What is postpartum depression?
Postpartum depression (PPD) is a complex mood disorder that occurs in some women after giving birth, characterized by adverse physical, emotional, and behavioral changes. According to the DSM-5 (Diagnostic Criteria Manual of Mental Disorders), postpartum depression is a type of major depressive disorder that usually occurs within 4 weeks after delivery. Diagnosis of postpartum depression depends not only on how soon after delivery symptoms begin, but also on the severity of the depression.
Postpartum depression is related to chemical, social and psychological factors during childbirth. It covers the physical and emotional issues that many new mothers experience after giving birth. PPD can be treated with medication and counseling.
After giving birth, a woman’s hormone levels undergo dramatic changes, which may be linked to postpartum depression. However, the exact relationship between this change and depression is unclear. We know that estrogen and progesterone (two female reproductive hormones) increase dramatically during pregnancy and then decrease rapidly after delivery. By day 3 after delivery, the levels of these hormones return to pre-pregnancy levels.
In addition to hormonal changes, social and psychological stress after childbirth can increase the risk of depression.
Most new mothers experience symptoms of ‘baby blues’ after giving birth. Of these, 1 in 10 women will experience longer-lasting, more severe depression after childbirth. One in 1,000 women will develop the most severe forms of postpartum psychosis.
New dads may also be affected. Research shows that about 10% of new fathers experience symptoms of depression in the first year of their child’s life.
What are the symptoms of postpartum depression?
Symptoms of postpartum depression may not be easily noticeable. Many women experience some of the following symptoms after giving birth:
- sleep disorder
- Changes in appetite
- Extreme fatigue
- Decreased libido
- Mood swings
Postpartum depression can also be accompanied by other, more severe symptoms of depression that are less common after childbirth, including:
- Lack of interest or intimacy with baby
- Often cry for no reason
- Depression
- Anger and paranoia
- Lack of fun
- Inferiority, despair and helplessness
- Thoughts of death or suicide
- Want to harm yourself or others
- Difficulty concentrating or making decisions
Some women develop symptoms of obsessive-compulsive disorder (OCD) after giving birth (approximately 1%-3% of women). These OCDs often manifest themselves as excessive worry about the baby’s health or an irrational fear of harming the baby. Some women also experience symptoms of panic disorder. You may have these conditions and depression at the same time.
If left untreated, postpartum depression can be harmful to new mothers and their babies. You should seek professional help as soon as possible if you:
- Symptoms persist for more than 2 weeks
- Unable to live a normal life
- Inability to cope with daily stress
- Want to harm yourself or your children
- Frequent feelings of extreme anxiety, fear and panic
Causes and Risk Factors of Postpartum Depression
It’s not your fault that you have PPD. Experts believe that postpartum depression can have many causes and vary from person to person. Here are some factors that may increase your risk of postpartum depression:
- Have experienced depression before or during pregnancy
- Younger age at pregnancy
- Conflicted feelings about pregnancy
-Number of children (the more children you have, the more likely you are to be depressed in subsequent pregnancies) - A history of mood disorders in the family
-Experienced a major stressful event, such as job loss or health crisis - Children with special needs or health issues
- Have twins or multiple births
- Have a history of depression or premenstrual dysphoric disorder (PMDD)
- Lack of social support
- single life
- Marital problems
There is no single cause of postpartum depression, but the following physical and emotional problems may be contributing factors:
- **Hormones. ** After giving birth, a woman’s estrogen and progesterone levels drop dramatically, which can affect mood. Thyroid hormones may also drop, causing you to feel tired, sluggish, and depressed.
- **lack of sleep. ** When you’re sleep-deprived and coping-deprived, you may become obsessed with the little things.
- **anxiety. ** You may feel insecure about whether you can care for your newborn.
- **Self-image. ** You may feel dissatisfied with how you look, who you are, or your life. These issues can all lead to postpartum depression.
What are the types of postpartum depression?
Here are three terms used to describe the emotional problems women may experience after giving birth:
- The ‘baby blues’ are a mild depression that up to 70% of women experience in the first few days after giving birth. You may experience ups and downs of emotions, such as from happy to sad. You may cry for no reason or feel irritable, impatient, anxious, lonely, and sad. The baby blues usually last only a few hours or 1 to 2 weeks at most. Generally, you don’t need a doctor to treat baby blues. It may be helpful to attend a support group for new moms or talk to other moms.
- Postpartum Depression (PPD) may occur in the days or months after delivery. PPD can happen after you have any child, not just your first child. You may have similar feelings to those of baby blues, such as sadness, hopelessness, anxiety, and crankiness, but these feelings will be more intense. PPD can affect your daily functioning. When your function is impaired, you need to see a doctor, such as your ob-gyn or family doctor. They can check you for symptoms of depression and give you a treatment plan. If you don’t treat PPD, symptoms will worsen. PPD is a serious condition, but it can be treated with medication and counseling.
- Postpartum Psychosis is a very serious mental illness that affects some new mothers. This disease usually occurs quickly within the first 3 months after delivery. Women may lose their sense of reality and experience auditory hallucinations (hearing sounds that are not there, such as someone talking) and delusions (believing things that are clearly irrational). Visual hallucinations (seeing things that are not there) are less common. Other symptoms include insomnia (difficulty falling asleep), irritability and anger, constant walking, restlessness, and strange feelings and behaviors. Women with postpartum psychosis need immediate treatment, often with medication to control symptoms. Sometimes women may be admitted to hospital because they are at risk of harming themselves or others.
How to treat postpartum depression?
Treatment for postpartum depression depends on the type and severity of your symptoms. Treatment options include anti-anxiety or antidepressant medications, psychotherapy, and joining a support group for emotional support and education. For severe cases, a new intravenous drug called brexanolone (Zulresso) is available.
For postpartum psychosis, antipsychotic medications are often also required. Hospitalization is also often necessary.
If you’re breastfeeding, don’t think you can’t take medications for depression, anxiety, or psychosis. Talk to your doctor. Many women take medications under the guidance of a doctor while breastfeeding. This is something you and your doctor need to decide together.
What are the complications of postpartum depression?
If postpartum depression is left untreated, it can affect your relationship with your baby, and your entire family:
- **yourself. ** If left untreated, postpartum depression may last for months or longer, or even become chronic depression. Even with treatment, postpartum depression can increase your risk of developing depression again in the future.
- **Baby’s father. ** When a new mother suffers from depression, the father may also be more likely to develop depression.
- **children. ** Children of mothers with postpartum depression are more likely to have sleeping and eating problems, crying, and delayed language development.
How to prevent postpartum depression?
If you have experienced depression, you should tell your doctor immediately when you find out you are pregnant or plan to become pregnant.
- **pregnancy period. ** Your doctor can monitor your mood. You can relieve mild symptoms of depression by attending a support group, receiving counseling, or other treatments. Sometimes, your doctor may prescribe medication even if you are pregnant.
- **After childbirth. ** Your doctor may recommend a postpartum check-up as soon as possible to check for symptoms of depression. The earlier it is detected, the sooner treatment can be started. If you have experienced postpartum depression, your doctor may recommend starting treatment soon after giving birth.
How to deal with postpartum challenges?
Here are some tips to help you cope with bringing home a newborn:
- Ask for help. Let others know what kind of help you need.
- Have reasonable expectations for yourself and your baby.
- Perform appropriate exercise within the scope permitted by your doctor; take a walk and breathe fresh air. There are good days and bad days.
- Eat healthy foods; avoid alcohol and caffeine.
- Maintain your relationship with your partner – give each other some time.
- Stay connected with family and friends – don’t isolate yourself.
- Don’t have too many visitors when you first get home.
- Block calls. You can also sleep or take a nap while your baby is sleeping.
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