Postpartum Depression: Symptoms And Treatment

Pregnancy and the arrival of a baby into the world usually cause joy and happiness. But it also triggers a whole bunch of strong feelings that go from rejoicing to fear or anxiety. Such is the intensity of these emotions that, in some cases, they can lead to postpartum depression.

This state is not synonymous with weakness, nor does it mean that the person did not want to have the baby. Postpartum depression is a psychological condition that can appear after childbirth for a variety of causes. In this article, we will talk about what this disorder is, its symptoms, causes, and treatments.

What is postpartum depression?

Postpartum depression is a psychological condition that appears as a complex combination of physical, emotional, and behavioral changes that occur after childbirth. According to different diagnostic manuals, postnatal depression is a form of major depression that tends to appear within four weeks after giving birth.

Although there are cases of postpartum depression in men, it is a mood disorder that affects women who have just given birth. The symptoms may appear as feelings of extreme sadness, lack of energy, anxiety, crying, mood swings and irritability and alterations in patterns of sleep and eating.

The causes are related to the chemical, social, and psychological changes involved in childbirth. Although the real link between these changes and this disorder has not positively, it is suggested that it is the main cause of this condition.

Besides, the lack of sleep, acquiring the role of mother and psychosocial and cultural factors also influence postpartum depression. Although a large number of parents experience a short period of worry, fear and even unhappiness after childbirth, this type of depression should only be taken into consideration when symptoms worsen and remain for more than two weeks.

Postpartum depression symptoms

The signs and symptoms can vary depending on the person and whether the depression is milder or more severe.

Baby blues

In the cases of mild depression, the symptoms last for a week or two. These include:

• Mood swings
• Anxiety
• Sadness
• Irritability
• Feeling overwhelmed
• Crying episodes
• Decreased concentration
• Changes in appetite
• Lack of sleep

Severe symptoms

At first, it can be confused with baby blues. However, if the signs are much more intense and last longer than two weeks, they can interfere with the ability to take care for the baby and handle other daily tasks.

Symptoms usually appear within the first few weeks after delivery, but may also begin much later, up to six months after the baby is born. Symptoms of postpartum depression may include:

• Depressed mood or severe mood swings
• Excessive crying
• Difficulty bonding with the baby
• Social withdrawal and isolation
• Loss of appetite or excessive increase in appetite
• Insomnia or hypersomnia
• Loss of energy or feeling extremely tired
• Anhedonia or inability to enjoy previously pleasurable activities
• Irritability or angry outbursts
• Fear of not being a good parent
• Feelings of shame, worthlessness, and guilt
• Lack of concentration and difficulty thinking clearly
• Severe anxiety and panic attacks
• Thoughts of self-harm or toward the baby
• Suicidal ideas

Postpartum psychosis

Postpartum psychosis is the most severe and rare. This uncommon psychological condition usually develops within the first week after childbirth and symptoms are even more severe than in the previous disorder.

This variety can present life-threatening thoughts or behaviors that require immediate medical attention and treatment. Among the signs and symptoms of postpartum psychosis we can find:

• Confusion and disorientation
• Obsessive thoughts about the baby
• Hallucinations and delusions
• Sleep disorders
• Paranoia
• Attempts of self-harm or toward the baby

What causes postpartum depression?

As we mentioned, there is no specific cause of postpartum depression, but it is hypothesized that physical and emotional alterations and changes play a significant role in the appearance and development of this condition.

Physical changes

During pregnancy, the hormone levels of estrogen and progesterone increase considerably. After giving birth, these levels suffer a very drastic fall that can contribute to its appearance.

Emotional changes

Acquiring the role of mother, the lack of sleep and expectations or social pressure can cause all kinds of changes and emotional disturbance that can be very difficult to manage.

Anxiety about feeling responsible for caring for a newborn, the perception of physical changes associated with pregnancy, or a feeling that one has lost control over one's life are also factors that contribute to intense feelings after childbirth and lead to depression.

However, these are changes that do not occur in all women after giving birth, so it is hypothesized that some risk factors favor the onset of postpartum depression  in some women and not in others. Risk factors for postpartum depression include:

• History of previous depression
• Bipolar disorder
• Postpartum depression in previous pregnancies
• Family history of depression or mood disorders
• Complications during pregnancy
• Experiencing stressful events during pregnancy
• Baby with health problems
• Difficulty breastfeeding
• Relationship problems
• Lack of support after pregnancy
• Economic problems
• Unplanned or unwanted pregnancy

Postpartum depression treatment

Fortunately, there are different types of treatment for postpartum depression. The most effective intervention depends on the severity of the depression and the needs of the person.

Baby blues

Baby blues usually subsides gradually within a few days without the need for any treatment. However, recommendations for this type of depression include:

• Rest as much as possible
• Accepting help from others
• Interacting with other mothers
• Have time for oneself
• Avoiding alcohol and toxic substances

Postnatal depression

Treatment usually includes psychological therapy, pharmaceutical therapy, or both.

Psychological therapy seeks to manage emotions and feelings in the best way possible. The person receives training in problem-solving, sets realistic goals and expectations, and learns to respond to motherhood situations in a positive way.

Pharmaceutical treatment usually includes therapy with antidepressants that have a mild effect on lactation. Hence the importance of combining pharmaceutical drugs with psychological therapy.

With proper treatment, postpartum depression usually goes away within about six months since the beginning of treatment. Sometimes, however, it can last much longer and become a chronic depression, so it is important to continue treatment even if the person begins to feel better.

Postpartum psychosis

Finally, in the case of postpartum psychosis, it requires immediate treatment, often including a period of hospital stay and surveillance. This type of treatment includes:

• Antidepressant medication, antipsychotics, and mood stabilizers
• Electroconvulsive therapy
• Psychological therapy

References

Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior and Development, 33:1–6.

Pearlstein, T., Howard, M., Salisbury, A. & Zlotnick, C. (2009). Postpartum depression. American Journal of Obstetrics and Gynecology, 200(4): 357–364.