POSTPARTUM DEPRESSION: SYMPTOMS, CAUSES, RISKS, TYPES, TESTS, AND TREATMENT OPTIONS IN 2023

The journey of becoming a new parent is filled with countless joys, challenges, and uncertainties. Among these, postpartum depression is a common concern for many new parents. But what exactly is postpartum depression, and how can it be identified and treated? In this blog post, we'll explore the different aspects of postpartum depression, including its symptoms, causes, types, and various treatment options. By understanding this complex condition, we can work together to support and empower new parents on their journey to happy and healthy parenthood.

Understanding Postpartum Depression

Postpartum depression (PPD) is a serious mood disorder characterised by severe mood swings following giving birth. It can affect as many as 1 in 7 mothers. Although it shares some similarities with major depression, postpartum depression is distinct as it specifically occurs after giving birth and usually lasts for a shorter period than major depression. It's essential to recognise and address this condition, as untreated postpartum depression can have lasting consequences on the well-being of both the parent and the child.

Individuals often experience a wide range of emotions after giving birth. These can vary from joy and excitement to anxiety and fear, sometimes even depression. These mood swings are quite common, with most new moms experiencing a form of baby blues lasting for 2-3 days, up to 2 weeks post-birth. However, new mothers still experiencing depressive symptoms beyond this period most likely have a more serious case of postpartum depression.

Various factors contribute to postpartum depression, including genetic predispositions, hormonal changes, and environmental stressors. Healthcare providers must be aware of these risk factors to provide appropriate care and support for those experiencing postpartum depression.

Recognising the Symptoms

Recognising the symptoms of postpartum depression is the first step towards seeking help and treatment. These symptoms can manifest within the initial few weeks following childbirth, though they may start as early as during pregnancy or as late as a year after delivery. Symptoms can include:

• Feelings of extreme sadness, worthlessness, hopelessness, or guilt.

• Anxiety or excessive worry.

• Exhaustion or difficulty sleeping.

• Changes in appetite or eating difficulties.

• Loss of energy and motivation.

• Reduced interest in hobbies or things you once enjoyed.

• Lack of interest in your baby.

• Thoughts of suicide or self-harm.

• Thoughts of harming your baby or feeling like you don't want your baby.

If you or someone you know is experiencing these symptoms, reaching out to a healthcare provider for support and guidance is essential. It's important to differentiate between postpartum depression, bipolar disorder, and other mood disorders that can occur after childbirth, such as baby blues and postpartum psychosis. Understanding these distinctions can help individuals and healthcare providers make informed decisions about the best course of action to address the specific needs of the parent and child.

Causes and Risk Factors

Postpartum depression is believed to be caused by a complex interplay of many factors. These include:

Family History and Mental Health

Family history plays a significant role in postpartum depression, with studies indicating that mothers with a family history of psychiatric disorders have a heightened risk of developing the condition compared to those without such a history. A personal or family history of the following factors has been associated with the onset of postpartum depression:

• Depression and anxiety
• Premenstrual syndrome (PMS)
• Negative attitude towards the baby
• The reluctance of the baby's gender
• History of sexual abuse

Healthcare providers must consider personal risk factors, including family history, when assessing and providing care for women experiencing postpartum depression. By taking these factors into account, healthcare providers can offer targeted interventions and support to help new parents navigate the challenges of this condition.

Hormonal and physical changes

After giving birth, women experience a massive drop in hormones involved in pregnancy, estrogen, progesterone, and other thyroid hormones. This quick drop may lead to feelings of tiredness, lethargy, and depression.

Physical changes to the body throughout pregnancy can be distressing to the individual. After months of getting used to these changes, individuals must now adapt to new changes to their bodies as they recover from giving birth. The shift to losing the pregnancy bump, discovering new stretch marks and scars on the body, recovering from potential stitches given after birth, and many more novelties on the body can be overwhelming for individuals. This, in combination with the many hormonal changes people experiences after giving birth, may cause feelings of depression.

Emotional issues

Sleep deprivation, being overwhelmed, and feeling anxious can also contribute towards developing either baby blues or more long-term postpartum depression.

Individuals may also experience difficulty with their new identity as a parent or feel as though they are unequipped or not competent enough to care for their child. These personal concerns or identity conflicts can also contribute to postpartum depression.

Social and Lifestyle Factors

Support systems and social networks act as protective factors against depression and other mental disorders. New parents who benefit from different forms of social support are thus more protected against postpartum depression. However, not everyone is fortunate enough to benefit from social support. Some factors that may contribute to the onset of postpartum depression include:

• Relationship issues with a spouse or other family members.
• Domestic violence, such as spousal sexual, physical, and/or verbal abuse.
• Financial strain.
• Cultural influences.
• Unplanned or unwanted pregnancy.
• Difficulty breastfeeding.
• Learning that your newborn has a health condition or special needs.

By addressing these social and lifestyle factors, healthcare providers can offer targeted interventions and support to help new parents navigate the challenges of postpartum depression. Some strategies to consider include the following:

• Building a solid support network.
• Practising self-care.
• Seeking therapy or counselling.
• Engaging in regular physical activity.
• Getting enough sleep.
• Eating a healthy diet.
• Avoiding alcohol and drugs.

In some cultures, individuals who have just given birth are well attended to and supported in various ways (i.e. help with childcare, cooking, cleaning, etc.). The physical and psychological support that individuals in these collectivistic communities benefit from has been shown to help lower rates of postpartum depression.

Understanding these risk factors is vital in providing appropriate care and support for individuals experiencing postpartum depression, as they may be at an increased risk. By addressing these risk factors, healthcare providers can offer targeted interventions and support to help new parents navigate the challenges of postpartum depression.

Types of Postpartum Mood Disorders

In addition to postpartum depression, other types of postpartum mood disorders can affect new parents. These include postpartum blues, postpartum mood and anxiety disorder, and postpartum psychosis. Although each of these conditions presents with different symptoms and severity, they all require attention, understanding, and appropriate interventions to ensure the well-being of both the parent and the child.

Baby Blues

Baby blues, also known as postpartum dysphoria or postpartum dysphoric syndrome, is a milder manifestation of postpartum depression that affects up to 80% of new mothers. Symptoms of baby blues may include feelings of unhappiness and tearfulness, which usually begin within the first few days after delivery and dissipate without medical treatment within a few days or up to two weeks. While baby blues can be an emotional challenge for new mothers, it's important to recognise that this condition is distinct from postpartum depression and generally resolves independently. Postpartum depression, on the other hand, is a more intense and enduring form of depression that can impact daily activities and the ability to care for the infant. Common symptoms of baby blues include:

• Frequently crying, often without reason.
• Not feeling like yourself.
• Feeling nervous around your baby.
• Feeling very tired.
• Having trouble falling asleep and/or staying asleep.
• Difficulty thinking clearly.
• Feeling that nothing will be the same again.

When symptoms persist beyond the initial two weeks or interfere with daily functioning, it's crucial to reach out to a healthcare provider for help addressing postpartum depression.

Postpartum mood and anxiety disorder

Postpartum mood and anxiety disorder refer to the distressing feelings an individual experiences during pregnancy (perinatal) and the first year after pregnancy (postpartum). While it is common to experience feelings of anxiety and nervousness surrounding becoming a new mother, what distinguishes regular nervousness from a mood and anxiety disorder is its severity. Individuals with mood and anxiety disorder typically feel as though they have no control over their thoughts and feel they are interfering with their lives. Moreover, individuals tend to experience excessive feelings of worry throughout the day and night, beyond the normal levels of anxiousness that new parents experience. Other symptoms of postpartum mood and anxiety disorder include:

• Chronic feelings of guilt or worthlessness.
• Profound feelings of failure as a parent.
• Loss of interest in activities that are usually enjoyable.
• Intense feelings of despair that interfere with daily responsibilities and self-care (i.e. eating, sleeping).
• Panic and anxiety attacks.
• Thoughts of harming self or their baby.
• Withdrawing from partner and/or other close relationships.
• Difficulties in bonding with the baby as a result of these symptoms.

Postpartum Psychosis

Postpartum psychosis is a rare but serious mental health condition that affects up to 1 in 1,000 new mothers. This condition typically manifests within the first-week post-delivery and may result in potentially life-threatening thoughts or behaviors. Signs of postpartum psychosis may include:

• Intense agitation
• Disorientation
• Feelings of despair and humiliation
• Lack of sleep
• Suspicion
• Delusions or hallucinations
• Hyperactivity
• Rapid speech
• Mania

Individuals with bipolar disorders or schizoaffective disorders are at an increased risk of experiencing postpartum psychosis.

Due to the heightened risk of suicide and potential harm to the baby, immediate medical attention from a mental health provider is necessary for postpartum psychosis. Hospitalisation may be required as part of the treatment plan. Psychotherapy and medications may also be recommended.

Understanding the different types of postpartum mood disorders can help individuals and healthcare providers make informed decisions about the best course of action to address the specific needs of the parent and child. By recognising and addressing these conditions, new parents can receive the support they need to navigate postpartum mental health challenges.

Diagnosis and Screening

Postpartum depression can be diagnosed by assessing depressive symptoms using different diagnostic tools, such as the Edinburgh Postnatal Depression Scale (EPDS) and referring to the Diagnostic and Statistical Manual for diagnostic requirements. The EPDS is a 10-item questionnaire designed to detect postpartum depression. By inquiring about symptoms of depression, such as feeling unhappy, anxious, or guilty, the EPDS can help healthcare providers identify individuals at risk for postpartum depression and differentiate it from a chronic depressive disorder.

It is recommended to screen for postpartum depression in mothers 2 to 6 months following childbirth. Early diagnosis and intervention can play a crucial role in managing postpartum depression and promoting the well-being of both the parent and the child. It is, therefore, important for new parents to be forthright with their healthcare providers to ensure that they receive an accurate representation of their feelings and experiences.

Treatment Options

Various treatment options exist for postpartum depression, such as anti-anxiety or antidepressant medications, psychotherapy, and support group involvement.

Pharmacological treatment

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are typically recommended as the initial treatment for postpartum depression. They have been found to be an effective treatment for postpartum depression as they can help reduce symptoms and improve movement. However, it is important to consult a healthcare provider before starting any medication, as they can help determine the most appropriate treatment plan based on individual needs and circumstances.

Antidepressants and Breastfeeding

Breastfeeding mothers often have concerns about the safety of taking antidepressants while nursing their infants. Although medications may be transferred to the baby through breast milk, many antidepressant medicines are considered safe during lactation. It is important to discuss the risks and benefits of taking an antidepressant with your healthcare provider while breastfeeding to ensure the most appropriate treatment plan for both you and your baby. By working closely with healthcare providers, breastfeeding mothers can receive the support they need to manage postpartum depression while ensuring the well-being of their infants.

Psychotherapy and Support Groups

In addition to medication, psychotherapy and support groups can effectively treat postpartum depression. Psychotherapy is essential to postpartum depression treatment, with research indicating that it is more effective than medication. Cognitive-behavioural therapy (CBT) and interpersonal therapy (IPT) are two psychotherapeutic approaches that can be used to address the underlying causes of depression, build coping skills, and enhance overall well-being. Psychotherapy provides a secure and supportive environment for individuals to express their emotions and concerns.

Support groups can offer a secure and encouraging atmosphere for individuals to share their experiences and emotions, learn coping tactics, and build a reliable support system. They can also help alleviate isolation and provide a sense of community. By participating in therapy and support groups, individuals with postpartum depression can receive the emotional support and guidance they need to navigate the challenges of this condition.

Coping Strategies and Prevention

While it may not be possible to prevent postpartum depression completely, some strategies can help manage and reduce the risk of developing the condition. Consult your healthcare provider and practice self-care techniques in order to manage postpartum depression effectively. By taking proactive steps to address potential risk factors and engage in healthy coping strategies, new parents can build a strong foundation for happy and healthy parenthood.

In addition to seeking professional help, new parents must prioritise their well-being and engage in self-care activities. This can include ensuring adequate rest, maintaining a healthy lifestyle, and delegating tasks whenever possible. By focusing on self-care and stress management, new parents can foster resilience and a sense of hope in their journey through parenthood.

Self-Care and Stress Management

Emphasising self-care and stress management is crucial in coping with and preventing postpartum depression. Adequate rest, a nutritious diet, regular exercise, and engaging in enjoyable activities can all contribute to a healthier mental state. By prioritising self-care and managing stress, new parents can better navigate the challenges of postpartum depression and promote overall well-being.

Building a Support Network

In addition to personal self-care practices, building a strong support network can also play a significant role in managing postpartum depression. Connecting with family and friends, participating in support groups, and obtaining professional assistance can help alleviate feelings of isolation and provide a sense of community.

A strong support network is essential for navigating the challenges of postpartum depression. By connecting with family, friends, or support groups, new parents can access emotional support, validation, assurance, and resources and information to help them cope with their condition. A support network can also help decrease feelings of isolation and provide a sense of community, empowering new parents to face the challenges of postpartum depression with confidence and hope.

To build a support network, consider reaching out to loved ones, joining a support group, or seeking professional help. These connections can provide emotional and practical assistance, helping new parents feel less alone in their struggles and better equipped to manage postpartum depression.

By investing in self-care and fostering a strong support network, new parents can build a solid foundation for their emotional well-being, cultivate resilience, and create a nurturing environment for their growing family.

Impact on Family and Relationships

Untreated postpartum depression and its subtypes can all have lasting consequences on family dynamics, relationships, and infant development. Parents who are depressed and anxious tend to smile less, talk less, and are less likely to engage with their newborns throughout their first year of life - all of which are essential for mother-infant bonding, which promotes healthy child development. As a result, children of depressed or anxious parents may experience behavioural and emotional difficulties, delays in language development, sleeping issues, and feeding issues. Moreover, individuals who lack parental attention and support throughout childhood may become depressed or anxious later in life.

Addressing postpartum depression is crucial not only for the parent's well-being but also for the child's healthy development. By seeking treatment and support, new parents can foster a nurturing environment that promotes the growth, development, and emotional well-being of both themselves and their children.

Postpartum Depression in Fathers

Postpartum depression can also affect new fathers, though it often goes unrecognised and undiagnosed. Symptoms of paternal postpartum depression can include:

• Sadness
• Fatigue
• Feeling overwhelmed
• Anxiety
• Alterations in eating and sleeping habits

Being young, having a history of depression, experiencing relationship problems, and struggling financially are some of the primary risk factors for postpartum depression in fathers. Other common factors include:

• Partner's depression. Individuals with depressed partners often end up showing signs of depression as well.
• Feeling disconnected. Mothers and their newborns have this natural, intense physical bond. Mothers can sometimes get so caught up in bonding with their baby that they may not realise the other parent may feel left out.
• Low levels of testosterone. Research has shown that throughout their partner's pregnancy, fathers also experience hormonal changes. More specifically, these men experience drops in their testosterone levels, which is known to lead to symptoms of depression.
• Sleep deprivation. Sleep plays a significant role in emotion regulation, among other things, and is a protective factor against mental health conditions like depression. As most new parents are juggling new routines and sleep schedules with their newborns, they are inevitably sleep-deprived, making them more susceptible to experiencing symptoms of depression.
• Adjustment to parenthood. Coupled with all other factors, the psychological adjustment to one's new identity or role can be daunting. As a result, parents lacking adequate social support may feel a certain ineptitude in successfully taking on their new role as a parent, which can contribute to feelings of depression and anxiety.

It's essential for both mothers and fathers to be aware of the potential for postpartum depression and to seek help if they experience any symptoms. By addressing postpartum depression in both parents, families can work together to create a nurturing and supportive environment for their growing family.

Postpartum depression is a complex and multifaceted condition that affects many new parents and is not simply caused by thoughts, feelings, or actions. Like other forms of depression, postpartum depression is not a choice and has nothing to do with the love one has for their child or their ability to be a parent.

By understanding its symptoms, causes, types, and treatment options, we can better support and empower those struggling with this condition. Through early diagnosis, appropriate interventions, and a strong support network, new parents can navigate the challenges of postpartum depression and build a solid foundation for a happy and healthy family life.

The Kusnacht Practice is equipped to treat postpartum depression and ensures health and care excellence, providing an array of specialised mental health therapies and treatments suited to each individual with Psychotherapeutic care, Medical treatment and care, Biomolecular Restoration (BIO-R®) and Family systems therapy. Our psychiatric and medical teams are dedicated to your well-being, providing personalised therapies tailored to your individual needs and goals. Whether it be to help manage symptoms of postpartum depression or other mental health concerns, our team is there to support you.

Remember, you are not alone in this journey, and with the right help and support, you can overcome the challenges of postpartum depression and embrace the joys of parenthood.

Get in touch with us to find out how we can help.