Postpartum Depression

Some of the most intense experiences a person can have are pregnancy, childbirth and becoming a new parent. As a result, when mothers experience childbirth their mental health can be impacted massively. Postpartum depression is extremely common with at least 13% of mothers experiencing postpartum depression.^{1 ­­}Additionally, nearly 4 million births occur in the United States annually and at least half a million mothers in the US experience this post-natal disorder every year.² Unfortunately, this subject area is not well researched and scientists are only just beginning to understand the biological factors which contribute to this disorder.³ 

Contributing factors include:

• Socioeconomic status
• Experiencing stressful events during pregnancy 
• Complications in pregnancy and birth
• Having multiple children (i.e. twins, triplets)
• Inadequate support from families and friends 
• A previous history of depression or anxiety 
• Chronic postnatal stressors postnatally including childcare arrangements or child temperament
• Employment status
• An unplanned pregnancy
• Poor attachment with your own mother
• A history of sexual abuse
• Lack of bonding through bottle feeding, and 
• Depression that occurs during pregnancy

This article will provide some insights into the condition and a few of the methods used at present to prevent postpartum depression. 

What is postpartum depression?

Postpartum depression, also known as postnatal depression, is a severe mental health condition that occurs as a result of childbirth. It is a prevalent disorder that can put both the mother and children at risk of harm. The major risk factors that can escalate this disorder are previous depression, stressful life events, poor relationships and lack of social support. ⁴ 

Types of postpartum depression

There are three different types of postpartum mood disorders that a mother can experience:

Baby Blues: When experiencing baby blues, your mood can fluctuate quickly, changing from happy to sad; for instance, feeling like a proud mum one moment to crying due to thoughts of not being a good mum the next. Baby blues can make you lose your appetite. Self neglect can also arise due to this disorder; for example not taking care of yourself, little physical activity, and poor hygiene as a result of being exhausted. It's also common to experience feelings of being anxious, irritable and overwhelmed. Prolonged periods of crying for no identifiable reason are a common symptom. Baby blues are typically experienced during the first week after childbirth. This condition is unpleasant but usually reduces after two to three weeks without seeking medical help. If it persists, it's preferable to seek medical help. During these periods it's important to also ask for support from friends, family, your partner or GP. 

Postpartum Depression: This is a common problem with more than 1 in every 10 women being affected at some time in their lives. Postpartum depression, also known as postnatal depression, not only affects the mother giving birth but can also affect parents of surrogate or adopted children, as well as family, friends and partners. Postnatal depression can occur at any given point after childbirth. This can develop into a serious condition, therefore it is important to seek help as soon as possible if you think you may have postnatal depression.

Postpartum psychosis or puerperal psychosis: This may be a severe mental health illness. It can start anytime and may occur ‘out of the blue’.⁵ Postpartum psychosis occurs in 1-2 over 1000 child births commonly within the first 2 to 4 weeks. After early childbirth, parents can experience paranoid or bizarre delusions, confused thinking, disorganised behaviour, mood swings, as well as not feeling like their ‘normal selves’. Postpartum psychosis is relatively uncommon compared with the baby blues and postpartum depression. The possible factors that would lead to postpartum psychosis may include having a history of bipolar disorder or schizoaffective disorder, puerperal hormonal shift, childbirth complications, sleep deprivation and intense environmental stress.⁵ 

Symptoms of postpartum depression

Often, mothers experience feeling down, tearful and anxious whilst experiencing the baby blues.

The signs that you may be depressed include: 

• Feeling sad, low or low moods, 
• No enjoyment of activities of previous interest, no interest in the wider world,
• Feeling exhausted and tired for prolonged periods, 
• Sleep deprivation, 
• Not being able to bond/connect with the baby, withdrawing from people close to you, 
• Difficulty concentrating, struggle to make decisions, 
• Intrusive thoughts (i.e. hurting yourself or others). 

Women may fail to detect this as postnatal depression occurs gradually. If you are experiencing any of the above symptoms, speak to your healthcare specialist or GP.

Causes of postpartum depression

Postpartum depression is common and is NOT your fault. There is no specific cause identified in the development of this disorder. Researchers believe that this condition can occur due to multiple individual reasons. 

There are various causes of postnatal depression. However, these physical and emotional issues can contribute to developing it further: 

• Hormones: The striking drop in oestrogen and progesterone, post-birth, can be a contributing factor. Other hormones produced by your thyroid glands can also make you feel exhausted and low
• Sleep deprivation: When you are having trouble sleeping you may not be able to cope as you usually would when small problems occur
• Anxiety: A constant worry about being unable to care for yourself or the baby
• Self Image: Thinking poorly of how you appear, lacking a sense of personal identity, feeling lost or not in control in life. All these physical and emotional issues can be due to postpartum depression

Who is at risk?

Parents, their children and support networks are at risk of suffering the effects of postpartum depression. Parents who have multiple births (twins, triplets etc.) and/ or single mothers have the highest risk of postpartum depression. If postpartum depression is not treated it can affect you for long periods of time, potentially leading to chronic depression. If the mother is depressed the father may also experience depression too. Children can also have trouble bonding, eating and sleeping due to the disorder. Additionally, children may be at risk of delays in language development and crying more than usual. In turn, children of parents with postpartum depression are more likely to develop depression and psychiatric disorders in later life. 

How long does postpartum depression last?

For some, postpartum depression can remain a long-term problem. Lack of treatment can cause depression to last for months or years. Therefore, access to appropriate and timely treatment can help to manage the symptoms of postpartum depression and improve your quality of life.

How is postpartum depression treated?

The treatment and recovery time frame can vary, as it depends on the severity of depression and an individual’s needs. Any underlying factors or illness can also affect the treatment of this disorder. 

The core ways that postpartum depression can be treated can consist of pharmacological interventions (antidepressants, or other medications) and/or cognitive behavioural therapy (CBT).

Cognitive Behavioural Therapy involves speaking to a psychologist, psychiatrist or any other mental healthcare professional. Therapy can help with targeting thoughts, feelings and behaviours that may occur due to the condition.

Antidepressants can balance brain chemistry and help with low moods. However, you need to work with your clinician to check the suitability of these medications for you, particularly if you are on antidepressants after childbirth and breastfeeding as medications can affect the chemical composition of breast milk.

Other medication could be added to your treatment such as medicine targeting anxiety or insomnia. For example, Brexanolone is a medication specifically for postpartum depression in adult women. The mechanism of action for Bexanolone is not fully known, however, it helps with balancing out the hormones that shift during pregnancy.

What happens if postpartum depression isn't treated?

A study that carried out a systematic review found that postpartum depression produces an environment that prevents growth and personal development, both for the parents and the child or children. Therefore it is important to detect and treat depression as early as possible to prevent prolonged consequences.⁶

How to prevent postpartum depression

Key things you can do to keep well during pregnancy are to maintain a healthy lifestyle and seek support from people close to you.

Join support groups or antenatal classes to socialise with other pregnant women. Talking to other parents can also help if you are a new parent. Some support charity groups you can contact include:

• Mind - a mental health charity
• PANDAS (Pre and Postnatal Depression Advice and Support) 

If you have a previous history or family history of depression or mental health problems, it is good to seek advice before and during pregnancy.

Self Help:

• Talk to family, friends and partner
• Accept Help from others when you need it. Parenting is difficult.
• Self-compassion, take care of yourself. Do things you enjoy (going for a walk, listening to music, having a bath)
• Rest, Rest, Rest! 
• Physical activity such as mild or moderate exercise (i.e. stretches, walking, yoga)
• Avoiding alcohol
• Eating healthily
• Ask your GP about support services in your local area

When should you seek medical treatment?

Seek medical help as soon as you (or your family or friends) notice any of the symptoms listed above.

Summary

In summary, postpartum depression is a relatively common and treatable disorder. It is good to remember that postpartum depression can affect anyone. If you or those closest to you think you are experiencing postpartum depression, seek medical advice as quickly as possible, there are lots of people willing to help. You can try to prevent symptoms by maintaining a healthy lifestyle and seeking assistance from medical professionals, particularly if you have had a past history of any mental health illnesses.