Pregnancy or childbirth is a huge milestone in a woman’s life and can easily be overwhelming. It can trigger several powerful emotions, ranging from happiness, joy, and excitement to fear, anxiety, and stress. But approximately 23% or nearly one-quarter of all women who recently gave birth develop strong feelings of sadness, despair, depression, and anxiety that may lead to postpartum depression. 

What is Postpartum Depression (PPD)?

PPD or Postpartum Depression is a complex interplay of behavioural, emotional, and physical changes that affects some women after childbirth. Clinically, postpartum depression is defined as the onset of depression symptoms in women within four weeks of delivery. The diagnosis and management of PPD varies, depending on the onset and severity of depressive symptoms. 

What are the types of postpartum depression?

There are three clinical varieties of mood changes that affect women during the postpartum period. These are:

1. Postpartum blues (or baby blues): According to the latest estimates, postpartum blues are very common and are characterized by mood swings such as crying without any reason or feeling anxious, impatient, cranky, angry, or even happy. Baby blues can last a few hours to a few days or even weeks after giving birth. According to the latest statistics, 13.8% of Canadian women experience postpartum anxiety or PPA symptoms after childbirth. 
2. Postpartum depression: Postpartum depression can occur days or even months after delivery. The symptoms mimic pregnancy blues (such as sadness, despair, anxiety, trouble sleeping or eating, and crankiness, but the severity of symptoms is severe. Postpartum depression affects the productivity of affected moms and interferes with day-to-day functions. Postpartum depression affects 17.9% of Canadian moms. Without any interventions, the symptoms may worsen over time. It is recommended to speak to a primary care provider to perform screening for postpartum depression. If you are diagnosed with postpartum depression, your doctor will suggest a treatment plan to manage the symptoms. 

3. Postpartum psychosis: Postpartum psychosis is a serious mental health issue that typically affects women within the three months of giving birth. It presents with severe deterioration of mental health and is characterized by losing touch with reality, excessive energy or agitation, paranoid thinking, delusional thoughts (believing in things that are irrational), and hallucination (hearing or seeing things that don’t exist). Other symptoms include troubled sleeping, strange feelings and behavior, restlessness, anger, and agitation. Postpartum psychosis affects 1 in 1000 postpartum women. 

Postpartum Depression in Fathers:

Postpartum depression also affects new dads. A new Canadian study suggested that paternal postpartum depression affects nearly 22% of new dads during the first year of childbirth. The symptoms are similar to what new mothers experience and may range from fatigue, tiredness, agitation, changes in eating or sleeping habits, and sadness. Risk factors that may aggravate the risk of developing postpartum depression are financial problems, marital conflict, and previous personal or family history of depression. 

Poor management or treatment of paternal postpartum depression can cause strain on the relationships with the baby and partner. It can also impact the development of the baby in the long term. 

The treatment of paternal postpartum depression involves psychotherapy, counselling, and support groups. In more severe cases, medications may also be advised. 

Signs & Symptoms of Postpartum Depression

The signs and symptoms of postpartum depression vary and are often mistaken for baby blues. But unlike baby blues, signs of PPD are more severe, and intense and may last longer. In addition, postpartum depression symptoms worsen over time and eventually interfere with the new mom's ability to take care of herself or the baby.

• Changes in appetite (loss of appetite or excessive eating) 
• Changes in the depth and quality of sleep (to little sleep or excessive sleeping)
• Loss of libido/sex drive
• Excessive fatigue/tiredness
• Changes in mood
• Withdrawal from friends and family
• Loss of interest or pleasure in activities that you previously used to enjoy 
• The excessive urge to cry without any reason
• Anger or rage
• Panic attacks or severe anxiety 
• Lack of interest in handling or taking care of the baby 
• Thoughts of hurting self or others
• Lack of decision making 
• Feeling hopelessness, helplessness, and despair
• Thoughts of self-harm or suicide 
• Feeling overwhelmed
• Feeling inadequate, ashamed, guilty, or worthless 

Causes of PPD:

Postpartum depression is not a result of something you did wrong during or after your pregnancy. Research suggests that there is no single cause of postpartum depression. Some possible causes of postpartum depression are:

Hormonal or chemical changes: Postpartum depression is the result of complex hormonal, chemical and physical changes that affect new mothers. For example, the concentration of key reproductive hormones (such as estrogen and progesterone) increases up to 10-folds during pregnancy. However, the hormone levels drop soon after childbirth and reach the pre-pregnancy baseline values within three days of delivery. Likewise, the concentration of thyroid hormone also drops soon after childbirth which may explain the fatigue, tiredness, and mental sluggishness. It is unclear how chemical changes due to hormonal fluctuations may cause postpartum depression. 

Besides hormonal factors, a variety of social, physical, and psychological changes associated with the birth of a baby further increase the risk of PPD. 

• Self-image: Pregnancy is a time to celebrate but some women may develop insecurity about their physical appearance. If you are feeling unhappy with the way you look or if you are going through issues with self-identity or your physical image, it may contribute to the development of postpartum depression.
• Anxiety: Moms who are single or who have minimal support often develop anxiety about how they will take care of the new baby.
• Trouble sleeping/ insomnia: Lack of sleep or sleep deprivation affects how we process thoughts and feelings. It also affects how we cope with stress and anxiety over seemingly minor events and may contribute to the development of postpartum depression. 

 

Risks factors involved in Postpartum Depression:

Several factors that can increase your chances of developing postpartum depression are:

• Maternal age (risk is higher if the mother is younger than 25) – the proportion of postpartum depression in mothers under 25 years of age is 30% vs. 23% in mothers over the age of 25
• Positive history of depression before or after becoming pregnant – about 31% of all mothers diagnosed with postpartum depression have a previous history of mood disorders or depression. 
• Number of kids (risk increases if you have more children)
• Positive family history of mood disorders or other mental health issues 
• Multiple gestations (risk increases in pregnancies with twins or triplets) 
• History of a recent stressful event, (loss of a loved one, loss of job or health crisis)
• Marital or relationship issues
• Living alone
• Having a child with health issues or special needs 
• Unwanted or unplanned pregnancy 
• History of sexual or physical abuse 

Treatment of Postpartum Depression

In most cases, no treatment or therapy is needed by a healthcare provider to manage pregnancy blues. Speaking to other moms or joining support groups often helps improve the symptoms.

The treatment of postpartum depression is largely dependent on the type and severity of symptoms. Treatment options may include a combination of antidepressant or antianxiety medications, counseling and education, enrollment in support groups for emotional support, and psychotherapy. To manage severe cases of postpartum depression, your doctor may advise oral medications such as antidepressants.

For the management of postpartum psychosis, hospital admission is often necessary. The drugs to treat psychosis are advised while the patient is monitored under supervision. 

If you are breastfeeding your baby, do not assume that you cannot take antidepressants, antianxiety, or other medications to manage psychosis. Make sure to speak to your doctor to revise any drug that may not be safe for your baby. 

Complications of Postpartum Depression: 

Untreated or poorly managed postpartum depression can affect new mothers' mental and physical health. It can also affect how the mother bonds and takes care of the new baby, eventually affecting the entire family's dynamics. 

• Complications in mothers: Untreated postpartum depression can last for months or even years and may eventually develop into chronic depression. Postpartum depression also increases the risk of developing chronic depression in the future, even with treatment. 
• Complications in fathers: Postpartum depression in mothers increases the risk of depression in fathers too 
• Complications in newborns: Babies born to mothers struggling with postpartum depression are more prone to experience eating and sleeping issues. They cry more than usual and are likely to develop language development delays. 

Prevention of Postpartum Depression  

If you have a personal or family history of depression, let your doctor know if you are looking to get pregnant or as soon as you learn that you are pregnant.

Prevention During Pregnancy: Your doctor can monitor your symptoms closely to assess the risk during pregnancy. Mild cases of depression during pregnancy can be managed by simple interventions such as counselling, support groups, and lifestyle modification. If your symptoms are more severe, your doctor can start medications. 

Prevention After Childbirth: Your doctor may perform an early postpartum screening to evaluate your symptoms. If you show signs and symptoms of postpartum depression, your doctor can put you on a treatment plan. If you have a history of postpartum depression in your previous pregnancies, your doctor can start the workup and treatment as soon as you give birth.  

When to see a doctor

Most parents suffering from postpartum depression often find it embarrassing to admit their sadness or seek professional help but remember that poorly managed postpartum depression can increase the risk of complications for both mom and the baby. You should seek medical help if:

• Symptoms persist longer than two weeks
• If your symptoms are affecting your productivity or your day-to-day functions
• If you are extremely anxious, agitated, or sad
• If you are experiencing feelings of harming yourself or the baby.
• If your symptoms are getting worse

Mednow has partnered up with LifeSupport as an extension of our holistic healthcare solutions. You can fill out a comprehensive mental health assessment form online and discuss the assessment results with your preferred mental health specialist over a phone call. Talk to a mental health expert from the comfort and privacy of your home or request direct referrals and additional support through the LifeSupport platform. 

How to Help Someone with Postpartum Depression?

People suffering from depression may not recognize their symptoms or identify what’s making them depressed. If you feel that your family, friend, or loved one is suffering from postpartum depression, support them and assist them in finding help. You can share helpful information with them so they can understand their symptoms better. Learn more here 

You can also share resources with them, such as LifeSupport’s mental health assessment tool so they can evaluate their symptoms before speaking to a professional.   

This article offers general information only and is not intended as medical or other professional advice. A healthcare provider should be consulted regarding your specific situation. While the information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the authors as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by Mednow or its affiliates.

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