Postpartum Depression - Causes, Symptoms and Treatment

The birth of a child is usually portrayed as a moment of great joy for the family, especially for the mother.

What many people do not know, however, is that between 40 and 80 percent of mothers may develop mood swings soon after delivery, which commonly include episodes of crying, anxiety, fear of not being a good mother, melancholy, anddifficulty sleeping. These mood changes usually appear within the first two to three days after giving birth and may last up to two weeks.

When the mood change after the baby's birth is very intense and lasts for more than 14 days, we may be faced with a picture called postpartum depression.

Postpartum depression is not a sign of weakness, lack of character or incompetence for the role of mother. Women who develop this form of depression should not underestimate their ability to be a good mother but should understand that they are suffering from a psychiatric disorder and that they need professional help to overcome the problem.

In this article we will specifically talk about the picture of depression that appears just before or after delivery. If you are looking for general information about depression, visit the following article: DEPRESSION - Causes, Symptoms and Treatment.

What is postpartum depression

Although this form of depression is called postpartum, it is a condition that can occur even during pregnancy in up to half of the cases. When depression arises after delivery, it usually manifests itself within the first 4 weeks after the baby's birth.

Clinical studies show that postpartum depression( PPS) affects about 10% of women, but this number is probably underestimated because often the diagnosis is not even made, since the depressed mother does not seek medical help. It is estimated that only half of the mothers with PPD end up receiving a diagnosis and, consequently, adequate treatment.

The onset of postpartum depression usually occurs as follows:

- 20% of women develop PPD during pregnancy.
- 38% develop when delivery is near.
- 42% develop after delivery.

Among mothers who develop depression after the baby's birth, the timing of opening the picture is usually:

- In the first 4 weeks for 54% of women.
- Between 4 and 16 weeks for 40% of mothers.
- After 16 weeks for 6% of women.

It is interesting to note that postpartum depression is not a disease exclusive to mothers. Parents may also have PPD.And as with women, depressive symptoms can make them have difficulty caring for themselves and their children.

Causes and Risk Factors

Postpartum depression is a disorder triggered by multiple factors. The fall in hormone levels that occurs shortly after the end of pregnancy, associated with physical exhaustion due to sleep deprivation and emotional stress that a newborn baby generates, usually have great weight in the mother's mood change.

Some factors increase the risk of the mother developing PPD.These are:

  • A history of postpartum depression in a previous pregnancy.
  • Marital conflicts.
  • Financial difficulty.
  • Mothers under the age of 25.
  • Single mothers.
  • Family history of depression.
  • Baby health problems.
  • Unwanted pregnancy.
  • Difficulty in breastfeeding.
  • Babies of difficult temperament.
  • Women with a history of severe post-menstrual tension( see: PMS SYMPTOMS - Premenstrual Tension).

Symptoms of Postpartum Depression

Symptoms of PDD are similar to symptoms of major depression that can occur in any individual( read: SYMPTOMS OF DEPRESSION).

As mentioned above, most women show signs of sadness and melancholy in the first 2 weeks postpartum but do not develop depression properly.

Signs and symptoms of postpartum melancholy include:

  • Frequent mood swings.
  • Anxiety.
  • Sadness.
  • Irritability
  • Easy crying.
  • Lack of concentration.
  • Loss of appetite.
  • Difficulty sleeping

Postpartum depression can be confused with postpartum melancholia, but its signs and symptoms are more intense, longer lasting, and often interfere with your ability to take care of your baby and handle other daily tasks.

Symptoms of postpartum depression include all those previously mentioned plus:

  • Difficulty connecting with your baby.
  • Reduced interest in previously enjoyable tasks.
  • Removal from family and friends.
  • Thoughts of harming yourself or your baby.
  • Abrupt fatigue or loss of energy.
  • Intense irritability and anger.
  • Intense fear of not being a good mother.
  • Feelings of worthlessness, shame, guilt or inadequacy.
  • Severe anxiety and panic attacks.
  • Recurring thoughts of death or suicide.

Despite the suicidal thoughts and the ideas of doing harm to the baby, there are rare cases where the two situations come true. Rates of suicide or postpartum infanticide are only 0.002%.

Postpartum psychosis

Although rare, both maternal suicide and infanticide are situations that can occur, especially if the mother develops a postpartum psychosis, which is like the most severe form of postpartum depression.

Postpartum psychosis affects about 0.1% of mothers and usually occurs within the first 2 weeks after delivery. Its signs and symptoms are:

  • Mental confusion and disorientation.
  • Obsessive thoughts about the baby.
  • Hallucinations and delusions.
  • Paranoia.
  • Attempts to harm yourself or your baby.

Postpartum psychosis is a medical emergency. If you think about doing harm to yourself or the baby, or have a family member who is in this situation, seek medical help right away.

To better understand psychosis, read: SYMPTOMS OF PSYCHOSIS.

Diagnosis of Postpartum Depression

Postpartum depression can be classified as mild or severe according to its symptoms. If the patient has 5 to 6 of the signs and symptoms listed below, she is classified as having mild to moderate postpartum depression. If you have 7 to 9 symptoms, your depression is classified as severe.

1) Depressed mood most of the day, on virtually every day.
2) Loss of interest in all, or almost all, activities most of the day, almost every day.
3) Significantly unintentional weight loss or weight gain in a few weeks( for example, a change of more than 5% of body weight, more or less, over a one month interval).
4) Insomnia or excessive sleep almost every day.
5) Agitation or lethargy almost every day
6) Fatigue or loss of energy almost every day
7) Feelings of worthlessness or excessive guilt, often with no real cause, almost every day.
8) Decreased ability to concentrate or make decisions almost every day.
9) Recurrent thoughts of death( not just fear of dying), recurrent suicidal ideation or a failed suicide attempt.

To be depressed, symptoms need to interfere with a woman's life in a personal, social and professional way, and can not be attributed to adverse drug effects or related to previously known health problems.

Treatment of Postpartum Depression

Treatment of postpartum depression is usually done with sessions of psychotherapy and use of anti-depressant medications.

With appropriate treatment, postpartum depression usually goes away within six months. In some cases, the picture may last longer, becoming chronic depression. Patients not adequately treated are at increased risk of developing into chronic depression.

The most commonly used anti-depressants are:
- Selective serotonin reuptake inhibitors( SSRIs) - for example: sertraline, escitalopram, fluoxetine, citalopram or paroxetine.
- Selective serotonin and noradrenaline reuptake inhibitors( SSRIs) - for example: venlafaxine or duloxetine.
- Bupropion.
- Mirtazapine.

Symptoms improve within 1 to 3 weeks, but it is important for the mother to understand that her good response does not authorize discontinuation of treatment. Early discontinuation of medications usually leads to episodes of relapse of the disease.