Postpartum Depression

Published in Panorama



Dealing with Post Childbirth Blues and Depression


John and Amy have a new baby boy. They were both excited when Amy became pregnant. But following the delivery, Amy is miserable and cries all the time. John does not know what’s happening to her and he is at his wits end, often getting angry with Amy for her crazy, unreasonable behaviour.

The magical journey of parenthood is not without its unique set of problems. If it’s exhilarating, it’s also exhausting, often beginning with a period of feeling blue, by the mother, reveals Dr.Sanjay Khanna, Psychiatrist, Zulekha Hospital, Sharjah. “Psychological problems after delivery are basically divided into three categories: Postpartum Blues, Postpartum Depression and Postpartum Psychosis,” explains Dr.Khanna.

Dr.Khanna elaborates, “Postpartum Blues are depressive symptoms which include periods of weepiness, mood swings, anxiety, exhaustion, inability to sleep, changes in appetite and irritability. All these feelings are normal during the first few days after childbirth and are usually very mild and also short-lived, usually starting on the 3rd day after delivery and lasting for a few days. These emotional disturbances are more common in women having the first child, in women having poor social or marital relations, in those women who are already apprehensive about labour or those who have pre-menstrual tension problems and are already depressed or anxious during their pregnancy. It may also be seen in women who have physical or sleep problems during pregnancy.”

According to certain studies, in some mums, the blues may not begin until the baby stops nursing! And even mothers who adopt babies go through a blue period, according to researches!

Blues may be a result of changing hormonal levels following delivery, says Dr.Khanna. Besides, the mother is faced with new challenges hitherto not realized and this may appear daunting in the initial days following delivery. There is a new sense of responsibility which the mother has to shoulder and she no longer has control of her own time the way she did prior to the birth of her child. The time she shared with her spouse is now reduced and diverted to the new arrival and above all she may be deprived of sleep, both on account of tending to the baby and suffering from insomnia. Sleep deprivation in itself may bring on mood swings and irritability in people, causing a blue period, adds Dr.Khanna.

However, if the blues last for more than a week or two, the mother may actually be suffering from postpartum depression (PPD), the symptoms of which are more severe than the blues, explains Dr.Khanna. It is therefore imperative to know what is normal emotional change following delivery and what is an emotional disturbance requiring medical attention and support. The extent, intensity, frequency and duration of these disturbances are what differentiate normal reaction to post delivery, from postpartum depression and psychosis.

Dr.Khanna elucidates, “At least 10% of new mothers develop a full-blown clinical depression which can last from two weeks to as long as a year. Postpartum depression can strike any woman, either immediately after the birth of her baby or many months later. However, ironically, PPD mostly begins between the 3rd and 14th day following delivery and this is actually the time when you actually feel the woman is getting out of the blues and is happy! The mother is back home from the hospital and then these problems begin. The symptoms of PPD are more severe where the mother loses interest in life, has intense trouble getting sleep, lacks concentration, persistently weeps for no reason, feels herself as being worthless, feels excessive guilt, feels alone and that nobody cares for her, fears going out, has decreased energy levels, is withdrawn socially, does not care about personal hygiene to the extent of even skipping baths, has panic attacks the symptoms of which could include dizziness, palpitation, confusion, feelings of impending doom, has disturbing thoughts and is prone to suicidal tendencies. The woman is unable to think clearly, wants to run away from all responsibilities and she feels she may be rejected by her partner because she is not good looking now and she may always have some abnormal thoughts and thinks she may harm or kill her baby.”

What causes PPD and are certain categories of women prone to it? Dr.Khanna responds, “A combination of elements contribute to PPD and these include hormonal, biochemical, psychological, genetic and environmental factors. The steep and sudden drop in hormone levels immediately after childbirth is only one of several reasons. The emotionally euphoric state of giving birth is soon replaced by the responsibilities of rearing the child. Apart from these factors, women with familial problems, relational problems, those delivering in their 30s, mothers who had traumatic childhood, who have disturbed interpersonal relationship with their husbands, in-laws, suffer from severe premenstrual syndrome, those who have had obstetric complications, those who were subject to early childhood trauma, have a history of abuse, or a dysfunctional family, have mixed feelings about the baby, tend to be victims of PPD.”

Postpartum psychosis (PPP) occurs when the woman acts on these abnormal thoughts, reveals Dr.Khanna. “This is an extremely rare disorder, occurring in 1-2 per 1000 pregnancies, characterized by delusions, hallucinations, grandiosity, bizarre thinking and suicidal impulses, with 25% of the women exhibiting these schizophrenic symptoms. The risk is greatest after the 3rd month of delivery. Although 80% of the women don’t have any risk factors, it has been seen that out of these patients, 5% of women do commit suicide and 4% commit even infanticide, killing their own babies under the effect of PPP. So the most important thing is early detection of PPD so that it does not become PPP,” emphasizes Dr.Khanna.

How are these post childbirth problems treated? Dr.Khanna reassures, “PPB is not an illness and will disappear on its own without any treatment except with support and constant reassurance by partner and family members. In addition, the mother should be sufficiently rested and enabled to sleep well. This may be made possible by the husband and other family members who could share in the household chores and looking after the newborn s needs. The mother should be encouraged to eat nutritious food, adequately enriched with proteins and liquids, especially if she is breast-feeding. The mother should be encouraged to take short breaks with her spouse, away from house-keeping and also join mothers-and-babies group so as not to make her feel isolated in her problems.”

The first step in the treatment of PPD is timely diagnosis of the problem, emphasizes Dr.Khanna. “Very often, mild and moderate depressions go unnoticed and the general physicians treat these patients with vitamins, et al. The Edinburg Post Natal Depression Scale is a very good scale to diagnose PPD. It involves a questionnaire being given to the mothers, responses to which give physicians a good idea of the problem. If the depression is severe, psychiatrists have necessarily to be called in to deliver appropriate treatment.”

Dr.Khanna continues, “As far as possible, we try treatment with psycho-therapy. If it is very severe, we treat with medication. But here we have to be careful in giving drugs since these drugs can find their way to the breast milk.”

Apart from psycho-therapy and medication, the major thrust of treatment is on creating a supportive environment for the mother and enabling her to participate in support groups. Complete recovery from PPD is possible with appropriate care and treatment, depending upon the timely diagnosis and treatment of the problem.

Women with postpartum psychosis may refuse medical treatment since they might not realize they’re having a problem. But medical help is a must for these patients as the problems will not resolve of themselves and the treatment objective is to ensure the safety of both mother and child and to instill in the mother the confidence that she is competent enough to parent the child while she recovers, explains Dr.Khanna.

Dr.Khanna further emphasizes, “Using anti-psychotic drugs along with psychotherapy and counseling sessions is a must for these victims. Besides, if you see a patient presently suffering from PPP, it would be most advisable to admit the woman in hospital rather than go for OPD (Out-patient department) treatment. Further, it is better to admit both mother and child because this enhances the chances of the mother recovering sooner.”

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