Childbirth can have a significant impact on a person’s life. Not only does childbearing cause a significant change in one’s hormones, but it can also be a considerable life change. The demands of motherhood can be overwhelming. Needing to wake up for regular feeds can cause sleep deprivation. Also, the immense amount of responsibility that comes with a new baby can impact a mother’s ability to stay connected with social relationships. On top of this, the experience of pregnancy and childbirth can have physical effects, causing lethargy and bodily pain, and overall change in physical appearance. These are typical occurrences after delivering a baby, however, these factors can be exacerbated further if one experiences a traumatic pregnancy and/or labour, if their child has a disability, or if the mother has a history of mental illness.
Since the Covid-19 pandemic, there has been a major shift in how people view mental health. People appear to be a lot more understanding when someone is not coping well mentally, and there appears to be less stigma towards people accessing mental health services. However, this shift appears to not apply to mothers with mental illness. There is still this massive expectation that mothers are ‘not allowed’ to not be okay, and a huge amount of shame surrounding maternal mental illness. Consequently, this limits mothers from engaging in mental health services.
What is postpartum depression (PPD)?
PPD is defined by the Diagnostic and Statistical Manual of Mental Disorders-5 as a Major Depressive Disorder (MDD), with the onset of the most recent episode occurring during pregnancy (prenatal) or within the four weeks after childbirth (postnatal). However, existing research, clinical practice and epidemiological studies report the postpartum period involves 12 months after childbirth.
How common is postpartum depression (PPD)?
Research has estimated 11–20% of new mothers experience minor and 7–14% major depression after the delivery of their baby. PPD not only affects the mother but can also have significant deleterious impacts on the child, with effects ranging from adverse maternal-infant bonding to infanticide and suicide.
How do I know if I have postpartum depression (PPD)?
It is not uncommon for mothers to feel overwhelmed after having a new baby. However, if you have any of the following symptoms of depression for more than 2 weeks, call your doctor, nurse, or midwife:
- Restlessness or moodiness
- Sadness, hopelessness or overwhelm
- Crying more than usual
- Thoughts of harming yourself
- Thoughts of harming your baby
- No energy or motivation
- Eating too much or too little
- Sleeping too much or too little
- No interest in your baby, feeling disconnected from your baby, or feeling like your baby is not yours
- Difficulty making decisions or being able to focus
- Memory problems
- Feelings of worthlessness, guilt, or like a ‘bad mother’
- Loss of interest or pleasure you previously enjoyed
- Withdrawal from friends and family
- Persistent headaches, aches and pains, or stomach problems
What is the difference between ‘baby blues’ and postpartum depression (PPD)?
‘Baby blues’ is not uncommon in the days after childbirth. Baby blues may involve;
- Mood swings
- Sadness, stress or overwhelm
- Crying spells
- Loss of appetite
- Trouble sleeping
Baby blues usually go away in 3 to 5 days after they start. The symptoms of postpartum depression last longer and are more severe. Postpartum depression usually begins within the first month after childbirth, but it can begin during pregnancy or for up to a year after birth.
How does postpartum depression (PPD) differ from major depressive disorder (MDD)?
The treatment of PPD is laden with numerous complexities. Women typically have more severe symptoms of depression and tend to present with comorbid anxiety, as opposed to men. The sex difference in the incidence of depression is greatest during the reproductive years, indicating that sex hormones and reproductive events play some role in the aetiology of depression. This suggests depression within the postpartum period differentiates from depression outside the postpartum period.
What should I do if I have symptoms of postpartum depression (PPD)?
Call your doctor, nurse, midwife, or paediatrician if:
- Your low mood doesn’t improve after 2 weeks
- Symptoms of depression get more intense
- It is difficult to work or get things done at home
- You cannot care for yourself or your baby (e.g., eating, sleeping, bathing)
- You have thoughts about hurting yourself or your baby
Ask your partner or a loved one to call for you if necessary. Your doctor, nurse, or midwife can assess you for depression. They can also refer you to a mental health professional for help and treatment.
What are the treatment options for postpartum depression (PPD)?
The common types of treatment options for postpartum depression are:
- Psychotherapy. Therapy involves talking to a therapist, psychologist, or social worker to learn strategies to manage your depression, helping the way you think, feel, and act.
- Pharmacotherapy. There are different types of medicines for postpartum depression. All medicines must be prescribed by your doctor or nurse. The most common type is antidepressants. Antidepressants can help relieve symptoms of depression and some can be taken while you’re breastfeeding.
- Transcranial Magnetic Stimulation (TMS). TMS is typically used when other depression treatments have not been effective. Transcranial magnetic stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.
- Electroconvulsive therapy (ECT). ECT can be used in severe cases to treat postpartum depression. It is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, to trigger a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.
These treatments can be used separately or in conjunction. Talk with your doctor or nurse about the benefits and risks of these treatments for depression when you are pregnant or breastfeeding.