By Dr Bharat Saluja
Qualification : MD Psychiatry
Monday March 16 2020 18:12 PM Comments 0
Six weeks after giving birth to an adorable son; Priya, a 27-year-old woman visited my clinic with suicidal thoughts, depressed mood and lack of sleep. She stated that she was feeling guilty because she did not feel attached to her baby and felt even worse when her relatives and friends congratulated her for becoming a mother. She stated that her family members and her family doctor did not take her seriously until the day when she tried to kill herself by ingesting poison. Subsequently, she was referred to me and was diagnosed and treated for Postnatal Depression.
Let us first understand a few things about Postnatal Depression (PND)/ Postpartum Depression (PPD):
Over the years, I have seen 100s of patients who suffer from PND and I have been asked some questions frequently by patients and their relatives. Through this post, I am trying to answer some of those questions.
How could one be possibly depressed after having a baby?
One would assume that the arrival of a new baby would bring in lot of joy and happiness. However, it is a reality that women are vulnerable to develop mood or even depression after childbirth. In fact, in the year after childbirth a woman is more likely to need psychiatric help than at any other time in her life.
Is postnatal depression a modern world illness? We never heard about it in our times?
The reality is that it was always there but was given different names in different generations and different cultures of the world.
Does postnatal depression happen only after normal delivery?
Not necessarily. It can happen after caesarean delivery, normal delivery, miscarriage or stillbirth. Pregnancy is the common factor.
When does postnatal depression happen? I started experiencing symptoms only after 6 months of delivery. Is it still postnatal depression?
The fact is that PND can begin during pregnancy (antenatal depression), immediately after birth, or gradually any time during the first year after birth. Most commonly the onset is within the first four months of delivery.
Can the father of the baby also suffer from postnatal depression?
It is a common misbelief that it affects only women but the reality is that around 5% of men will experience depression during the postnatal period. Many people think that men experience paternal postnatal depression as a result of, or in conjunction with, their partner’s depression. However, men can experience postnatal depression independently from their partners.
Do all women with postnatal mood disorder experience similar symptoms? Is it different for different women?
It is very different for different women. It can present as either Baby blues (least severe), Postnatal Depression or Postnatal psychosis (most severe).
Baby blues affect about 80% of new mothers and usually occurs between the third and tenth day after birth. Symptoms include tearfulness, anxiety, mood fluctuations and irritability. Such feelings are transient and usually pass off with supportive counselling and without any antidepressant treatment.
Postnatal psychosis (or puerperal psychosis) affects 1 in 500 mothers and usually occurs in the first 3-4 weeks after delivery. It is most serious form of postnatal mood disorder. It presents with mixture of depressed, irritable or elevated mood along with psychotic symptoms such as delusions and hallucinations, insomnia, and inappropriate responses to the baby. It is a medical emergency which requires hospitalization. Women with postpartum psychosis are more likely to commit suicide or kill their own child than the general population. To ensure the safety, it is recommended to hospitalize the mother, mobilize the family to ensure care of the newborn, and treat the patient with antipsychotic medication and (occasionally) electroconvulsive therapy.
Postnatal depression, or PND affects about 15% of women beginning anywhere from 24 hours to several months after delivery. It presents with the same symptoms as those of depression in other circumstances including
How does PND affect how I feel about my baby?
Mothers find it very difficult to handle certain feelings and thoughts they experience about their baby such as ‘I am not able to love my baby’, ‘I don’t feel close to my baby’, ‘I feel guilty as I am not a good mother’, ‘my baby is responsible for how I feel’.
What Causes PND?
The combination of biological, psychological, and social factors contributes to PND.
Biological factors include a family history of mood disorder (genes), sudden changes in pregnancy hormones following delivery, sleep disturbance, and difficult pregnancy.
Psychological factors include difficult birth, traumatic childhood experiences, treatment for infertility, certain personality traits such as perfectionism, history of previous losses such as previous miscarriage/s and limited social and emotional skills.
Social factors include lack of close family and friends, intrusive or difficult family relationships, unsupportive partner and financial difficulties.
How to manage/treat PND?
Treatment of PND includes talking therapies (psychological intervention) and medications depending upon the severity.
Talking to a trained counsellor or therapist can be a relief as it can help you to understand and make sense of your difficulties. Specialised treatments like Cognitive Behavioural Therapy (CBT) help you to see how some of your ways of thinking and behaving may be making you depressed. It is usually safe to undergo talking treatments, but since they may bring up bad memories, there is a possibility of some unwanted effects. You can feel low or distressed post these treatments. Psychotherapy can put a strain on relationships with people close to you; so make sure you see a trained therapist or counsellor.
Most commonly, antidepressant medication is prescribed to treat PND. Antidepressants take at least 2 weeks to start working and you would need to take them for around 6 months after you start to feel better. If you are breastfeeding your child, don’t forget to discuss discuss the safety issues with your psychiatrist.
