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Postpartum depression (PPD) is a non-psychotic depression that women may experience shortly after childbirth.
PPD is different from the “baby blues,” which begin within the first three or four days of giving birth, require no treatment and lift within a few hours or days. PPD is a deeper depression that lasts much longer. It usually starts within the first month after childbirth (although it can occur any time within the first year) and can last weeks to months. In more serious cases, it can develop into chronic episodes of depression.
Apart from the fact that it happens soon after childbirth, PPD is clinically no different from a depressive episode that occurs at any other time in a woman’s life. PPD symptoms are the same as in general depression and must meet the same criteria for diagnosis. However, not surprisingly, the content of the symptoms of PPD often focuses on motherhood or infant care.
Every woman is different, but these are some of the more common signs and symptoms of PPD:
depressed mood or depression with anxiety
anhedonia, which involves a loss of interest in things that would normally bring pleasure, including the baby
changes in weight or appetite, which may involve gaining or losing weight
sleep disturbance and fatigue—common symptoms of depression but very difficult to gauge, since both are normal for new mothers
physical feelings of being slowed down or restlessness, jumpiness and edginess
excessive feelings of guilt or worthlessness, which can be exacerbated by not bonding with the baby, when feelings of extreme joy, and love are expected
diminished concentration, inability to think clearly, which can be worsened by sleep deprivation
recurrent thoughts of death or suicide. For example, the woman may catch herself thinking that the baby and she are better off dead, or that “the world is such an awful place to bring a new child into that we would be better out of it.”
Signs of depression are often missed in new mothers because significant changes in sleeping patterns, interests, cognitions, energy levels, moods and body weight are a normal part of new motherhood.
New mothers often resist acknowledging these signs even to themselves because of the pressure to meet societal expectations of what it means to be a “good mother,” including how she should be feeling, thinking and behaving.
Although it is not known what causes depression (and therefore PPD), it is believed that there is no single cause. Physical, hormonal, social, psychological and emotional factors may all play a part in triggering the illness. This is known as the biopsychosocial model of depression, and is accepted by most researchers and clinicians. The factor or factors that trigger PPD vary from one woman to another. For example, sleep deprivation resulting from having a new baby can make a woman vulnerable to other factors that trigger depression.
Treatment of PPD is generally the same as that for depression that occurs any other time in a woman’s life. Treatments include psychotherapy, social support and antidepressant medications. PPD if prolonged and untreated is detrimental to the mother’s health and can disrupt family relations, undermine infant-mother attachment and impair the child’s long-term development.
Society’s messages that new motherhood should be a happy time can create barriers for getting help. A new mother may be reluctant to recognize that she needs help with depression or seek treatment because she fears admitting (even to herself) how she is feeling (or not feeling) about her baby.
psychotherapy such as interpersonal and cognitive-behavioural therapy (CBT)
increased social support from friends and family and more emotional support from partners
maternal relaxation or massage
bright light therapy.
Using antidepressants while breastfeeding
Breastfeeding has significant health benefits for the infant and is psychologically important to many mothers. Mothers who take antidepressant medication and who wish to breastfeed may worry about the possible effects of the medication on the baby. Research is inconclusive, but we know that small amounts of the medications do pass into breast milk. Mothers are sometimes advised to wait eight or nine hours after taking antidepressants before breastfeeding.
Will PPD come back again?
Experiencing an episode of depression at any time in life increases the likelihood of experiencing further episodes. Research suggests that the minimum risk of experiencing a non–childbirth-related episode of illness is 25 per cent. The risk of having another postpartum episode may be as high as 40 per cent, with approximately 24 per cent of all recurrences occurring within the first two weeks postpartum.