Published: Tuesday, May 7, 2013

INTERPRETER OF MALADIES

Postpartum depression

By Nighat Ara, Psychiatrist, Counsellor and Therapist

A spectrum of mental conditions can occur in the postpartum period and depression is one of the most common ones. The onset of an episode of depression within the first four weeks of delivery is referred to as postpartum depression. An estimated 10-40 per cent of all women tend to suffer from it. A milder condition, known as “Postpartum Blues”, is however more common than a full blown postpartum depression.

Page 1602The common symptoms are sadness, tearfulness, lack of pleasure and clinginess. The range of symptoms can vary from milder symptoms of tiredness, irritability, anxiety, etc. to severe symptoms of delusional beliefs and hallucinations that happen in case of Psychotic Depression only. Duration of postpartum blues is quite transient lasting only a few days whereas postpartum depression can last a few months. Most patients recover fully but the risk of developing a similar condition after subsequent childbirth becomes higher. Besides, at least half of the women who suffer from postpartum depression are likely to suffer from clinical depression unassociated with pregnancy at a later stage of their lives. Family history and past history of mental illnesses are additional risk factors in postpartum depression. This condition is more prevalent in first time pregnant women.

In case of psychotic depression, the delusional content can be a threat to the mother’s and the baby’s life. For the sake of mother and child, these conditions need to be corrected as quickly as possible. Ignoring these symptoms can inevitably lead to unfortunate loss of lives and destruction of families.

The hormonal changes related to pregnancy are thought to be the key biological factor playing a role in precipitating the condition. Female hormones (oestrogen and progesterone) rise greatly during pregnancy and fall sharply after delivery. Stress axis of human body (hypothalamus-Pituitary-Adrenal gland) is extra sensitive to oestrogen, which consequently makes the mother more susceptible to stress at this phase of her life.

Psycho-social factors can also contribute to further stress. Clinical observations show that mothers with poor social support are more prone to postpartum depression.  Financial stress and marital discord make them more vulnerable. Stress related to the additional responsibility of motherhood and the overall environmental demands on the mother-to-be can easily tip the psychological balance. The demand of child care on top of sleep deprivation, nutritional deficiency and regular household responsibilities can easily overwhelm a mother.

Page 1603 Besides, maternal mental health is unequivocally important in raising emotionally sound children. Cortisol (a stress hormone) flowing high in maternal blood can subsequently interfere with the mother-child attachment formation which is pertinent to the growth of the right hemisphere of the baby’s brain. Research shows that the right side of the brain is bigger at birth than the left hemisphere and its healthy growth depends on the attachments between the baby and the caregiver.  Again, maternal emotions are easily transmitted through the mother’s body energy and touch to the baby (affective synchrony) and eventually produces a long term implication on the baby’s psycho-social growth.

Inability to take care of the baby goes against the maternal instinct of a woman. This dilemma, compounded by social stigma around mental illness, puts the mother in a downward spiral of negative emotions.

A proper analysis of a person’s history would be essential in developing an individually tailoured treatment plan. A realistic goal to alleviate stress as much as possible by mobilising all personal and social resources would be highly rewarding. Proper rest, sleep and balanced nutrition should be ensured. The mother needs to be treated with compassion and support.

Antidepressants and electro-convulsive therapy in severe cases have been found to be useful. Antipsychotic medications are indicated only in case of psychotic symptom management.

Photo: Sazzad Ibne Sayed
Model: Allena and Shama