Postpartum Depression

Introduction

Becoming a  mother can be difficult. This is due to a major psychological shift from viewing oneself as a woman who is pregnant to viewing oneself as a new mother. This major emotional shift may create problems.

Following childbirth, seesawing emotions and heightened emotional responses may occur. This emergence of emotions is either called postpartum blues or baby blues. The frequency varies, but may occur around 50 percent of the time. It is considered a normal variant following the birthing process. These periods may be characterized by mood lability, irritability, feeling overwhelmed and exhausted, periods of weeping may be present, and other mood disorders. It usually tends to occur two to five days after giving birth. It usually resolves without requiring medical treatment within a week or two. In addition to mood swings, crying spells may occur as well. This is not unusual as the woman’s body tries to readjust itself after the momentous events of childbirth. Mood swings are usually due to changing hormone levels in the woman’s body. It is a common finding following many pregnancies. In addition to discussing the symptoms with your gynecologist and obstetrician, it may also help you to discuss your feelings with friends, your spouse, and your family. The key is not to be afraid to ask for help, especially when you need to sleep. Postpartum blues is a mild form of depression, however, and if it does get more severe, the term is postpartum depression. If this is the case there may be a persistent inability to cope.
 

Symptoms of Postpartum Depression

Postpartum depression is considered a major depressive episode that may be associated with anxiety, persistent depression, irritable mood, or prolonged anxiety. It does present with typical depression symptoms that can include problems with concentration, memory, decision-making, irritability, decreased appetite, loss of sleep, loss of pleasure in usual daily activities, low self-esteem, negative thinking and worrying, persistent sadness, helplessness, and feelings of hopelessness. In addition, another aspect of postpartum depression is the feeling of significant impairment or feeling unable to care for your baby and yourself. Some women may have problems that may involve interpersonal relations. The new mother may not be able to get along with people. Some suggest such problems arise as the mother tries to adjust to the realities and demands of her new baby. The difference between postpartum blues (baby blues) and postpartum depression is that postpartum blues is short-lived and it ends without treatment in a short period of time. If it does persist for more than two weeks you should have a discussion with your obstetrician/gynecologist.

In addition to lasting longer, if you do have symptoms that are correlated with depression such as irritability, hopelessness, sadness as mentioned above, you should also mention these to your obstetrician/gynecologist. Postpartum depression is seen in about 15 percent of mothers. If you do have a history of depression, your likelihood of having postpartum depression is going to be higher, and if you had postpartum depression with one of your prior pregnancies, your likelihood of redeveloping this problem again is going to be even higher.

It is not clear why some women experience postpartum depression and others do not. It is clear, however, that lowered estrogen levels and shifts in progesterone, cortisol, and beta-endorphin levels are associated with this entity. If you do have symptoms for more than two weeks, you do need to get help. Along with your physician, you can decide on what course of management you would like to take. It is important to know that postpartum depression can be treated. Most women only develop general fatigue and loss of energy, weight loss, feelings of inappropriate guilt, or feelings of worthlessness. On the other hand, some women may feel sadness, loss of interest in daily activities, difficulty concentrating, recurring thoughts of anxiety, death, or suicide. In this case, the depression is considered to be severe and immediate help is required.

Childbirth is an important event that affects the body and the mind of the mother. It is very common to have mixed feelings while recovering from childbirth and caring for your new baby. It is important not to be embarrassed or afraid to discuss your feelings with friends, your family, your spouse, and your healthcare provider.

Most commonly, postpartum depression can be treated through psychotherapy and/or antidepressant medications, if required. Your primary physician can help you, if she or he cannot, then you will be referred to a specialist for treatment. Initially, psychotherapy is attempted. At times, combination with medications, or changing to medications may be necessary. Treatment usually is for a short time, unless the severity is higher.

A more severe form is called postpartum psychosis and it only affects 0.1 percent of postpartum women. If it does occur, it occurs within the month of childbirth and it constitutes a medical emergency, hospitalization may often be necessary. These are women that may tend to have suicidal feelings and require immediate attention. In women who suffer from postpartum psychosis, there is a four percent chance of infanticide.

Breastfeeding during treatment
When planning for treatment of postpartum depression, the patient’s wish to breastfeed can be respected. The transfer of medication to the baby can be minimized by the mother breastfeeding before she takes her pills. Although depression medications are excreted in breast milk in mothers that are breastfeeding, no cases of deleterious effects have been noted in infants.
 

Conclusion

About 15 percent of women who give birth will develop postpartum depression. Women with a history of depression are at greater risk and women who have suffered through one episode of postpartum depression are also at a higher risk for developing postpartum depression. Some other risk groups involve women that have had history of mood disorders, family history of mood disorders, adverse life events, marital discord, and poor social support.

The incidence of postpartum blues is around 50 percent, and, as mentioned earlier, the incidence of postpartum depression is around 15 percent. The onset of postpartum blues is usually around five days after delivery whereas the postpartum depression onset is usually within the first six months following delivery. The duration of postpartum blues is usually around 10 days, however, the duration of postpartum depression may last up to years if left untreated. Therefore, treatment is essential once postpartum depression does occur.

There is no association with postpartum blues with a prior history of depression, however, there is an association of postpartum depression if there is a prior history of depression. Overall, a birthing experience is a very happy one. On the other hand, in some women it may be complicated with postpartum blues and depression. Once again, it is important to note that if this does occur it is treatable and it is temporary, as long as help is available.
 

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