Baby Blues: Post Partum Depression

The birth of a baby can trigger a jumble of powerful emotions, from excitement and joy to fear and anxiety.
But it can also result in something you might not expect — depression. Postpartum depression (PPD), also called postnatal depression, is a type of clinical depression, which can affect both sexes after childbirth.
Many new moms experience the “postpartum baby blues” after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues typically begin within the first 2-3 days after delivery, and may last for up to 2 weeks. When this is more severe, and lasts longer, it is called Post-Partum Depression. African-American mothers have been shown to have the highest risk of PPD at 25%, while Asians had the lowest risk at 11.5%. The cause of PPD is not well understood. Hormonal changes, genetics, and major life events have been hypothesized as potential causes.

Post-Partum Depression is characterised by sadness, hopelessness, low self-esteem, guilt, feeling of being overwhelmed, sleep and eating disturbances, inability to be comforted, exhaustion, emptiness, inability to experience pleasure from activities usually found enjoyable, social withdrawal, low or no energy, becoming easily frustrated, feeling inadequate in taking care of the baby, decreased sex drive, occasional or frequent anxiety.

African-American mothers have been shown to have the highest risk of PPD 25% while Asians had the lowest risk 11.5%
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There are several known predisposing factors like prenatal depression or anxiety, family history of depression, moderate to severe premenstrual symptoms, birth-related physical trauma, previous stillbirth or miscarriage, formula-feeding rather than breast-feeding, cigarette smoking, low self-esteem, childcare or life stress, low social support, poor marital relationship or single marital status, low socio-economic status, infant temperament problems/colic, unplanned pregnancy etc.

The criteria required for the diagnosis of postpartum depression are the same as those required to make a diagnosis of non-childbirth related major or minor depression. The criteria include at least five of the following nine symptoms, within a two-week period: Feelings of sadness, emptiness, or hopelessness on nearly every day, loss of interest or pleasure in activities, weight loss or decreased appetite, changes in sleep patterns, feelings of restlessness, loss of energy, feelings of worthlessness or guilt, loss of concentration or increased indecisiveness, recurrent thoughts of death, with or without plans of suicide.

A variety of treatment options exist for PPD, and treatment may include a combination of therapies. If the cause of PPD can be identified, treatment should be aimed accordingly.

Non-pharmacologic therapy – Both individual social and psychological interventions appear effective in the treatment of PPD. Other forms of therapy, such as group therapy and home visits, are also effective treatments. Internet-based cognitive behavioural therapy has been developed and tested and has shown promising results with lower negative parenting behaviour scores in those who participated. It is unclear if acupuncture, massage, bright lights, or taking omega-3 fatty acids are useful.

There is evidence, which suggests that selective serotonin reuptake inhibitors (SSRIs) are effective treatment for PPD. However, the quality of the evidence is low given it is based on very few studies and patients. It remains unclear which antidepressants are most effective for treatment of PPD, and for whom antidepressants would be a better option than non-pharmacotherapy.

Prevalence of PPD in fathers inversely correlates with socioeconomic status, i.e., unemployed fathers demonstrated the greatest vulnerability to developing PPD. Several negative development outcomes in children have been associated with paternal depression. In a cross-sectional study, pre-school children, three to five years of age, who faced paternal depression as infants developed increased behavioural problems relating to conduct and hyperactivity, more in boys than in girls.

Without treatment, postpartum depression can last for months or years. In addition to affecting the mother’s health, it can interfere with her ability to connect with and care for her baby and may cause the baby to have problems with sleeping, eating, and behaviour as he or she grows.

Remember, postpartum depression isn’t a character flaw or a weakness. Sometimes it’s simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms – and enjoy your baby.

Dr Mini Nampoothiri is an Obstetrician and Gynaecologist practicing with the Apollo Hospitals in Navi Mumbai. She is also Vice President at NMOGs and has practiced at Terna Shayadri Hospital, Surya Hospital, and MGM Hospital prior to joining Apollo.

http://www.connectedhealthquarterly.com/2016/08/01/postpartum-depression...