Postpartum depression

In this article we will follow on and discuss the causes and symptoms of Postpartum depression and major depression.

Postpartum depression occurs in 7% of women during the first year after delivery.

Although every woman is at risk, women with the following conditions are at higher risk:

• Postpartum blues (e.g., rapid mood swings, irritability, anxiety, decreased concentration, insomnia, crying spells)
• Prior episode of postpartum depression
• Prior diagnosis of depression
• Family history of depression
• Significant life stressors (e.g., relationship conflict, stressful events in the last year, financial difficulties, parenting with no partner, partner with depression)
• Lack of support from partner or family members (e.g., financial or child care support)
• History of mood changes temporally associated with menstrual cycles or oral contraceptive use
• Prior or current poor obstetric outcomes (e.g., previous miscarriage, preterm delivery, neonate admitted to the neonatal intensive care unit, an infant with a congenital malformation)
• Prior or continuing ambivalence about the current pregnancy (e.g., because it was unplanned or termination was considered)
• Problems with breastfeeding

Causes and Symptoms

The exact causes of postpartum depression is unknown; however, prior depression is the major risk, and hormonal changes during the puerperium (first 6 weeks post childbirth), sleep deprivation, and genetic susceptibility may contribute.

Symptoms and Signs of Postpartum Depression: Symptoms of postpartum depression are similar to those of major depression and may include:

• Extreme sadness
• Mood swings
• Uncontrollable crying
• Insomnia or increased sleep
• Loss of appetite or overeating
• Irritability and anger
• Headaches and body aches and pains
• Extreme fatigue
• Unrealistic worries about or disinterest in the baby
• A feeling of being incapable of caring for the baby or of being inadequate as a mother
• Fear of harming the baby
• Guilt about her feelings
• Suicidal ideation
• Anxiety or panic attacks

Typically, symptoms develop insidiously over 3 months, but onset can be more sudden. Postpartum depression interferes with women’s ability to care for themselves and their baby. Women may not bond with their infant, resulting in emotional, social, and cognitive problems in the child later. Partners may also be at increased risk of depression, and depression in either parent may result in relationship stress.

Without treatment, postpartum depression can resolve spontaneously or become chronic depression. Risk of recurrence is about 1 in 3 to 4. Other potential psychiatric disorders in the postpartum period include anxiety and, rarely, postpartum psychosis.

Premenstrual Dysphoric Disorder (PMDD) and depression share some similarities, but they also have distinct traits. Here’s a summary of the 11 traits of PMDD compared to depression:

Timing: PMDD symptoms occur in the luteal (second) phase of the menstrual cycle (after ovulation and before menstruation) and resolve shortly after menstruation begins. Depression symptoms are more constant and not tied to the menstrual cycle.

Mood Swings: PMDD involves severe mood swings, irritability, and anger that are cyclical. Depression involves a persistent low mood.

Anxiety: PMDD often includes heightened anxiety and tension. Depression can include anxiety, but it is not as cyclically tied to the menstrual cycle.

Physical Symptoms: PMDD includes physical symptoms like bloating, breast tenderness, and headaches. Depression typically does not include these specific physical symptoms.

Severity: PMDD symptoms are severe enough to interfere with daily life and relationships. Depression also interferes with daily life but is not specifically tied to the menstrual cycle.

Duration: PMDD symptoms last about 1-2 weeks per month. Depression symptoms are more persistent and can last for months or years.

Sleep Disturbances: Both PMDD and depression can cause sleep disturbances, but in PMDD, these are cyclical.

Appetite Changes: PMDD can cause specific cravings and appetite changes before menstruation. Depression can cause changes in appetite, but these are not cyclical.

Energy Levels: PMDD can cause fatigue and low energy in the luteal phase. Depression causes persistent low energy.

Concentration Issues: Both PMDD and depression can cause difficulty concentrating, but in PMDD, this is cyclical.

Treatment Response: PMDD often responds well to hormonal treatments and lifestyle changes. Depression may require a broader range of treatments, including medication and therapy.

Postpartum psychosis (PPP) is a mental health emergency. This condition affects a person’s sense of reality, causing hallucinations, delusions, paranoia or other behaviour changes. In severe cases, people with PPP may attempt to harm themselves or their newborn. This condition is treatable, and early treatment increases the odds of a good outcome.

What is postpartum psychosis?

Postpartum psychosis (PPP) is a reversible — but severe — mental health condition that affects people after they give birth. This condition is rare, but it’s also dangerous.

IMPORTANT: People with postpartum psychosis have a much higher risk of harming themselves, dying by suicide or harming their children. Because of this, PPP is a mental health emergency. If you have the symptoms of PPP or are near someone who shows signs of it, it’s important to seek immediate help.

There are 3 types of Postpartum depression (PPD): Baby blues, Postpartum Depression and Postpartum Psychosis.

In this first article we will be exploring the baby blues and its symptoms.

Baby blues

About 3/4 of women suffer from what we call baby blues shortly after giving birth. The symptoms can result in emotional sensitivity, irritability, restlessness, and low mood (tearfulness). Crying for no known reason, sadness, and anxiety. These feelings occur within the first week of giving birth and usually settle down within a fortnight if not sooner. This is due to the resettling of your hormones after giving birth.

Mood episodes can have their onset either during pregnancy or postpartum. Although the estimates differ according to the period of follow-up after delivery, between 3% and 6% of women will experience the onset of a major depressive episode during pregnancy or in the weeks or months following delivery but some research deems it to be a little higher. Current diagnostics offers a detailed note on using the Major Depressive Disorder with Peripartum Onset diagnosis.

Fifty percent of “postpartum” major depressive episodes begin prior to delivery. Thus, these episodes are referred to collectively as peripartum episodes. Women with peripartum major depressive episodes often have severe anxiety and even panic attacks.

 Prospective studies have demonstrated that mood and anxiety symptoms during pregnancy, as well as the “baby blues,” increase the risk for a postpartum major depressive episode.

In the second article of this subject, I shall explore and explain the criteria for postpartum depression in greater detail.