Postpartum Depression: Symptoms, Types, Risks and Treatment

Postpartum depression is the condition suffered by the women following childbirth, typically arising from a combination of hormonal changes, psychological adjustments to motherhood, and fatigue. It usually starts within four weeks of giving birth and may last up to as long as 12 months. 

Pathophysiology: 

This happens because of a drop in hormones post-delivery. Levels of Estrogen & progesterone, female reproductive hormones increase 10fold during pregnancy. By three days after a woman gives birth, these hormones drop to a pre-pregnancy state. Along with the hormonal changes, even social and psychological factors play a role in postpartum depression. 

Symptoms & Signs:

Symptoms of PPD can be hard to detect as many mothers have these changes normally post childbirth 

• Difficulty sleeping 
• Loss of appetite or overeating 
• Fatigue and lack of energy 
• Loss of pleasure 
• Persistent aches or pains, headaches, and cramps which don't resolve with treatment 
• Feeling of hopelessness, worthlessness & helplessness 
• Persistent sad, anxious, or 'empty' feeling 
• Thoughts of suicide or suicide attempts 
• Thoughts of hurting someone else or the baby 

Types of  Postpartum Depression:

• Baby blues 
• Postpartum depression(PPD) 
• Postpartum psychosis 

"Baby blues" - This is commonly seen in most women on days right after childbirth. The new mom has sudden mood swings, like feeling very happy and then feeling very sad, or may cry for no reason. Baby blues may only last a few hours to 1 to 2 weeks after delivery. And usually, 
no treatment is required. 

• Prevalence is 300-750 per 1000 women. 

PPD - This is a more severe form of baby blues where the feelings are more robust and may make it harder for the new mom to cope with daily activities. This may last from a few days to months; if not treated, the symptoms can worsen. While PPD is a severe condition, it can be treated with some antidepressant medication and counseling.

• Prevalence is 100-150 per 1000 women. 

Postpartum psychosis - is a severe mental illness where women can lose touch with reality, having hallucinations & delusions. These women must be treated immediately and may also 
need hospitalization. 

• Prevalence is 1 to 3 per 1000 women. 

When To Seek Help From Professional?

Untreated postpartum depression can be dangerous to the mother and the baby. Consult your doctor when: 

• Symptoms persist for more than 2weeks 
• Normal functions of the new mom are affected 
• New mom is not able to cope with daily activities 
• They have harmful thoughts 
• They are feeling extremely anxious or scared or panicked most days 

Identifying High-Risk Women:

• History of depression before pregnancy or during pregnancy 
• Age of the new mom - higher incidence in young moms 
• Unplanned pregnancies - before the woman is ready for her transition into a mother 
• Number of children - the more number of children, the more likely the chances of PPD in 
• subsequent pregnancy 
• History of premenstrual dysphoric disorder (severe PMS mood swings) 
• Limited social support 
• Nuclear family/living alone 
• Unresolved Marital conflicts 

Complications: 

• For the new mom: PPD, if not treated, can get worse eventually and may lead to chronic depression. Mother and child bond gets affected. 
• For the father: when the mother is depressed, the father is also more likely to develop depression 
• For the child: children of PPD mothers tend to have sleeping & eating issues, crying more than normal & delays in language development. 

Treatment: 

• Identifying women/mothers who are at high risk for developing PPD 
• Counseling the mother and the family members 
• Encourage breastfeeding 
• Developing strategies on how to help the mother tackle PPD with teamwork (dedicated maternal mental health programs) 
• Antidepressant medication 
• Hormonal therapy, if required