Post partum depression is a highly under reported condition that affects many women across the world. Who have undergone childbirth. post refers to after and partum refers to a latin word that means birth. “during the 1st week after childbirth,many women(upto 85%)experiences a brief period of mood symptoms and anxiety mostly due to exertion,loss of sleep. about 10 to 15% of women however experiences more significant mood symptoms in the post partum period , called post partum depression.
Signs and symptoms: Post natal depression is by far the most widely discussed perinatal mood disorder. Defining as arising in or persisting into, the first postnatal year.it presents similarly to depression at other times. while most mothers suffer from being is emotionally low after childbirth. Extended periods of depression should be looked into.The depression can begin at any time between delivery and six months or even a year. In more severe forms the women may express suicidal thoughts.It is usually characterized by
- low mood,
- tearfulness,
- emotional lability,
- fatigue,
- excessive anxiety,
- attachment difficulties and
- withdrawal from social events
. Main reasons: Although the precise cause of post partum depression is unclear many scientifical studies point that it is linked to the hormonal fluctuation that a woman experiences after childbirth. number one is
.blame it on your hormones: During pregnancy the levels of female hormones estrogen and progesterone increase upto 10 folds.within the 1st 48 hours after delivery this hormone level decline dramatically. Research suggest a connection between rapidly declining hormone levels and the appearencec of symptoms of PPD.other hormones such as prolactin (levels of which are lower at the time of delivery but begin to raise sharply in the 1st week following delivery) and changes in blood levels of cortisol and aldosterone have also been implicated in PPD.
Why does postnatal depression matter ?
Its effects on mother
1. psychiatric illness was the most common cause of indirect deaths and the largest cause of maternal deaths overall in the last CEMACH report(why mothers die 2000—2002)
2. it is reasonable to speculate that a tremendous amount of damage was also present in families where the woman did not die,but made a failed attempt at suicide.
3. although symptoms of depression may remit spontaneously,or respond to counselling ,about 1/3 rd of women will remain depressed and need further treatment.
4. untreated depression may contribute to the development of a chronic refractory mood disorder in the mother, a potentially negative influence on the marital relationship with the possibility of contributing to raised rates of separation in couples. This will also have a negative impact on the baby or othe siblings.
5. difficulties are often concealed.this may be due to cultural attitudes to mental health problems.women fear the label and what they perceive as the stigma:they are afraid that they will be seen as a bad mother and the baby will be taken away. The disease process itself makes people feel isolated and not want to relate to anyone including health professionals.
Impact on the child
This is one area of research in which there is good evidence that postnatal depression particularly if moderate or severe can have long lasting negative effects on any children in the family,with new infant being particularly at risk. There appear to be both short and long term effect.
Short term
1. Infants are often reported as being of more difficult temperament by their mothers(although this may be because the mothers are themselves not coping well and giving poor feedback emotionally to the children,who then behave in a more difficult fashion in order to gain attention.
2. less sensitive mother-infant interactions are seen,leading to insecure attachment pattern
3. one study has even reported PPD to be a risk factor of sudden death syndrome(SIDS)
Long term
1. A number of researchers have found adverse effects persisting for sometime,and this effect appears to be more marked for boys.
2. Sinclair and murray found PPD to be associated with significantly raised levels of child disturbance at the age of 5 years ,specially in boys.
3. another group of researchers has been following a cohort of 149 women recruited at 3 months post partum. 132 of their chidren was followed upto the age of 11 years.children of women depressed at 3 months were found to have significantly lower IQ scores, more attention problems and difficulties in mathematical reasoning and were more likely to have special educational needs. Boys were more severely affected than girls.
4. finally a meta analysis conducted by Beck concluded that post partum depression had a small but significant effect on children’s cognitive and emotional development.for all these reasons identification and active treatment of women experiencing post natal depression is important.
Management :
Treating it right: “ the 1st step is medical evaluation by a physician or psychiatrist to rule out presence of other illnesses”. counselling and psychotherapy can help women identify factors that may be causing depression. Counselling along with participation in a support group is recommended.however care should be exercised before putting breast feeding mothers on medication.the most commonly used treatments for depression are antidepressants ,psychotherapy or a combination of two.which of these is the right treatment for an individual depends on the nature and severity of the case.
