Being a parent is exciting, but can also be overwhelming for mental health. It is only natural to have feelings of worry or doubt, especially among first-time parents. But when baby blues feelings include loneliness or extreme sadness, severe mood swings, and very frequent crying, you or a loved one may be suffering from postpartum depression.
Postpartum depression (PPD), also known as postnatal or perinatal depression, is a mental illness affecting women during or after giving birth.
A common and well-known phenomenon is the baby blues, which happen in the days after childbirth. Baby blues come with feeling sad, overwhelmed, or anxious, having crying spells, and having trouble sleeping, but last only three to five days, or a maximum of two weeks after a baby is born.
If these signs continue for longer periods, they may be symptoms of postpartum depression. Postpartum depression involves the brain and affects a person's physical and behavioral health. Symptoms of PDD are more severe than baby blues and last much longer.
Around one in seven people can develop postpartum depression. While recovery from baby blues happens fast, postpartum depression can severely affect women's health and ability to return to normal function. It also affects a woman's relationship with the infant, as maternal brain response is compromised in postpartum depression.
Postpartum depression can be better understood as having a major depressive episode that occurs following childbirth and requires treatment.
Untreated postpartum depression can be dangerous. Without treatment, it is associated with serious morbidity for a mother, child, and the whole family system. Perinatal depression can cause a lot of suffering for women during a time when personal and societal notions of motherhood can make it difficult to express these feelings or ask for help.
Postpartum depression most commonly starts about one to three weeks after childbirth but can happen in both pregnant and postpartum women. It can last for up to one year, but depressive episodes are more common in the first three months after delivery.
In some cases, perinatal depression can continue and develop into chronic depression. That is why feeling sad, hopeless, or empty for longer than two weeks should prompt women to contact a healthcare professional for a postpartum depression screening. Women who find that their baby blues do not go away should never hesitate to seek treatment.
Postpartum depression is not caused by a single factor, but more probably by a combination. There are numerous risk factors that may contribute.
There are changes in hormone levels when a woman gives birth. A sharp decrease in the levels of estrogen and progesterone occurs in the hours after childbirth. In a similar way that small changes in hormone levels cause mood swings or tension before menstrual periods, these sharp changes may play a role in developing postpartum depression after giving birth.
Another hormone-related risk factor is the thyroid. The thyroid is a small gland that helps to regulate the body's use and storage of energy from food. Levels of thyroid hormone may drop after giving birth, and low levels of the hormone can cause some depressive symptoms. A blood test can determine whether this condition causes symptoms of postpartum depression.
Women who have a history of depression, meaning that they have had depression before, during, or after pregnancy, or who are being treated for depression not related to pregnancy at the current time run an increased risk of developing postpartum depression. Mental health history plays a role in the psychological risk factor.
A history of anxiety, a negative attitude toward the baby, and disappointment or reluctance about the baby's gender, are considered perpetual factors for postpartum depression. A history of sexual abuse also contributes to the development of postpartum depression.
Doubt is a common feeling women have about pregnancy. The way a woman feels about her pregnancy and her fetus is affected by an unplanned or unwanted pregnancy, but even when it is planned, it takes time to adjust to the idea of a new baby. Undergoing stressful experiences during pregnancy can increase the likelihood of developing postpartum depression.
Emotional stressors may include a recent divorce, a difficult marriage or relationship, financial stress, stressful life events such as a recent death of a loved one, moving to a new city, or family illness.
Stressful life events during pregnancy or after childbirth, like a difficult delivery, premature birth, or very severe illness during pregnancy can also contribute to postpartum depression.
A risky pregnancy, involving an emergency cesarean section is another risk factor. Meconium passage - a developmentally programmed postnatal event- and umbilical cord prolapse - when the umbilical cord slips down in front of the baby after the waters have broken, as well as low hemoglobin, may also be associated with postpartum depression.
Sleep cycles, physical activity, exercise, as well as eating habits may affect postpartum depression. Vitamin B6 converted to tryptophan and later serotonin, affects mood and is known to be involved in postpartum depression via its conversion. Decreased sleep and altered sleep cycles are also associated with postpartum depression.
Physical activity or exercise decreases depressive symptoms; it decreases low self-esteem and increases endorphins and opioids, bringing positive effects on a woman's mental health. These factors altogether improve self-confidence, and problem-solving capacity, and helps in focusing on the surrounding environment.
Having few friends or family members to talk to and low partner support is linked to postpartum depression.
There has been consistent identification that inadequate social support is one of the risk factors for developing postpartum depression. Low support in both the prenatal and postnatal periods is associated with an increased risk, while the highest risk for postpartum women was those who had low objective or practical support.
The symptoms of postpartum depression affect a person's quality of life and that of loved ones around them. Symptoms of postpartum depression are not the same for everyone. It varies from person to person, and can even change from day to day.
Women with postpartum depression may have intense feelings of despair, sadness, and anxiety that can prevent them from doing daily tasks. The other symptoms of postpartum depression include:
Similar to postpartum depression, anxiety in pregnancy has many adverse effects on the birth outcome and maternal mental health. At the same time, it is a risk factor for postpartum depression. Anxiety and stress during pregnancy are related to infant behavior, motor activity, preterm delivery, and fetal heart rate. Postpartum anxiety can lead to lower self-confidence in a mother and can have long-term consequences for children, including delayed mental development.
Whereas postpartum depression comes with depressive symptoms of changed appetite, sleep disturbance, psychomotor retardation or agitation, and low energy, postpartum anxiety is a different condition. Even though they may share some symptoms, postpartum anxiety comes with:
As mentioned before, postpartum depression also affects the baby. This does not mean that all children will be affected in the same way, or necessarily present symptoms in every phase of their lives. But in general, the child is affected in behavioral or cognitive ways.
In the prenatal stage, poor nutrition, a higher risk for premature birth or low birth weight, and a higher chance for spontaneous abortion may occur in the presence of postpartum depression. When in the infant stage, a baby may adopt a protective or angry style of coping, remain passive and withdrawn, and have dysregulated attention and arousal.
As a toddler, a child of a mother who suffers from postpartum depression may have a less mature expression of autonomy, may internalize or externalize problems, and have lower interaction. They may play less creatively and have lower cognitive performance.
School-aged children may present with impaired adaptive functioning, affective disorders, conduct disorders, and anxiety disorders. They may show lower IQ scores, struggle academically, or develop attention deficit/hyperactivity disorder.
Consequences of maternal depression in the adolescent child may show as depression, anxiety, phobias, panic disorders, or substance abuse and alcohol dependence. They may have developed learning disorders as well.
Even though this mental illness is more frequently reported in mothers, postpartum depression can occur in fathers too. Typically occurring in approximately 8 to 10% of fathers within three to six months postpartum, in men it may develop over a year.
Even though there are no established criteria for postpartum depression in men, symptoms include irritability, depression, and restricted emotions. There are potential risk factors that may contribute to postpartum depression in men, including marital discord, poverty, unintended pregnancy, or a history or current depression of the mother. Sleep deprivation and the disruption of the circadian rhythm - positively correlated with depression symptoms in women - could also increase the risk of developing postpartum depression in men.
Changes in hormones might make postpartum depression in fathers more likely, as testosterone, estrogen, cortisol, prolactin, and vasopressin could change in men after their babies arrive.
It could likewise be associated with anxiety disorders, and can negatively affect the father, the developing child, and the family units. In men, postpartum depression may show the following symptoms:
Treatment methods include psychotherapy and pharmacotherapy for men with postpartum depression, and screening tests may sometimes be similar.
Another reason why seeking treatment early is very important, is the risk of postpartum depression progressively worsening. When this happens, it could be severe or even life-threatening.
Postpartum psychosis is a severe form of postpartum depression. It is a psychiatric and medical emergency, that comes with the risk of harm. Women may experience thoughts about harming themselves or their baby, and the risk - whether deliberate or accidental - is very real.
Postnatal psychosis is not very common, with an estimated global prevalence of 0.089 to 2.6 per 1000 births, but it does happen and is more of a risk for women who have bipolar disorder or schizoaffective disorder. It usually begins in the first two weeks after birth.
Postpartum psychosis requires immediate treatment, commonly in the hospital.
Symptoms are similar to that of postpartum depression but more intense and with additional signs. These include:
Luckily, appropriate treatment usually results in an improvement of postpartum depression symptoms. Many women go undiagnosed and without treatment because of privacy; not wanting to disclose to family members and avoiding social stigma. New mothers often suffer under the stigma that disclosure may lead to abandonment, and they avoid seeking help out of fear of a lack of support.
But there is help, and the manner of treatment depends on the severity of depression and each person's individual needs. In the case that someone is suffering from an underlying illness or an underactive thyroid, for example, a doctor may treat the condition and refer the person to an appropriate specialist. A doctor may also ask about other mood-related symptoms, to determine whether another condition, such as bipolar disorder, is present, or whether symptoms are caused by postpartum depression. They may then refer the person to a mental health professional.
How is postpartum depression diagnosed? Some normal physical or emotional requirements of motherhood include changes in energy and appetite, heightened concern for their baby, and sleep deprivation. These demands make the identification of depression in the postpartum period more complicated.
Since there are no blood tests or body scans that can show this mood disorder, a doctor will instead ask certain questions about the state of mind, called depression screening. This distinguishes postpartum blues from postpartum depression and postpartum psychosis.
Questions are usually asked according to common screening tests. This includes the Edinburgh Postnatal Depression Scale (EPDS), which has a list of ten statements. A patient will state how often they have felt the way each statement describes within the last seven days. Questions are related to symptoms of depression, like feeling guilty, anxious, or unhappy. A higher score indicates possible postpartum depression.
Another commonly used screening tool is called the Postpartum Depression Screening Scale (PDSS).
Antidepressant medications work to balance brain chemicals that control our moods. There are many types of antidepressants, and sometimes antidepressant therapy involves combining antidepressant medicines.
Some examples of these medications include selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac) and sertraline (Zoloft). Others used are serotonin and norepinephrine reuptake inhibitors (SNRIs), like desvenlafaxine (Pristiq) and duloxetine (Cymbalta).
There are also atypical antidepressants that target several neurotransmitters in the brain that affect mood. They may be effective in treating depression that does not respond to SSRIs. Examples of these atypical antidepressant medications include trazodone (Desyrel), nefazodone (Serzone), and bupropion (Wellbutrin).
Tricyclic antidepressants (TCAs) such as imipramine (Tofranil) or amitriptyline (Elavil), as well as monoamine oxidase, inhibitors are two older classes of antidepressants and are less commonly used.
The pharmacologic treatment of postpartum depression comes with some concerns. These include metabolic changes in the postpartum period, the perceived stigma of being a 'bad mother' for needing medicine, the effect of treatment on the mother's ability to take care of a new baby, and infant exposure to medication in breast milk.
Medications can transfer to a baby through a mother's milk. There are barriers to appropriate treatment because of the concern about medication effects in breastfeeding infants. But since the transfer level is generally low and some antidepressant medications are considered safe, it may come without risk. Other antidepressants, including selective serotonin reuptake inhibitors, have been linked to cranial defects and cardiac defects when taken in early pregnancy. Some medications are specifically safe to use during breastfeeding with little risk of side effects. It is always best to talk to a healthcare provider about the risks or benefits of taking a specific antidepressant
Hormones play a vital role in developing postpartum depression. Postpartum women may have a significantly greater level of cortisol, prolactin, thyroxine, and estrogen. This is why hormone therapy can help manage it.
Studies have shown that women receiving estrogen over the first month of treatment, showed faster and greater improvement in symptoms as measured on the Edinburgh Postnatal Depression Scale and in clinical interviews.
Hormone therapy with estrogen may come with some side effects, such as weight changes, abdominal cramps, migraines, headaches, nausea and vomiting, changes in vaginal discharge, high blood pressure, and hair loss.
Mental health professionals who specialize in treating postpartum depression can meet with a person regularly to talk. As a very useful tool in mental health, psychotherapy, or talk therapy, can be prescribed alone or with antidepressants.
This therapy may include cognitive behavioral therapy, whereby self-analysis and guidance help to replace unhealthy coping mechanisms, and feelings and triggers are identified and managed so that behavior may change. Participating in cognitive behavioral therapy may reduce postpartum depression for those who are at a higher risk of developing it.
Interpersonal therapy can also help a person to better understand their behavior and how they behave in relationships. It can greatly help someone work through any problems.
Other forms of talk therapy that may be helpful are found in support groups. Usually led by a counselor or therapist and in a group setting, a person can talk with other mothers in a support group and learn from their experiences. There are various support groups for new parents, and they can provide useful information and ideas about how to handle the everyday stresses that come with postpartum depression. Support groups can be found at local hospitals, community centers, family planning clinics, and treatment centers.
Some measures can be taken to help prevent postpartum depression. If a person has a history of depression at any time in their life or if they are taking antidepressants, it can help to inform gynecologists, family physicians, or any other health care professional as early as possible in prenatal care. As knowledge about postpartum depression has grown, risk factors in patients as early as their first care visit are now something that healthcare professionals look out for. It would be best if they are informed even before pregnancy, so that they may suggest a treatment for right after birth in order to prevent postpartum depression.
Being realistic about expectations for oneself and the baby may help, as may limiting visitors when first going home. Ensuring that enough exercise - such as taking a walk and leaving the house for a break - is done can help overall mental health. Asking for help and letting others know that they can help ensures social and emotional support, which includes keeping in touch with friends and family. Loved ones of women that give birth could watch out for symptoms of depression and can help a mother to seek treatment as soon as possible.
Treatment for postpartum psychosis often includes medication to treat depression or the use of a combination of medications, like mood stabilizers, antipsychotic medication, and benzodiazepines. But postpartum psychosis is a psychiatric emergency that requires immediate treatment. If someone is not responding to these medicines, then electroconvulsive therapy is another option.
While signs and symptoms are usually treated while being admitted to a treatment center, hospitalization may be necessary especially when other treatments have not been successful.
When severe postpartum depression or postpartum psychosis occurs, electroconvulsive therapy (ECT) - electric currents passed through the brain and causing an intentional brief seizure, done under general anesthesia - can reduce the symptoms.
ECT is a safe and effective treatment option in patients experiencing relapse or exacerbation of severe mental disorders, such as bipolar disease or schizophrenia, during the postpartum period.
Apart from antidepressant therapy, the FDA has also approved a medication known as Zulresso (Brexanolone) to treat postpartum depression.
For patients with severe postpartum depression that do not respond to ECT, injection of Brexanolone is an intravenous treatment option for postpartum depression in adult women. This is the first drug to be approved by the FDA specifically for postpartum depression. Placebo-controlled studies showed an improvement in depressive symptoms after the end of the first infusion.
Due to its limited clinical experience and restricted availability, the medicine is only recommended if people do not respond to antidepressants or ECT. It is only available at certified healthcare facilities and requires enrollment in the Risk Evaluation and Mitigation Strategy Program for its use. The program continuously monitors patients during the infusion for any signs of a sudden loss of consciousness, hypoxia, or increased sedative effects.
A non-invasive brain stimulation therapy, known as Transcranial Magnetic Stimulation (TMS) could be another treatment method. This procedure uses magnetic waves to stimulate underactive nerve cells, common in people with major depression. TMS sessions are typically done in five sessions per week over the course of four to six weeks.
The therapy is safe and well tolerated and is especially effective in treating patients who are resistant to antidepressants or psychotherapy. The most common side effects are mild headaches, scalp discomfort, and facial muscle tingling or twitching, all of which fade as the treatment progresses. TMS poses a risk only to those who have any metal in or around their head, as this may interfere with magnetic fields from the coil placed over the head during therapy. A small risk, no more than that of common antidepressants, is seizures.
In one study, women who did not take anti-depressants but had postpartum depression were given twenty rTMS treatments over four weeks, and the duration of the effect was measured at one month, three months, and six months post-treatment. A significant reduction in depressive symptoms was revealed by the end of the second week, while at one month, eight out of nine participants achieved remission of symptoms. At six months, seven out of the eight women that remitted remained in remission without further psychiatric intervention, while there were also indications of improvement in bonding.
Another study applied rTMS treatment to six patients with postpartum depression, and measurement of effect was obtained weekly, after three months, and after six months. Four out of the six patients achieved remission and two responded with improvement, and there was also no evidence of cognitive change or disruptions in breastfeeding.
If you or a loved one is struggling with postpartum depression, or are wondering whether baby blues are more serious than it seems, GIA Miami can help.
We offer the most advanced and up-to-date approaches to treating postpartum depression. As we understand that depression is individual, these evidence-based therapies are also tailored to suit your needs. With cutting-edge technologies and a caring and compassionate team of medical professionals, GIA Miami has more than a century of combined experience in treating mental health conditions.
We treat depression by encompassing a range of techniques, including transcranial magnetic stimulation(TMS) and cognitive-behavioral therapy (CBT), group therapy, family therapy, and psychiatric services. Our treatments are also flexible so they can fit around your life. Get in contact today to find out how we can help.
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