Do you remember when we talked about depression and we said that even positive life events can be stressful and may eventually lead to depression if mismanaged? Well, having a baby can be one of those events. Children are a blessing from the Lord but sometimes the transition can be hard especially for the first-time mothers.
Post partum simply means after birth while peripartum refers to the time shortly before, during, and after giving birth. Postpartum depression therefore refers to clinical depression that happens after childbirth. We will use the abbreviation PPD, even though my professor does not encourage it. (I won’t tell if you don’t).
The DSM V (Diagnostic and Statistical Manual of mental disorders), does not consider postpartum depression as a separate condition but as a type of depressive disorders. It is classified as a depressive disorder with peripartum onset in lay terms; depression that presents during the peripartum period. It is considered peripartum because it does not always present after birth. Sometimes it presents earlier; 50% of the episodes actually happen before delivery. (DSM V)
Even without adding childbirth, depression is already twice more common in women than in men. Women are usually at increased risk of mood disorders during periods of hormonal fluctuations e.g. before menses, after child birth, during menopause. 1 in 5 women usually experience a mental health problem during pregnancy or in the year after giving birth.
According to WHO, this condition affects 13% of women within an year of childbirth. It is also one of the leading causes of murder of children less than one year of age – occurs in about 8 per 100,000 births.
Although less common, postpartum depression can also affect fathers and partners- paternal postpartum depression.
We are not talking about baby blues. Postpartum or postnatal depression is more than baby blues.
How is PPD different from Baby blues?
Baby blues is usually a normal occurrence. It happens in about 50-80% of women. It is normal for a mother to feel low, emotional, and tearful or experience anxiety in the first week after delivery. However, baby blues don’t last for more than two weeks. If the symptoms are more intense, last longer than two weeks and affects the mother’s ability to take care of the baby then it is likely to be postpartum depression.
What causes PPD?
Thank God for the era we are in where the practice of medicine is now evidence based and we have access to a lot of information. This reduces the chances for stigma and increases the chances that a woman experiencing these symptoms will seek help.
The cause of PPD is not fully understood but there are various risk factors that have already been identified. These include;
- A personal or family history of depression
- Unplanned or unwanted pregnancy
- Low socio-economic status or lack of social support
- Stressful events during pregnancy; birth related psychological or physical trauma
- Premature or complicated delivery
- Other physical illness such as diabetes or thyroid disease
- Poor marital relationship or single marital status among others.
What are the symptoms of postpartum depression?
The criteria for diagnosis are similar to that used in major depressive disorders. PPD is basically a major depressive disorder that presents in the peripartum period. More specific symptoms include:
- Depressed mood or severe mood swings
- Fear of harming the baby or themselves
- Severe anxiety and even panic attacks
- Excessive crying and inability to handle even minor problems
- Difficulty bonding with the baby
- Inability to sleep even when the baby sleeps or sleeping too much
- Feeling less attractive
- Suicidal ideation
- Intense irritability
- Feeling like they have lost control over their life
- Reduced interests in activities they previously found pleasurable among others.
Why is it important to seek help?
PPD can last for months or even longer. If it is left untreated it does not just disappear. The patient can also develop a more severe form known as peripartum psychosis. This is a more dangerous presentation of the disease where the mother gets command hallucinations to kill the infant or delusions that the infant is possessed. It happens in about 1 in 500 to 1 in 1000 deliveries and it is more common in first time mothers.
PPD puts the woman at risk of developing a major depressive disorder(clinical depression) later in life so if it important that the condition is addressed early enough.
It is also important to seek treatment because this condition does not only affect the mother. PPD in the mother can also predispose the partner to the same condition. It also affects the child’s growth and development.
How does it affect the child’s growth and development?
The mother-infant relationship is certainly the most important human relationship and if disrupted can alter the child’s life completely. Post partum depression affects the mother’s ability to bond and take care of her child and this can cause many problems in the child even later in life. This includes:
- Cognitive development – the child may walk and talk later than normal, he/she may also experience problems in school
- Socially – the child may develop social withdrawal, aggressiveness or experience difficulty in developing relationships
- Psychologically- disruption of mother-infant relationship puts the child at high risk of developing depression later in life.
- Behavioral development – the child may get altered sleep patterns, aggression and hyperactivity
- Emotionally – he/she may experience low self esteem and high levels of anxiety.
“A mother is only as happy as her unhappiest child.”Quote by Nicole Helget:
PPD is a recognized mental health disorder and treatment is available. If you have experienced any of these symptoms or have noticed them in your loved one, please seek medical advice.
Author: Fridah .W. Wachira, 5th Year medical student (MBChB) at Kenyatta University, Kenya and a medical blogger. Contact; Facebook: Dr Wachira Fridah, Email: firstname.lastname@example.org, You Tube channel: Convo with Dr. Fridah and James Wetu.