A guide on postpartum depression: What’s normal, when to seek help, how to cope

What is postpartum depression?

According to the American Psychiatric Association, up to 1 in 7 women may experience postpartum depression; unlike baby blues, it doesn’t usually go away on its own without treatment. 

What causes postpartum depression/baby blues?

Baby blues can be common (up to 70% of all new mothers) and usually manifest in women feeling a little down, tearful or anxious in the first 1-2 weeks of giving birth; these symptoms typically resolve on their own, and usually do not interfere with your ability to carry out daily activities. 

If symptoms start later or last longer, there is a possibility that you may be having postpartum depression rather than a simple case of baby blues. Women with PPD may face significant impedance and difficulty in going about their daily lives. 

What are the signs of postnatal depression?

Symptoms of postpartum depression vary between individuals but can include one or more of the following: 

• Appetite changes (either eating more or less than usual) 
• Loss of interest in things previously enjoyed, or in the baby
• Anxiety
• Panic attacks 
• Difficulty concentrating 
• Feeling of guilt or worthlessness
• Mood changes including irritability, anger, sadness, crying 
• Insomnia, or sleeping too much 
• Fear of not being a good mother or being left alone with the baby 
• Feeling tired all the time
• Withdrawing from social interactions with others 
• Difficulty bonding with the baby 
• Thoughts of self-harm or harming the baby (this requires immediate help) 

If the fore-mentioned symptoms are severe or last longer than 2 weeks, you should seek help. Remember, seeking help is NOT a sign of weakness - it is not your fault and you should not perceive yourself as a bad parent. 

What’s the difference between postpartum depression and postpartum psychosis? 

Postpartum psychosis is rare, occuring in 1-2 every 1000 deliveries[1], but extremely serious, requiring immediate medical attention. 

Symptoms of postpartum psychosis are more extreme than depression and may include: 

• Agitation
• Delusions
• Rapidly changing moods
• Auditory hallucinations
• Extreme paranoia

In some cases, women with postpartum psychosis may have a personal or family background of bipolar disorder or schizophrenia, or may have developed it following a previous pregnancy. 

How soon does PPD start, and how long does it last? 

PPD can appear days or months after childbirth, and can last for weeks, months or more if untreated. 

What puts a woman at a higher risk of PPD?

Although PPD can affect any woman, there are some women who can be at increased risk of developing PPD. These include:

• Personal or family history of depression, anxiety or mental disorders 
• Women who had antenatal depression (or depression in pregnancy) 
• Women who are isolated or lack social support networks 
• Women who underwent difficult or traumatic pregnancy/childbirth, or have a challenging baby or a baby with special needs 
• Women with other stressors e.g. family/financial issues, domestic violence etc. 
• Rapid fluctuations in hormone levels during pregnancy or after delivery 

Is postpartum depression curable, and is medication needed? 

Yes, postpartum depression is curable with proper treatment. It is important to seek treatment as  children of mothers with postpartum depression who are untreated are at greater risk of cognitive, emotional, developmental deficits and impaired social skills[2]. 

The first line therapy for PPD generally includes psychotherapy if the depression is mild; if the depression or anxiety is severe, medications are usually required - these should be instituted together with lifestyle modifications within a supportive social network. 

Support groups, exercise, carving out time for yourself and eating healthily can also go a long way in helping you overcome postpartum depression. 

Should I see a therapist or OBGYN for postnatal depression? 

If you suspect that you may be suffering from postpartum depression, you should contact any medical professional - be it your ObGyn, your general practitioner or a therapist to seek help early. Prompt assessment is important and referrals can then be made to a psychologist, psychiatrist or mental health professional. Remember - you are not alone! 

How can you prevent PPD? 

There is no proven way to prevent PPD - even women who had smooth sailing pregnancies and deliveries with great social support networks can develop PPD. With greater awareness, however, you and your partner can be on the lookout to ensure early recognition of the symptoms of PPD so that prompt help and treatment can be sought. 

References 

1. VanderKruik, R., Barreix, M., Chou, D., Allen, T., Say, L., Cohen, L. S., & Maternal Morbidity Working Group (2017). The global prevalence of postpartum psychosis: a systematic review. BMC psychiatry, 17(1), 272. https://doi.org/10.1186/s12888-017-1427-7
2. Field T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant behavior & development, 33(1), 1–6. https://doi.org/10.1016/j.infbeh.2009.10.005