Post partum depression

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Postpartum depression is a mood disorder that begins after childbirth and usually lasts beyond six weeks.

The onset of postpartum depression tends to be gradual and may persist for many months, or develop into a second bout following a subsequent pregnancy. Postpartum depression affects approximately 15% of all childbearing women. Mild to moderate cases are sometimes unrecognized by women themselves. Many women feel ashamed if they are not coping and so may conceal their difficulties. This is a serious problem that disrupts women's lives and can have effects on the baby, other children, her partner, and other relationships. Levels of depression for fathers also increase significantly.

Postpartum depression is often divided into two types: early onset and late onset. An early onset most often seems like the "blues," a mild brief experience during the first days or weeks after birth. During the first week after the birth up to 80% of mothers will experience the "baby blues." This is usually a time of extra sensitivity and symptoms include tearfulness, irritability, anxiety, and mood changes, which tend to peak between three to five days after childbirth. The symptoms normally disappear within two weeks without requiring specific treatment apart from understanding, support, skills and practice. In short, some depression, tiredness, and anxiety may fall within the "normal" range of reactions to giving birth.

A late onset appears several weeks after the birth. This involves a slowly growing feeling of sadness, depression, lack of energy, chronic tiredness, inability to sleep, change in appetite, significant weight loss or gain, and difficulty caring for the baby.

Causes and symptoms

At the present, experts cannot say what causes postpartum depression. Most likely, it is caused by many factors that vary from individual to individual. Mothers commonly experience some degree of depression during the first weeks after birth. Pregnancy and birth are accompanied by sudden hormonal changes that affect emotions. Additionally, the 24-hour responsibility for a newborn infant represents a major psychological and lifestyle adjustment for most mothers, even after the first child. These physical and emotional stresses are usually accompanied by inadequate rest until the baby's routine stabilizes, so fatigue and depression are not unusual.

The experience of post partum depression varies considerably but usually includes symptoms that into these general categories:

Feelings:

  • Persistent low mood
  • Inadequacy, failure, hopelessness, helplessness
  • Exhaustion, emptiness, sadness, tearfulness
  • Guilt, shame, worthlessness
  • Confusion, anxiety, and panic
  • Fear for the baby and of the baby
  • Fear of being alone or going out.

Behaviors:

  • Lack of interest or pleasure in usual activities
  • Insomnia or excessive sleep, nightmares
  • Not eating or overeating
  • Decreased energy and motivation
  • Withdrawal from social contact
  • Poor self-care
  • Inability to cope with routine tasks.

Thoughts:

  • Inability to think clearly and make decisions
  • Lack of concentration and poor memory
  • Running away from everything
  • Fear of being rejected by partner
  • Worry about harm or death to partner or baby
  • Ideas about suicide.

Some symptoms may not indicate a severe problem. However, persistent low mood or loss of interest or pleasure in activities, along with four other symptoms occurring together for a period of at least two weeks, indicate clinical depression, and require adequate treatment.

Risk Factors

There are several important risk factors for postpartum depression, including:

  • Stress
  • Lack of sleep
  • Poor nutrition
  • Lack of support from one's partner, family or friends
  • Family history of depression
  • Labor/delivery complications for mother or baby
  • Premature or post mature delivery
  • Problems with the baby's health
  • Separation of mother and baby
  • A difficult baby (temperament, feeding, sleeping, settling problems)
  • Preexisting neurosis or psychosis

Diagnosis and Treatment

There is no diagnostic test for postpartum depression. However, it is important to understand that it is, nonetheless, a real illness, and like a physical ailment, it has specific symptoms.

Several treatment options exist, including medication, psychotherapy, counseling, and group treatment and support strategies, depending on the woman's needs. One effective treatment combines antidepressant medication and psychotherapy. These types of medication are often effective when used for 3-4 weeks.

Any medication use must be carefully considered if the woman are breast-feeding, but with some medications, continuing breast-feeding is safe. Nevertheless, medication alone is never sufficient and should always be accompanied by counseling or other support services.

Alternative treatment

Postpartum depression can be effectively alleviated through counseling and support groups, so that the mother doesn't feel she is alone in her feelings. Constitutional homeopathy can be the most effective treatment of the alternative therapies because it acts on the emotional level where postpartum depression is felt. Acupuncture, Chinese herbs, and western herbs can all help the mother suffering from postpartum depression come back to a state of balance. Seeking help from a practitioner allows the new mother to feel supported and cared for and allows for more effective treatment.

A new mother also should remember that this time of stress does not last forever. In addition, there are useful things she can do for herself, including:

  • Valuing her role as a mother and trusting her own judgment.
  • Making each day as simple as possible.
  • Avoiding extra pressures or unnecessary tasks.
  • Trying to involve her partner more in the care of the baby from the beginning.
  • Discussing with her partner how both can share the household chores and responsibilities.
  • Scheduling frequent outings, such as walks and short visits with friends.
  • Having the baby sleep in a separate room so she sleep more restfully.
  • Sharing her feelings with her partner or a friend who is a good listener.
  • Talking with other mothers to help keep problems in perspective.
  • Trying to sleep or rest when the baby is sleeping.
  • Taking care of her health and well-being.
  • Not losing her sense of humor.

Prognosis:

With support from friends and family, mild postpartum depression usually disappears quickly. If depression becomes severe, a mother cannot care for herself and the baby, and in rare cases, hospitalization may be necessary. Yet, medication, counseling, and support from others usually cure even severe depression in 3-6 months.

Prevention

Exercise can help enhance a new mother's emotional well-being. New mothers should also try to cultivate good sleeping habits and learn to rest when they feel physically or emotionally tired. It's important for a woman to learn to recognize her own warning signs of fatigue respond to them by taking a break.

Photo by John Nyboer

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