What is Postpartum Depression (PPD)?

Dr. Mbikayi Tshimanga, Gynaecologist & Obstetrician at Melomed Richards Bay
FCOG (SA), F.MAS (India)

PPD is a complex mix of physical, emotional, and behavioural changes that happen in a women after giving birth. It's relatively common, and it's treatable.

1 out of 8 new moms suffer from baby blues - a normal short lived period of feeling sad, weepy, or moody that is triggered by hormonal changes after giving birth.

PPD is not just 'BABY BLUES'.
PPD can occur up to one year after having a baby, but it most commonly starts about one to three weeks after childbirth.

Symptoms of Postpartum Depression

Women with PPD have intense feelings of sadness, anxiety, or despair that prevent them from being able to do their daily tasks:
• Feelings of guilt, shame or hopelessness
• Lack of interest in the baby
• Feelings of anger or irritability
• Possible thoughts of harming the baby or yourself
• Appetite and sleep disturbance
• Feeling guilty about not being a good mom or doubting your ability to care for the baby
• Crying and sadness
• Loss of interest, joy or pleasure in things you used to enjoy.

Risk factors for Postpartum Depression

Postpartum depression is probably caused by a combination of factors:
Previous or family history of depression:
Women who have had depression at any time - before, during, or after pregnancy - or who currently are being treated for depression have an increased risk of developing PPD.

Emotional factors:
Feelings of doubt about pregnancy are common. If the pregnancy is not planned or is not wanted (e.g. being a teen mom) can affect the way a woman feels about her pregnancy and her unborn child.

Having a baby who has been hospitalised:
Parents of babies who are sick or who need to stay in the hospital may feel sad, angry, or guilty. These emotions can affect a woman's self-esteem and how she deals with stress.

Pregnancy:
Difficulty getting pregnant, pregnancy and birth complications as well as preterm labour and delivery (before 37 weeks) increase the risk for PPD.

Non-breastfeeding moms:
A recent study found that breastfeeding may help improve maternal mental health and reduce the risk of PPD. But remember “fed is best.” While we can't ignore the benefits of breastfeeding, the pressure to breastfeed can negatively affect the mental health of new mothers who struggle to do so.

Being a mom to multiples, like twins, or triplets

Lifestyle factors:
Lack of support from others and stressful life events, such as a financial difficulties, a family illness, or moving to a new city, can greatly increase the risk of PPD

What causes Postpartum Depression?

The precise cause of PPD remains unclear, however several biological mechanisms play a role in the development of the disease. The postpartum period is characterised by:
• Rapid decline of pregnancy hormones - oestrogen and progesterone decrease sharply in the hours after childbirth. These changes may trigger depression in the same way that smaller changes in hormone levels trigger mood swings and tension before menstrual periods.
• Oxytocin, "the bonding hormone" increase after delivery and with breastfeeding. Lower levels of oxytocin are associated with PPD.

These rapid hormonal changes among other emotional and physical changes (sleep deprivation) all play a role in PPD development.

What can be done to help prevent postpartum depression?
If you have a history of depression at any time in your life or if you are taking an anti-depressant, tell your ob-gyn or other healthcare professional early in your prenatal care. You might need to begin treatment right after you give birth to prevent PPD. If you were taking anti-depressants before pregnancy, your ob-gyn can assess your situation and help you decide whether to continue taking medication during your pregnancy.

How is postpartum depression treated?
• Medication:
  PPD can be treated with anti-anxiety and anti-depressant medication. Anti-depressants balance the chemicals in the brain that control moods.
  It may take three to four weeks of taking the medication before you start to feel better.
  
  Can anti-depressants cause side-effects?
  Anti-depressants can cause side effects, but most are temporary. If you have severe or unusual side effects that get in the way of your normal daily habits, notify your ob-gyn or other healthcare professional. You may need to try another type of anti-depressant.
  If your depression worsens soon after starting medication or if you have thoughts of hurting yourself or others, please get urgent medical help.
  
  Can anti-depressants be passed to my baby through my breast milk?
  Anti-depressants can be transferred to a baby during breastfeeding, but the levels found in breast milk are generally very low. Deciding to take an anti-depressant while breastfeeding involves weighing the benefits of breastfeeding against the potential risks of your baby being exposed to the medication. It is best to discuss this decision with your ob-gyn or other healthcare professional.


• Counselling & Education:
  Talk therapy (also called psychotherapy) is also used to treat depression, often in combination with medication. In talk therapy, you and a mental health professional discuss your feelings and how to manage them. Sometimes, therapy is needed for only a few weeks, but it may be needed for a few months or longer.

What should I do if I think I have postpartum depression?
If you think you may have PPD, or if your partner or family members are concerned that you do, it is important to see your obstetrician-gynaecologist (ob-gyn) or other healthcare professional as soon as possible. Do not wait until your postpartum check-up.