Postpartum Depression

gregorkowalnew

Dr Gregor Kowal
Senior Consultant
in Psychiatry and Psychotherapy,
German Board Certified,
Medical Director,
Clinic for Health and Medical Care
Phone: 00971-4-4574240

The birth of a baby triggers always powerful emotions, usually of positive nature. Sometimes however it results in a depression.

After childbirth more than 50 % of women experience the “postpartum baby blues” including sadness, mood swings, anxiety and sleep deprivation. “Baby blues” typically begin immediately after delivery. It is a transient postpartum mood disorder with mild depressive symptoms lasting for up to two weeks. The symptoms are self-limited.

Less frequently the symptoms are more severe and long lasting showing all signs of a depression called postpartum depression (PPD), or postnatal depression. Approximately 15% of all women are affected by postpartum depression following the birth of a child. Postpartum depression begins usually between two weeks to a month after delivery. In about half of the cases the symptoms of depression start already during the pregnancy. That’s why in the DSM-5, postpartum depression is diagnosed as depression with “peripartum onset”, which means as anytime either during pregnancy or in the time following the delivery. Nevertheless, the majority of psychiatrists will diagnose postpartum depression as depression with onset anytime within the first year after delivery.

A less common and more severe than postpartum depression is the postpartum psychosis. The psychotic symptoms are delusional thoughts and hallucinations, often disorganized thinking and also mood swings.

The symptoms of PPD are: low mood, low self-esteem, sleeplessness, feeling of being overwhelmed and inadequate in taking care of the baby, difficulty bonding with the baby, loss of appetite, social withdrawal, anxiety, and irritability. Sometimes the mothers develop overprotective behavior and irrational thoughts that something can happen to the baby. In other cases the mothers develop thoughts of death or suicide related to herself and even to the baby. The latest is based on a delusional idea: if I’m not there no one can take care of the baby so it’s better to “take it with me”.

1. Diagnostic

The criteria required by DSM V for the diagnosis of postpartum depression are the same as those required for the diagnosis of non-childbirth related major depression. For the diagnosis of the PPD DSM V requires at least five of the following (nine) symptoms:

1. Feelings of sadness, emptiness, or hopelessness, nearly every day, for most of the day or the observation of a depressed mood made by others

2. Loss of interest or pleasure in activities

3. Weight loss or decreased appetite

4. Changes in sleep patterns

5. Feelings of restlessness

6. Loss of energy

7. Feelings of worthlessness or guilt

8. Loss of concentration or increased indecisiveness

9. Recurrent thoughts of death, with or without plans of suicide

2. Cause

The cause of PPD is still not clear. Among the identified risk factors are:

-Hormonal changes (especially drop in hormones such as estrogen and progesterone)

-Genetic factors

-Sleep deprivation

-Anxiety about parenthood. The mother feels unable  caring for the child

-Loss of mother’s autonomy (feeling of loss of control over life)

-Past traumatizing life events

-Personal or family history of depression

-Poor marital relationship or single marital status

-Low socioeconomic status

-Unplanned/unwanted pregnancy

Fathers

Research on postpartum depression have mostly focused on mothers but recently has been found that father can develop also a PPD. There is a positive correlation between maternal postnatal depression and paternal depression, most likely due to factors such as marital satisfaction.  The prevalence of father PPD is lower than in

Mothers

Untreated postpartum depression can last for several months or longer, sometimes evolving into a chronic depressive disorder, which can last for years.

Children

John Bowlby a British psychologist, psychiatrist, and psychoanalyst, known for his interest in child development wrote for World Health Organization a report on the mental health of homeless children in post-war Europe. The result was Maternal Care and Mental Health published in 1951.

His main conclusions was, that “the infant and young child should experience a warm, intimate, and continuous relationship with his mother in which both find satisfaction and enjoyment” and that not to do so may have significant and irreversible mental health consequences.

According to his attachment theory, attachment in infants is primarily a process of proximity seeking to an identified attachment figure.  A carrying and laving parental responses lead to the development of patterns of attachment which will guide the individual’s feelings, thoughts, and expectations in later relationships

Children of mothers who have untreated postpartum depression are more likely to have emotional and behavioral problems, such as eating disorders, depressions, bipolar disorders, personality disorders and will develop more frequently addictions. In their adult live there are more prone to suffer from socio-behavioral problems such as an inability of creating stable relationships and developing successful professional careers.

3. Prevention

– Close monitoring during pregnancy and after childbirth by gynecologist (in case of preexistent depression by psychiatrist) for signs and symptoms of depression. The Edinburgh Postnatal Depression Scale, a standardized self-reported questionnaire, may be used to identify women who have postpartum depression.

– Preparation for the delivery by the gynecologist and with support groups.

– In case of a history of postpartum depression, psychotherapy could be implemented after delivery.

4. Treatment

Psychotherapy: Non-pharmacologic therapy social and psychological interventions appear effective in the treatment of PPD. The evidence based method of treatment is the CBT (Cognitive Behavioral Therapy).

Medication

There is proofed evidence those antidepressants such as for example the selective serotonin reuptake inhibitors (SSRIs) are safe and effective in treatment for PPD.