalopram, and paroxetine) prescribed for four to six weeks. Brexanolone (Zulresso) can relieve depression by restoring hormonal balance. For severe cases of depression with psychosis, mood stabilizers such as lithium or antipsychotic agents and tranquilizers are given. However, breastfeeding can pass these medications onto the baby so the baby needs to be transferred to formula milk before starting this medication.

  1. Alternate therapies

Mothers with PPD may try alternate therapies such as bright light therapy, acupuncture, massage, or omega-3 fatty acid supplementation. Regular physical exercise, a balanced diet, a good sleep schedule, meditation and yoga can help in PPD.

Electroconvulsive therapy is recommended in very severe cases of PPD, unresponsive to psychotherapy and medications. It is usually performed under general anesthesia and involves an electric shock being applied to the brain using electrodes placed over the head. The procedure is usually performed twice weekly for 6 to 12 weeks.

Author:

 Dr. Pooja Toshniwal Paharia is a Consultant Oral and Maxillofacial Physician and Radiologist, M.DS (Oral Medicine and Radiology) from Mumbai. She strongly believes in evidence-based radiodiagnosis and therapeutic regimens for benign, potentially malignant, or malignant lesions and conditions either arising from the oral and maxillofacial structures or manifesting in the associated regions.

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