Is it Postpartum Depression or Something Else?

From “We’re having a baby!” to “The baby’s coming!”, a baby’s birth is perhaps one of the most glorious events in an expecting family’s life. But, the thought of welcoming a little one into the family can be distressing and fearsome as well, especially for first-time parents. After all, raising a child is an entirely different milestone; it requires commitment, patience, and tender loving care. 

A woman undergoes complex hormonal, physical, and emotional changes during pregnancy, which can take its toll after birth. While it is completely normal to feel fatigued after giving birth to a baby, most women experience significant sorrow, distress, and anxiety as well. Apart from stress, a new mother might experience tedious mood swings which can have their typical highs and lows. 

But, can these perpetual feelings of sadness implicate your day-to-day functioning? Should you ignore these mood disturbances and consult a doctor?

Baby Blues Vs. Postpartum Depression

Known commonly to affect over 80% of new parents – ‘baby blues’ are characterized by mood swings and feelings of tiredness and sadness occurring within 3-5 days of childbirth. Baby blues can last for hours or even days; taking the picture of postpartum depression if symptoms persist longer than 2 weeks.

Baby blues can go away on their own with minimal reassurance. But, symptoms of postpartum depression or perinatal depression can become aggressive and unmanageable on their own. Therapy and counseling can help mothers navigate their mood disorders and manage accordingly. While medication is also a mode of treatment, it is necessary to consult a psychiatrist and psychologist for adequate management.

What is Postpartum Depression (PPD)

Over 15% of mothers suffer from severe debilitating episodes of postpartum depression irrespective of caste, creed, and ethnicity. It can interfere with the daily functioning of life due to worsening mood swings, excessive fatigue, poor cognition, and feelings of hopelessness. 

Despite being treatable and manageable, postpartum depression can cause a new mother to overlook her health and in turn, her infant’s wellbeing. Feeling a mix of emotions after giving birth is considered normal, but a new mother might feel reluctant to address her moods or ask for help. If left untreated, postpartum depression will not only affect the mother’s health gravely but also deprive the infant of receiving optimum attention and care. 

Symptoms of Postpartum Depression

Some common symptoms and signs of PPD include:

• Frequent crying with or without a profound reason
• Severe mood swings – you might feel excited and active at one moment only to fall into crippling sadness the next.
• Loss of self-worth – you might feel like a failure even if your perception of a good life is happily on track
• Lack of interest in performing day to day activities which might cause you to neglect your child
• Feeling of unattractiveness which can induce body dysmorphia and a decline in libido 
• Lack of motivation coupled with hopelessness 
• Excessive fatigue and tiredness 
• Loss of appetite leading to weight loss or binge eating leading to significant weight gain. 
• Lack of interest in caring for the baby which can provoke guilt and shame
• Obsessively ruminating over intrusive thoughts which might involve mental or physical compulsions
• Immense fear of harming oneself or the infant which might be a reason why mothers experience detachment
• Excessive sleepiness or insomnia – you might be up all night or consider sleep as an escape or compulsion to divert your mind from racing thoughts.
• Poor cognition and lack of concentration
• Overtly distressed about the child’s safety – for instance, you might overcompensate by cleaning every nook and corner in order to maintain hygiene and prevent contamination.

The symptoms and signs of postpartum depression may vary in severity as well as from patient to patient. But, it is important to note that PPD compromises the quality of life and daily functioning quite significantly. 

Over 34% of women feel a certain lack of attachment from their newly born, while the rate of suicide amongst women suffering from postpartum depression is sad, 20%. Postpartum depression might lead to Postpartum Psychosis, which despite being rare, is a serious delusional disorder.

Causes of Postpartum Depression

This rollercoaster of emotions is highly influenced by the sudden drop in estrogen and progesterone levels after childbirth. Fluctuation in hormonal levels of oxytocin, prolactin, and thyroxine, has also been implicated in the progression of PPD. 

Identifying the underlying cause might play a role in diagnosing and treating PPD as well as preventing such episodes in future pregnancies. But, it is important to note that PPD can occur independently without any risk factor or root cause. 

Some common causes and risk factors of developing PPD include:

• Past medical history of mental illness such as mood disorders, obsessive compulsive disorder, generalized anxiety, and/or depression.
• Previously untreated or poorly managed postpartum depression. 
• Stressful lifestyle and work life, especially one riddled with financial instability and an uncertain future
• Feelings of loneliness pertaining to lack of emotional or physical support.
• Complicated relationships such as a failing marriage or infidelity (for instance, fear of being cheated on or getting a divorce),
• Unexpected childbirth experiences such as prolonged labour or complicated delivery.
• Complicated pregnancy due to systemic illnesses such as diabetes, hypertension, or renal insufficiency.
• History of Premenstrual Syndrome (PMS) or Premenstrual Dysmorphic Disorder – both are accompanied by overwhelming mood swings prior to menses and vary in severity.
• Giving birth to a baby with a challenging temperament, underlying illnesses, or special needs, thus mandating more time, patience, and attention. 
• Age plays a major role and can interfere with childcare. For instance, younger mothers such as teens can find it extremely difficult to take on a new family member. Older mothers, especially those who have been struggling with infertility or trying for another baby for quite some time, are also at a higher risk of developing PPD. 

PPD in Men – Is it Evident?

Postpartum depression in men is less accounted for, but can also have similar if not severe, symptoms as well. Around 10% of men go through PPD with the 3 – 6 month benchmark after childbirth. Many men might feel unable to establish a connection or a bond with their child, which can induce feelings of guilt and worthlessness. Seeing their partner in pain, distress, and mood swings after childbirth can also cause PPD in men. 

While hormonal changes in men are not as significant after their partner’s childbirth, many men develop low testosterone levels with a spike in estrogen levels. The hormonal imbalance might alter the cortisol and serotonin levels in the body, thus leading to stress, anxiety, crankiness, irritability, and depression. 

How Long Does PPD last?

Postpartum depression can occur anytime within the first year of childbirth. It can either begin after 2 weeks of delivery or take up to 8 weeks to appear initially. Most cases of postpartum depression can resolve within 3 to 6 months of childbirth, but in severe cases, they can stick around for more than a year.

As many women do not seek treatment, symptoms of PPD can persist longer than a year as well. In severe cases, postpartum depression can morph into a major depressive disorder if left undiagnosed and untreated. According to a study published in 2014, symptoms of PPD can persist for more than 3 years after childbirth as well!

Postpartum Depression Treatment

Postpartum women are usually screened for symptoms of PPD during their 6-week postnatal visit. As symptoms can arise after 2 weeks of childbirth, it is important to raise any suspicion and consult a doctor for prompt diagnosis of PPD. 

Therapy and medication are the two standard modes of treatment for PPD. Therapy and medication go hand in hand, but can also be used independently, as per your doctor’s recommendations.

Antidepressants and Mood Stabilizers

Selective Serotonin Reuptake Inhibitors (SSRIs) are the safest antidepressant medications during postpartum. Sertraline and citalopram are ideally preferred as their metabolites are at low levels in breast milk, and thus, might not expose the infant to adverse effects. Other preferred SSRIs include paroxetine which can help women combat intrusive thoughts with depression as evident in Postpartum Obsessive Compulsive Disorder as well. 

Tricyclic antidepressants such as imipramine can be used for combatting anxiety and depression in lactating mothers. While imipramine is not known to cause any side effects in the infant after exposure to breast milk, doctors might prescribe it after a postpartum period of 2 months has passed.

Lithium, a potent mood stabilizer, is a preferable mood stabilizer during breastfeeding.

While lamotrigine is safe in pregnancy, its use is contraindicated in lactating mothers. Carbamazepine, a mood stabilizer and also an antiepileptic, is disregarded during pregnancy but monitored vigorously for any occurrence of side effects in the lactating woman.  

Cognitive Behavioural Therapy

Cognitive-behavioral therapy is highly beneficial in managing symptoms and signs of PPD. CBT alone has shown an immense response in patients suffering from OCD or depression. 

A trained CBT professional can help you understand your thought patterns and modify your responses when exposed to such challenges. Through counseling, guidance, and therapy, you might be able to take care of yourself and the baby with confidence and peace.

Postpartum Depression Group Counseling 

Your therapist might advise postpartum depression group counseling sessions that you can join to share and talk about your experiences. Group therapy is quite helpful, as it allows you to meet other struggling parents with similar symptoms of PPD. 

Plus, talking about your pain and distress always helps. If you lack emotional support or have a busy lifestyle, joining group therapy might help you see a different perspective and thus, openly discuss your parenting concerns.

The Final Word

Every day is perceived as a huge stepping stone when a person is suffering from depression. The sudden yet expected overload in responsibilities triggers fear and anxiety, especially in parents who find it hard to balance work life with their chores at home. 

Know that you are not alone if you are struggling with depression. Knowing that you are responsible for taking care of the baby might be a trigger, but that does not mean that you have to suffer in isolation. It never hurts to ask for help; it does not make you a bad parent. You are human, and so is the whirlpool of emotions you are experiencing in this tough period.

Always remember to practice postpartum depression self-care. Selfcare begins at home and does not require you to spend hundreds on skincare and spa appointments. Drink fresh juices and keep yourself hydrated, eat fresh fruits and vegetables, drink milk if you are nursing so that your baby can build stronger bones, and lastly, get enough sleep and rest. Share the workload between your partner, or hire a housekeeper (if you can afford it) to tend to the household chores.

Call 911 if your moods become too depressive. Ask for help – the sooner the better.

– Disclaimer –
This blog is for informational & educational purposes only, and does not intend to substitute any professional medical advice or consultation. For any health related concerns, please consult with your physician, or call 911.