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Posted by on Jun 30, 2014 in blog, Gynaecology | 0 comments

Post Partum Depression

Post Partum Depression

 

The arrival of a baby is a much awaited event in any family, and an occasion for joy and celebration all around. This should naturally be a time when the mother also should be experiencing happiness and contentment with the fruit of her labour. Sadly, this is not always the case and many mothers actually experience sadness and a disturbed mood. Not often noticed by the person or her family members, this depression can have a deleterious effect on the woman and her baby also. It is therefore important to know the various ways this can present, and what needs to be done about this disturbance.

What are the various patterns of mood disturbance after delivery?

There are three patterns of presentation:

  • Postpartum blues – A transient disturbance seen in over 50 % of mothers. It starts on the 3rd to 5th day after delivery, and usually ends before the 14th day. Typically, the mother is tearful, anxious or irritable, has sleep disturbance and may be unresponsive.
  • Postpartum depression – A more severe form of depression, it is actually a full-blown depressive syndrome, starting within the first two or three months after the delivery. Seen in 10 to 15% of mothers, there is pervasive sad mood, with guilt feelings, indifference to the baby, insomnia.
  • In severe cases, the mother may have suicidal ideas, which may even extend to ideas of killing the baby too.
  • Postpartum psychosis – The most severe form, here the mother may be agitated and highly disturbed. Affecting 0.1to 0.2 % of mothers, here the patient may have hallucinations and bizarre ideas, and may ignore the baby altogether.

What are the causes of postpartum mood disturbances?
There are several causes postulated to be leading to mood disturbances after delivery:

  • Hormonal – There is a precipitous fall in estrogens and progesterones after delivery and this is probably responsible for the baby blues. The thyroid hormones and cortisol also fall during this period.
  • Genetic factors may play a role especially in depressive syndromes and postpartum psychosis. Many of these mothers have a past or family history of mood disorders.
  • Stress – Any stressful event, in the period before delivery increases the likelihood of depression. The stress of role transition and lack of support systems, also contribute to the blues.
  • Age- Younger women, especially adolescents are more vulnerable. 

Is it necessary to treat depression occurring after delivery?

Postpartum blues are by definition self-limiting, and the mother only needs emotional support and tangible help. However, postpartum depression and psychosis can be harmful to the mother as well as the baby if left untreated. It may impact the cognitive, social and psychological well being of the child too, if neglected.

What are the treatment options available?
Several options are available for treating postpartum depression. Mild cases can be treated by psychotherapy, where the therapist focuses on dysfunctional thoughts, helps the patient in resolving conflicts, and aids the patient in issues such as role transition to motherhood,career concerns, etc. Severe forms of depression and psychosis however, may need to be treated with medication or sometimes with electroconvulsive therapy.

Is it safe to breastfeed while on medication?
Since medication is also secreted in milk, it is better to use medications with caution. Breast-feeding should be totally avoided with drugs like lithium and anti-psychotics. However, certain medications like SSRIs (sertraline, fluoxetine, etc.) are relatively safe and can be given after discussing the pros and cons with the mother.

What is the outcome of mood disturbances after childbirth?
As stated earlier, the blues are self-limiting, although some of them may progress into depression. Postpartum depression lasts shorter than other depressions, and the response to treatment is generally good. There is a likelihood of it recurring after subsequent pregnancies.

What should family members or the family doctor do?
Be on the lookout for depression and the blues in every mother! Ask about her emotional state and depression can come tumbling out. Offer support, and help. Where the depression is severe, especially if there are suicidal thoughts or dysfunctional behaviour, refer her to a psychiatrist for evaluation. Timely help goes a long way and restores the happiness, which is every mother’s and child’s due.

 

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