Prevent the Perils of Postpartum Depression

Monday blues we understand, post vacation blues we totally get, but baby blues! What’s that? How can melancholy be linked with the source of ultimate joy (a baby)? How can presence of new life engender feelings of fear, rejection and pain? –  Rashmi Ullas investigates.

Hands down, the best day of my life was the day when I first saw my baby girl and the best phase was this journey of motherhood. So much joy, so much love, such bliss… Babies are truly God-given gifts to this world. But do all mothers feel this way?

I don’t think anyone could detest a baby, but for some, coping with parenthood (especially in the early stages) becomes a huge challenge. And unfortunately, postpartum depression exists and in today’s era, which is witnessing more stress, smaller families, financial crunch and lack of familial support, postpartum depression is heard of more often than ever.

Understanding postpartum depression

There’s no doubt that the birth of a baby is a struggle for new parents. They are constantly battling their new responsibilities, lack of experience and of course, lack of sleep. This brings about feelings of sadness and distress, which the doctors often refer to as baby blues. Luckily, baby blues go away in a week or so.

But postpartum depression doesn’t. This is a serious and long lasting condition, which is dangerous for the mother, her baby and her loved ones. A victim of postpartum depression is often overwhelmed with feelings of extreme sadness, anxiety, and exhaustion. These lowly feelings can even interfere with daily activities and sometimes push her to do the unthinkable (harm the baby and herself).

The underlying causes

Postpartum depression results from a combination of physical and emotional factors. The hormones oestrogen and progesterone drop after pregnancy, which lead to mood swings. The physical exhaustion from lack of sleep and rest after delivery add to the stress, and women can become prone to postpartum depression.

Sometimes an unfortunate event such as miscarriage and stillbirth could become the underlying cause and otherwise, the surrounding environment could be the reason why she easily slips into postpartum depression. The emotional triggers for postpartum depression could result from a previous history or family history of depression or disorders such as bipolar disease. Some women get very poor support from their spouse or family and may eventually end up with depression.

Some women undergo this phase because of an unwanted or unplanned pregnancy or due to their inherent character to remain in control. Newborns take up most of the time and are very unpredictable. The woman’s schedule is in a mess and she barely gets time away from the child; this affects every new mother, but especially takes a toll on women who can’t cope with chaos. Some babies are colicky too, which means they are constantly crying and leave the new parents haggard.

These or other stresses in life could push the woman towards depression. So it is not what the woman does or does not do, but it’s the changed environment and her predisposition, which makes her vulnerable to postpartum depression.

How do you know it’s postpartum depression?

The feeling of extreme sadness, hopelessness, emptiness and anxiety could indicate that the woman is heading towards depression. Loss of pleasure in everyday activities, loss of appetite, sudden loss or gain of weight, insomnia are all indications of postpartum depression.

In extreme cases, the woman may even see or hear things that don’t exist. All these factors will definitely affect her concentration levels and the attention she gives to her baby.

Women could experience postpartum depression symptoms immediately after the child’s birth or after the baby blues subside. Although these are pointers, only a doctor can tell if the woman has postpartum depression.

As patients or caregivers, you should watch out for these indicators in the new mother and report them to your doctor immediately:

  • Disconnection from her baby
  • More crying episodes, without any obvious reason
  • Increased worrying or anxiety
  • Mood swings, irritability and restlessness
  • Excessive sleeping or insomnia
  • Poor concentration, memory for small details and decision making abilities
  • Increased anger and rage
  • Loss of interest in pleasurable activities
  • Constant complaints of headaches, stomach problems, and muscle pain
  • Loss of appetite and withdrawal from friends and family
  • Loss of self-confidence of being a mother
  • Thoughts of harming self or the baby

What next if you see these symptoms?

Depression is a condition that worsens if left untreated and so it is important that the woman and her family seek help immediately. Sometimes the woman may look normal, but would be suffering from within. There is no fault in admitting you have depression; it is important to open up. Encourage the woman to speak up with the family and the doctor.

The doctor will diagnose postpartum depression after a thorough physical examination and will interview the patient to get an insight into her condition. Based on the mother’s condition, the doctor will prescribe a treatment with counselling and/or medicines. She will need to come for followup check ups to assess her condition and progress.

Treatment may include cognitive behavioural therapy (which is aimed at helping the woman recognise and change her negative thoughts and behaviours), interpersonal therapy (which is aimed at helping the woman understand and work through problematic personal relationships) and medication (such as antidepressant drugs, which are safe during lactation).

Once a woman has been diagnosed with postpartum depression, it is important that the family supports her and keeps a close watch on her progress. The woman should eat a healthy diet, exercise regularly and rest as much as possible. She should always be surrounded by friends and family members, who can listen to her woes and encourage her to come out of this state.

Getting help is important

A lot of mothers and their babies are lost to postpartum depression, so it is important to reach out to them. The first and foremost aspect in this battle is to overcome the stigma and provide support to the mother and her child. Staying close to the mother and reassuring her of better times ahead, guiding her to bond with her baby and taking care of her emotional and physical needs could avert the dangers that surround postpartum depression.

We interviewed Dr. Cornelia Chee (Director and Senior Consultant, Women’s Emotional Health Service, National University Hospital, Singapore) to find out more about postpartum depression and what needs to be done in this aspect.

How do you know if you have postpartum depression? Wh at are the signs that family members should look out for?

The signs of postpartum depression include low mood, lack of interest in previously enjoyed activities, lack of interest in the baby, feeling overwhelmed, tearfulness, poor concentration, excessive guilt or selfblame, irritability and in extreme cases, feeling that one and/or the baby is better off dead.

Do fathers get postpartum depression as well?

Yes, fathers can experience postpartum depression, though the hormonal factors would obviously not be at play here. Having a baby can bring about a great transition in one’s lifestyle and role. Financial stress often exacerbates postpartum depression in fathers, especially if they are facing unemployment.

How long does it usually last? What should a new mother do if the symptoms do not seem to improve?

Postpartum depression can start during pregnancy or be part of a longstanding depression. An episode of depression typically lasts for a few months. If the symptoms do not seem to improve, seeking help early from a professional who is well versed in postnatal depression would be ideal. Medication can make a big difference in some cases and is compatible with pregnancy and breastfeeding, but treatment should always be individualised.

What causes postpartum depression? Why are some women more susceptible to it?

Very often, we see women have a combination of several factors that lead to postpartum depression. Triggers common to all may be a relatively poor quality of sleep due to the inevitable disruptions caused by awakenings, adjustments to role transitions (especially for first-time mothers), intrapersonal as well as interpersonal with her partner and/ or family, and/or lack of emotional and practical support. For second or third-time mums, the triggers could come from handling the older children at the same time. Juggling work and family is also an issue.

What are the factors that increase the risk of postpartum depression?

Multiple factors are responsible, though hormonal factors are less important than previously thought for the majority of cases. A biological predisposition (such as having a personal or family history of depression), adverse social circumstances (like an unwanted pregnancy, poverty, poor marital and family support, etc.) and personality factors (like the excessive need for control and perfectionism, etc.) could contribute to the risk.