Postpartum Depression and How to Manage it.

Becoming a mother, holding her beautiful child in her arms, is one of the most joyful and cherished moments in a woman’s life. While this big news and happiness are celebrated with friends and family, the struggles a woman experiences after childbirth during her postpartum period often remain unspoken and under-discussed, even in the most liberal societies.

Childbirth can be a very painful, and for some, a toll-taking experience. The body goes through not only physical but also emotional and mental changes. These changes present as a variety of signs and symptoms in the body. Mild mood swings, afterbirth cramps, perineal pain, sleep deprivation, fatigue, anxiety, depression, constipation, and haemorrhoids are some of the common symptoms experienced. However, some women may spiral into severe post-partum depression when they’re unable to navigate through these changes.

Baby Blues or Postpartum Depression?

Baby blues, also called maternity blues or postnatal blues, can be experienced in the first few days after childbirth. These are mild, temporary, and self-resolving symptoms lasting not more than 2 weeks.¹ Postpartum depression, on the other hand, is a severe, persistent depressive condition in new mothers, experienced in the first month after childbirth up to 3 months or longer.³ It can also begin after the first post-partum month.² Postpartum depression can interfere with daily activities, interests and the ability to care for the newborn child.

Signs and Symptoms

The signs and symptoms of baby blues include mild mood swings, fatigue, confusion, crying spells, and irritability.¹ The symptoms of PPD can be similar to major depressive disorder ³ including persistent sadness, fatigue, loss of appetite, anxiety, feeling of guilt and self-harm and carelessness or disinterest in the infant and self.^2,4,5 Although the signs and symptoms of PPD and baby blues might often seem similar to each other, what makes them differ is the intensity, onset and duration of the symptoms experienced.

Postpartum Depression Around the World

The prevalence of PPD is found to be around 9-17%,⁶ with high-income countries estimated at 13% and 20% in low and middle-income countries.⁷ Around 1 in 7 women experience major depressive symptoms during post-partum.⁸ Baby blues are shown to be a risk factor for progressing into postpartum depression. Both are similar to each other, yet have differences in severity. While the former can resolve on its own, the latter often requires expert medical treatment and strong support from family and caregivers.

Causes and Risk Factors

A variety of causes and risk factors, such as clinical and medical history, socioeconomic status and psycho-social factors, may play a role in the development of PPD. As per previous studies, the following are some of the leading causes for PPD.^2,3,4

• Previous history of depression
• Depression or anxiety during previous or current pregnancy
• Delivery or pregnancy complications
• Difficulties in childcare
• Premenstrual issues
• Stressful life
• Lack of family and social support
• Absence of spouse/partner
• Marital issues
• Unemployment and financial problems
• Young age at motherhood

Diagnosis and Screening of Postpartum Depression

The signs and symptoms of PPD can be misunderstood as being baby blues or routine symptoms post-delivery.² Hence, early recognition and screening are important for prevention as well as the worsening of PPD. As per the International Classification of Diseases (ICD-10), postpartum depression does not have any differential diagnosis. It recognises postpartum depression, when a patient shows signs of major depressive disorder within 6 weeks after childbirth.⁴ A major depressive episode or major depressive disorder includes symptoms such as loss of interest in activities, fatigue, feelings of worthlessness or guilt, suicidal thoughts, sleep disturbances and loss of appetite lasting more than 2 weeks.^2,4 Screening for PPD can be initiated as early as the later phases of pregnancy (third trimester) and shortly after delivery.

The most commonly used measure for screening PPD is the Edinburgh postnatal depression scale.² It is a questionnaire that consists of 10 self-assessment short questions. A score of 12 or more on the EPDS is considered borderline PPD.^2,4 The accuracy of the EPDS is found to be 70-90%.⁴ Paediatricians who used EPDS were able to diagnose PPD in the first weeks and take measures for its timely management.³

Consequences of Postpartum Depression

Research shows that PPD can affect both mother and child.^2,4-7 It can lead to emotional, social, and psychomotor maladjustments in children, and if left untreated, recur in later life. Ignoring the signs and symptoms of PPD or misdiagnosing them as baby blues can risk both the infant and the mother.⁷ Hence, it is necessary to diagnose and treat PPD. The consequences of PPD are as follows:^2,4-7

• Negative or hostile relationship with infant/child
• Affects the mother’s mental health status
• Disinterest in procreation/future pregnancies
• Suicidal thoughts
• Emotional, behavioural and cognitive impairment in infants and children, such as speech impairment, etc.
• Violent behaviour and mental disorders in children in their teenage years
• Negative impact on marriage and social life

How to Overcome Postpartum Depression

Family support and caregiver support

The role of family and caregivers begins much before childbirth, i.e., pregnancy. Participation and support of family members, particularly spouses and partners, play a pivotal role in dealing with the challenges during pregnancy and after childbirth.

Medical professionals (OBGYN & Paediatrician roles)

Medical professionals play an important role in the early screening and management of PPD in women. General practitioners, physicians, gynaecologists and paediatricians can implement screening methods for women at different visits, such as routine prenatal visits, gynae visits, postnatal visits, etc. Implementing screening measures like using the Edinburgh postnatal depression scale ^2,4 to monitor for symptoms shortly after childbirth, and also the patient health questionnaire-9 for screening more than 8 weeks postpartum.⁷ Some institutes and countries recommend the implementation of perinatal depression screening during pregnancy visits and postpartum visits, such as the American College of Obstetricians and Gynaecologists and the National perinatal depression plan launched by the Australian federal government, resulting in a 50% decrease in psychiatric disorders hospital admissions. Similar practices have also been implemented in China since 2020.⁷

Treatment of Postpartum Depression

• Psychotherapy: Psychotherapy is the most preferred and 1st line treatment for the management of PPD. It involves therapies such as cognitive behavioural therapy (CBT), interpersonal therapy or interpersonal psychotherapy (IPT) for marital, social and new motherhood role change issues.^2,4
• Physical exercises: gentle physical activity such as yoga, walking or early morning sun exposure may have a calming effect and support recovery alongside medical treatment.
• Pharmacotherapy: antidepressants or anti-depression medication are considered as 2nd line treatment for PPD. The most commonly used drugs are Selective Serotonin receptor inhibitors (SSRIs).

The most recommended method for treating PPD is the combination of CBT, IPT, physical exercise and antidepressants (if psychotherapy is not available/failed or the patient does not opt for it).^2,4

Conclusion

Postpartum depression is a condition in which a woman experiences severe sadness, fatigue, anxiety, worthlessness, guilt and other major depressive symptoms after childbirth. The worldwide prevalence of postpartum depression is found to be around 9-17%, affecting women primarily in their reproductive age. Lack of family and social support, absence of spouse, stressful life, and young age are the common causes and risk factors of PPD, highlighting the role and importance of family, spouses and society during and after pregnancy. PPD can alter the relationship between mother and child, affecting the mental, emotional and cognitive capabilities of the child. More awareness about postpartum depression, its timely recognition and encouragement to seek help is essential for the management of postpartum depression and to eradicate its long-term consequences.

References:

1. Tosto V, Ceccobelli M, Lucarini E, et al. Maternity Blues: A Narrative Review. J Pers Med. 2023;13(1):154. Published 2023 Jan 13. doi:10.3390/jpm13010154 https://pmc.ncbi.nlm.nih.gov/articles/PMC9863514/
2. Pearlstein T, Howard M, Salisbury A, Zlotnick C. Postpartum depression. Am J Obstet Gynecol. 2009;200(4):357-364. doi:10.1016/j.ajog.2008.11.033 https://pmc.ncbi.nlm.nih.gov/articles/PMC3918890/
3. Ceriani Cernadas JM. Postpartum depression: Risks and early detection. Arch Argent Pediatr. 2020;118(3):154-155. doi:10.5546/aap.2020.eng.154 https://pubmed.ncbi.nlm.nih.gov/32470247/
4. Dominiak M, Antosik-Wojcinska AZ, Baron M, Mierzejewski P, Swiecicki L. Recommendations for the prevention and treatment of postpartum depression. Ginekol Pol. 2021;92(2):153-164. doi:10.5603/GP.a2020.0141 https://pubmed.ncbi.nlm.nih.gov/33448014/
5. Nguyen HTH, Hoang PA, Do TKL, Taylor-Robinson AW, Nguyen TTH. Postpartum depression in Vietnam: a scoping review of symptoms, consequences, and management. BMC Womens Health. 2023;23(1):391. Published 2023 Jul 26. doi:10.1186/s12905-023-02519-5 https://pmc.ncbi.nlm.nih.gov/articles/PMC10369808/
6. Simhi M, Sarid O, Cwikel J. Preferences for mental health treatment for post-partum depression among new mothers. Isr J Health Policy Res. 2019;8(1):84. Published 2019 Dec 5. doi:10.1186/s13584-019-0354-0 https://pubmed.ncbi.nlm.nih.gov/31806009/
7. Zhang Y, Wang H, Wu S, Xiao Y, Jiang F. Empowering new mothers in China: role of paediatric care in screening and management of postpartum depression. BMJ. 2024;386:e078636. Published 2024 Aug 30. doi:10.1136/bmj-2023-078636 https://pmc.ncbi.nlm.nih.gov/articles/PMC12036563/
8. Gopalan P, Spada ML, Shenai N, et al. Postpartum Depression-Identifying Risk and Access to Intervention. Curr Psychiatry Rep. 2022;24(12):889-896. doi:10.1007/s11920-022-01392-7 https://pmc.ncbi.nlm.nih.gov/articles/PMC9702784/

Disclaimer

The information on HealthOdysseyHub is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. We strive to keep our content accurate and up-to-date, but healthcare knowledge changes quickly. Always consult a qualified healthcare professional before making decisions based on our content. Some topics may cover alternative or complementary medicine. These may not align with conventional practices. Approach such information with caution and seek multiple opinions before any medical intervention.