Post-partum depression
what changes in moms’ brains after giving birth
Having a baby can trigger a variety of strong emotions in women, from excitement and joy to fear and anxiety, and they may even experience various types of depression.
Most new moms experience post-partum syndrome “baby blueswhich usually includes mood swings, easy crying, anxiety and difficulty sleeping. It appears in the first 2 to 3 days after birth and can last up to two weeks. It has a favorable evolution, it tends to recover quickly, the symptoms clear up in a few days. If these feelings don’t go away, the mother feels sad, hopeless or anxious for more than 2 weeks, she may have postpartum depression.
About one in seven women may develop postpartum depression (PPD).
Post-partum depression most commonly occurs within 6 weeks after childbirth, but symptoms can start earlier – during pregnancy – or later – up to a year after childbirth
The incidence is higher in teenage girls, mothers giving birth prematurely and women living in urban areas. Postpartum depression is a serious mental health condition that affects certain areas of the brain, influencing behavior, physical health and functionality. It affects the mother’s relationship with the child because she may not feel connected to her child, as if she is not the child’s mother, may not care for the child or feel that she does not love the child. These feelings can range from mild to severe.
Having a baby is a difficult and exhausting process. A woman undergoes many hormonal, physical, emotional and psychological changes during pregnancy, and the mother’s socio-familial environment undergoes extraordinary changes.
Pathophysiology
The postpartum pathogenesis (PPD) is currently unknown, with genetic, hormonal, psychological and social stressors. There is ample evidence that changes in reproductive hormones stimulate dysregulation of biological, endocrine and immunological systems in susceptible women. Rapid changes in reproductive hormones, such as estradiol and progesterone, after childbirth can be a potential stressor in susceptible women, and these changes can lead to depressive symptoms. Oxytocin and prolactin regulate the milk let-down reflex and breast milk synthesis, and low levels of oxytocin are seen particularly in PPD and unwanted early weaning. During the third trimester, lower levels of oxytocin are associated with increased depressive symptoms during pregnancy and after childbirth.
RISK FACTORS IN POSTPARTUM DEPRESSION
- history of depression, either during pregnancy or at other times.
- diagnosis of bipolar affective disorder.
- postpartum depression after a previous pregnancy.
- family history of depression or other mood disorders.
- experiencing stressful events in the past year, such as pregnancy complications, illness or job loss, etc.
- health problems or other special needs of the child.
- twins, triplets or other multiple births
breastfeeding difficulties - problems with your spouse or partner
- poor socio-family support
- financial problems
- unplanned or unwanted pregnancy
SYMPTOMS OF POSTPARTUM DEPRESSION
are identical to non-puerperal depression with an additional history of childbirth and may include:
- depressed mood or severe mood swings
- difficulties relating to the child
- tendency to social isolation
- changes in appetite
- sleep disturbances
- tiredness or low energy
- loss of interest
- intense irritability and anger
- fear of not being a good mom
- despair
- feelings of worthlessness, shame, guilt
- reduced ability to think clearly, reduced ability to concentrate or make decisions
- anxiety
- severe anxiety and panic attacks
- thoughts of harming yourself or your child
- recurrent thoughts of death or suicide
Untreated, postpartum depression can last for months, even years.
Remission of symptoms reduces the risk of behavioral and psychiatric problems in offspring. Patients with PPD may also have psychotic symptoms that include delusions and hallucinations, such as voices telling them to harm children.
Postpartum depression in the other parent
Studies show that new dads can also experience postpartum depression. They may feel sad, tired, overwhelmed, anxious or have eating and sleeping disorders. These are the same symptoms experienced by mothers with postpartum depression.
Fathers who are young, have a history of depression, have relationship or financial problems are more likely to have postpartum depression. Postpartum depression in fathers – also called paternal postpartum depression – can have the same negative effect on relationships and child development as postpartum depression in mothers.
If you feel depressed after the birth of your baby, you may be reluctant or embarrassed to admit it. It’s important to see a specialist as soon as possible if symptoms of depression have any of these characteristics:
- It doesn’t fade after two weeks.
- They’re getting worse.
- It lightens the burden of caring for your child.
- It makes everyday tasks easier.
- You have recurring thoughts of hurting yourself or your child
TREATMENT / MANAGEMENT in postpartum depression
The treatment for postpartum depression is complex, including psychotherapy, antidepressant drugs or innovative treatment methods such as transcranial stimulation.
Cognitive-behavioral psychotherapy is the first-line treatment option for women with mild to moderate peripartum depression, especially if mothers are hesitant to start medication and are breastfeeding their newborn. Combination therapy with antidepressant medication (selective serotonin reuptake inhibitors are the first choice) is recommended for women with moderate to severe depression.
For breastfeeding women, recommendations should be made after discussing the benefits of breastfeeding, the risks of antidepressant use during breastfeeding and the risks of an untreated condition. Repetitive transcranial magnetic stimulation or transcranial electrical stimulation are treatments that may offer an alternative option for breastfeeding women who are concerned about exposing their baby to the effects of drugs. They are non-invasive, painless, safe, effective and well-tolerated treatment methods with minimal side effects (headaches, discomfort, redness or numbness at the site of stimulation, muscle twitching in the face)
PREVENTING post-partum depression
If you have a history of depression – especially postpartum depression – tell your doctor if you’re planning to get pregnant, or let him or her know as soon as you find out you’re pregnant.
During pregnancy, your doctor may monitor you closely for symptoms of depression. Mild depression can be managed with therapy, counseling or support groups, and in moderately-severe cases medication and/or transcranial electrical/magnetic stimulation may be recommended, even during pregnancy.
After giving birth, your doctor may recommend an early postpartum check-up to detect symptoms of postpartum depression. The earlier it is diagnosed, the earlier treatment can be started, using treatment methods that can be safely given while breastfeeding.
COMPLICATIONS of postpartum depression
If left untreated, postpartum depression can interfere with the mother-child bond, affect breastfeeding, the baby’s physical and mental development, cause family problems and increase the risk of suicide.
For mothers, untreated postpartum depression can last for several months or longer, sometimes becoming an ongoing depressive disorder. Even when treated, postpartum depression increases a woman’s risk for future episodes of major depression.
For the other parent, postpartum depression can cause emotional tension, exhaustion. When a new mother is depressed, the risk of depression in the child’s other parent may also increase.
Bibliography
- https://www.ncbi.nlm.nih.gov/books/NBK519070/
- https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617
- https://www.marchofdimes.org/find-support/topics/postpartum/postpartum-depression
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8304475/
- https://womensmentalhealth.org/posts/tdcs-pregnancy/
- https://womensmentalhealth.org/specialty-clinics-2/postpartum-psychiatric-disorders-2/
Dr. Oana Nantu – Specialist psychiatrist
more blog posts
Med Anima Iași:
Str. Străpungere Silvestru nr. 60, bl. CL 11, sc. B, ground floor, Iași, county: Iași
Med Anima Belcești:
com. Belcești, B entrance, Bl. 4, county: Iași
Med Anima Timișoara:
Bd. Eroilor de la Tisa nr. 8, 1st floor, Timișoara, county: Timiș
