Dr. Tariq Jagnarine
Fam Med, Endocrinology/Diabetes
Postpartum depression can occur after giving birth. It involves a persistent low mood as well as other depression symptoms. Having postpartum depression does not mean that a person does not love their baby. It is a mental health condition, and treatment can resolve it. Anyone with symptoms should see a doctor immediately.
Postpartum depression affects 1 in 9 new mothers, the Office on Women’s Health report. Symptoms may arise within 1 month or 1 year of delivery. They include a persistently low mood that lasts for at least 2 weeks. Also, according to an older study, 10% of new fathers experience similar depression, the highest rates of which occur within 3 to 6 months after childbirth.
Postpartum depression is different from the “baby blues” that many new parents experience.
CAUSES
Doctors do not know exactly what causes postpartum depression, but it can affect anyone. Genetic factors may play a role, and environmental factors may also contribute. The following may increase the risk of developing postpartum depression:
• Past trauma
• Hormonal fluctuations
• Previous diagnosis or family history of depression or bipolar disorder
• Physical and emotional stress of delivery and childcare
• Added stress at work or at home
• Difficulty sleeping
• Feeling overwhelmed
• Feeling unattractive
• Feeling the need to be a perfect parent but feeling unable to achieve this
• Not having any free time
• Having breastfeeding difficulties
• Having a substance use disorder
• Having a baby with special needs
• Having had an unwanted pregnancy
• Being younger than 20
• Having a lack of support from family and friends
• Having had complications during delivery
• The need for the infant to spend time in the hospital
• Experiencing preterm birth
• Having a baby with a low birth weight
STILLBIRTH AND PREGNANCY LOSS
There are an estimated 2 million stillbirths every year, one in every 16 seconds, after 20 weeks of pregnancy. This may increase the risk of postpartum depression. Experts report that 14.8% of people who experience pregnancy loss have postpartum depression, compared with 8.3% of those with regular deliveries.
SYMPTOMS
Postpartum depression can affect people differently, but below are some common signs and symptoms:
• Low or sad mood
• Anxiety and irritability
• Fatigue and lethargy
• Feeling guilty, worthless, hopeless, or helpless
• Pain, such as a headache or stomachache
• Lack of appetite
• Difficulty thinking or focusing
• Low motivation and a lack of interest in activities
• Difficulty bonding with the baby
• Feeling unable to care for the baby
• Frequent or long bouts of crying
• Feeling unable to make decisions
• Withdrawing from friends and family
• Having no interest in the baby, or feeling as if they are another person’s responsibility
Some people experience postpartum psychosis, a severe mental health problem that needs immediate medical attention. Symptoms include hallucinations, delusions, mania, paranoia, and confusion. Others experience baby blues. This is different from postpartum depression. It affects many new parents and usually disappears after 3 – 5 days.
A healthcare provider can help a person understand the cause of a low mood after childbirth, and they can provide effective treatments and self-care strategies, if necessary.
Postpartum depression can cause people to think about harming their child or themselves, including thoughts of suicide. If anyone has these thoughts, they or someone else should seek immediate help.
DIAGNOSIS
If symptoms of depression last 2 weeks or longer within 1 year of giving birth, a person should receive medical attention. This is also crucial for anyone who is having trouble caring for themselves or their baby. The doctor would ask questions about symptoms and medical histories. The doctor may also request blood tests to rule out other causes of depression.
TREATMENT
Treatment for postpartum depression is essential for the well-being of the parent and their newborn. The sooner a person receives it, the sooner they are likely to recover. Treatment is effective in most cases. Once the issue has been identified, the doctor usually prescribes a combination of psychotherapy and medication.
Tips for helping to support recovery include:
• Acknowledging the problem
• Being open about any feelings
• Getting help from friends and family
• Joining a support group. Support groups can reduce the feelings of isolation and provide tools and helpful strategies.
Medications
These may be antidepressants, which can help manage symptoms and improve the mood. They may take 6 to 8 weeks to work, however. If psychosis occurs, antipsychotic medications can help.
All medications can have adverse effects, and it is important to work with a doctor closely to find a treatment plan that works.
There is also a small risk that some medications can enter breast milk. The doctor would work with the person to find one what is likely to be safe and effective.
PSYCHOTHERAPY
Cognitive behavioural therapy, sometimes called CBT, may help resolve moderate postpartum depression. Its aim is to find new ways to approach and interpret situations, and to develop more positive ways of thinking.
Interpersonal therapy may also be a good option. Its goal is to improve communication skills and help develop social networks. This can help a person manage challenges that may otherwise lead to depression.
Treating severe postpartum depression
If symptoms are severe and other strategies are not effective, it may help to spend time in the hospital. In some cases, a doctor may recommend electroconvulsive therapy.
ALTERNATIVE THERAPIES
Some people may use the following therapies to help relieve postpartum depression:
• Bright light therapy
• Acupuncture
• Massage
• Omega-3 fatty acid supplementation
There is limited evidence that any of this works, however. Check with a doctor first. Anyone interested in acupuncture should be sure to find a qualified practitioner.
SELF-CARE TIPS
During and after pregnancy, a person can take some steps to help prevent or manage postpartum depression. Strategies include:
• Having a healthful diet, and getting regular exercise
• Keeping all medical appointments, and following up about health concerns
• Eating small meals regularly to maintain blood sugar levels
• Getting at least 7–8 hours of sleep each night
• Planning during pregnancy to reduce stress after delivery
• Speaking openly to loved ones about feelings and concerns
• Keeping in touch with friends and family, especially if parenting alone
• Asking a healthcare professional about local self-help groups
• Asking others for help with practical and emotional challenges
• Resting, rather than doing housework, when the baby sleeps
• Avoiding major changes, such as moving house, soon after delivery
• Seeking help for housing, social, and other issues that arise
• Learning more tips for coping with postpartum depression.
Postpartum depression is a common and potentially serious mental health condition. Without treatment, the symptoms can worsen, making it harder for the person to care for the baby and themselves. Anyone who experiences a low mood for at least 2 weeks in the first year after delivery should seek medical care. Treatment can help significantly.
