Postpartum depression (PPD) is a serious mood disorder that not only impacts the mother but can have an impact on the baby as well. Early identification and treatment of postpartum depression are critical to reducing the impact on both mother and baby.
There isn’t 100% agreement on how to define the postpartum period, but a common consensus is that it refers to the first twelve months after delivery. Depression is one of the most common complications associated with childbirth.
The prevalence of postpartum depression is in the range of 10 to 15%. The prevalence rate is even higher in low to middle-income countries. Unfortunately, depression in the postpartum period commonly goes undetected and untreated.
What causes postpartum depression?
Postpartum depression can start after the baby is born, but in some women, it doesn’t emerge for a few months after delivery. Most women begin to have symptoms by the time the baby is two months old.
Several risk factors increase the chances that a woman will develop postpartum depression. The strongest risk factor is a history of previous depression, whether it also occurred in the postpartum period or at another time. There are several other risk factors for postpartum depression, including age under 25 or over 35, family history of PPD, poor physical health, an unexpected or unwanted pregnancy, and being a victim of intimate partner violence. Gestational diabetes increases the chances of depression developing in the postpartum period, as does obesity.
There is substantial evidence that “adverse life events” increase the risk of developing depression during the postpartum period. For example, a history of physical or sexual abuse during childhood is a risk factor for PPD. Other adverse life events that increase the risk of postpartum depression include military deployment, discrimination, financial hardship, divorce, and natural disasters.
If a delivery has had a poor outcome, such as a stillbirth or neonatal death, the risk of postpartum depression also goes up. The same is true if the baby is consistently very difficult to soothe (e.g., colic) or if the mother has a tendency to over-worry about the baby.
The cause of postpartum depression is multifactorial. Factors thought to contribute to the onset of this mental health condition include genetics, hormones, stressful life events, social challenge, and psychological issues such as a tendency to be anxious.
The drops in estrogen and progesterone that occur at delivery are thought to influence mood in the postpartum period. Increased stress hormones levels may play a role in triggering depression in women with newborn babies. The role of inflammation in PPD is of great interest to researchers in the field.
Researchers are looking into the possibility that diet and nutritional supplements impact rates of depression in the postpartum period. For example, there is some evidence that vitamin D deficiency increases the risk of depression developing in the postpartum period.
Low mood, an inability to enjoy things in life, low self-esteem, difficulty with concentration, and feelings of guilt can all be part of a depressive episode associated with having a baby. The severity of this condition can range from mild to severe. Severe cases are often characterized by symptoms that onset before delivery and include significant anxiety. Serious delivery complications increase the risk of severe postpartum depression.
Postpartum depression symptoms
Most women who experience depression after delivery have other mental health symptoms. Anxiety is the most common co-morbidity, but eating disorders, obsessive-compulsive disorder, PTSD, and substance use disorders can also accompany postpartum depression.
A mother with depression may not specifically complain of low mood when speaking to her doctor. Instead, her mood disorder may present as a lack of interest in her baby, a failure to attend post-natal appointments, fears of being a bad mother, and a negative opinion of the infant. (e.g., seeing the child as attention-seeking or deliberately defiant).
In rare cases, depression in the first year after delivery results in suicide or infanticide. These tragic outcomes are two of the reasons that detecting depression in the postpartum period is critical. The presence of psychotic symptoms, such as paranoid delusions, in PPD increases the risk of violence.
Other important, but less severe, consequences of postpartum depression include lower rates of breastfeeding, difficulty with bonding between mother and baby, reduced rates of vaccination in the infant, and marital conflict. Some depressed mothers may interact less with their babies, which can negatively impact child development.
Between a third and a half of women with postpartum depression will still be symptomatic twelve months after delivery. There is also a 40 to 50% risk that women with PPD will become depressed after their next baby is born.
Postpartum depression treatment and therapy
For mothers who experience mild to moderate depression in the first year of their baby’s life, the first-line treatment is psychotherapy. For example, cognitive behavioral therapy and interpersonal therapy are both used to treat PPD. Therapy can help women adjust to parenthood as well as improve marital relationships.
If therapy is not available or if the mother prefers to take medication, antidepressants can also be used to treat mild to moderate PPD. Exercise and acupuncture can be beneficial to some women with postpartum depression.
In the case of severe postpartum depression, antidepressants are the recommended treatment in most cases. Mothers who take antidepressants can often continue to breastfeed but need to discuss this issue with their treating physician. Electroconvulsive therapy (ECT) is a treatment option for severe or treatment-refractory PPD. For example, ECT may be used to address acute suicidality and strong urges to harm the baby.
Postpartum depression is a condition that contributes to both morbidity and mortality in mothers and their babies. As such, it is crucial to detect and treat this condition as early as possible. Doctors can easily screen for PPD during post-natal visits and implement the necessary treatment. From a public health perspective, ensuring that women have sufficient social support and financial resources in the postpartum period is critical. Both interventions would go a long way towards helping lower the rates of PPD and improve health outcomes for both women and children.