13 February 2019
- Dr. Fatima Hansrod
Pregnancy and motherhood are thought to be the most beautiful time in a women’s life. Unfortunately for some women it can be marred by anxiety and depression with the women feeling hopeless, helpless and overwhelmed by this new role. The postpartum period is defined as the first twelve months following delivery. Postpartum depression presents like major depressive disorder.
The challenges of having a new baby such as fatigue and poor sleep can mimic depressive symptoms and the differentiation between the two can cause a significant diagnostic challenge. Normal postpartum difficulties or post partum blues consist of mild and self limiting symptoms. With postpartum depression the symptoms can be severe and may need treatment. Depression can effect the functioning of a person and can have negative consequences for both the baby and the mother; therefore early identification and management is essential.
The exact cause of postpartum depression is unknown but it is suspected that genetic factors and hormonal changes post delivery could be the cause of post partum depression. Post partum depression frequently co-occurs with other psychiatric problems such as anxiety or substance abuse.
Symptoms to look out for are low mood, suicidality or self harm, changes in sleep, social withdrawal, guilt, changes in appetite, low energy, poor self care, hopelessness and helplessness. The above occur shortly after delivery and last a minimum of two weeks with some change in functioning. The severity of the illness is based on the severity and number of symptoms preset and the effect that the illness has on the persons functioning.
The risk factors for developing post partum depression are being a single parent, family history of post partum depression, multiparty, physical or sexual abuse, intimate partner violence, an unwanted pregnancy, anxiety related to child birth, poor health, previous depression , antenatal depression, high levels of post natal stress, poor social and financial support, young age, body image dissatisfaction, certain personality traits, perinatal anxiety, winter births, sleep difficulties, adverse pregnancy outcome, post partum blues, breastfeeding difficulties and childcare difficulties.
The impact of postnatal depression on the newborn are poor bonding with the mother, failure to thrive, harm or neglect of the child and neurodevelopmental abnormalities. The impact of untreated postnatal depression in the mother is poor bonding with infant, poor self care and suicidality or self harm.
The course of postpartum depression varies in severity and the symptoms may resolve spontaneously or require active management. The management of post partum depression requires identification of symptoms and a team approach with monitoring of both baby and mother. Simple measures such as improved self care (bathing, sleeping and eating) and improved social support may improve the person’s mental health. Psychological management in the form of supportive therapy, interpersonal therapy and cognitive behavior therapy may be the sole form of treatment or can be used in conjunction with pharmacotherapy; depending on the severity of the depressive symptoms. Patients with moderate to severe depressive symptoms or patients who are high risk may require the use of an anti depressant. Certain serotonin reuptake inhibitors are relatively safe in pregnancy and breastfeeding.
The impact of management on the baby and mother are decreased risk with regard to harm, improved ability to function and improved bonding. If medication is required, the risk and benefits need to be weighed as certain medications can negatively impact the baby or fetus.
The key take home message of this article is early identification and appropriate management of depressive symptoms.