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Understanding post-partum depression

Photo: georgetown.edu

By Rimli Bhattacharya

“Mental illness lives all around us every day. I’ve seen it in other family members, I’ve seen it in friends, and I’ve dealt with it myself with my own postpartum depression.” – Rachel Hollis

In the recent years, the mental ailment – depression – has taken an upper hand. We do feel low, sad or moody from time to time but if the feeling stays for long, for example weeks, months and years, we term this affliction as depression. It is a serious mental indisposition and calls for medical intervention. While depression is a broad spectrum subject and cannot be summed up in one essay, I would like to write only on Post Partum Depression (PPD). PPD is described as an assorted group of depressive prodrome that a new mother faces during the first year of the birth of her infant. The American Psychiatric Association, Diagnostic and Statistical Manual of Mental Heath Disorders – IV (DSM IV), categorizes “postpartum” to evoke syndromes of any major depressive disorder, bipolar and any transient psychotic breakdown within four weeks of delivery. They are divided into three categories: ‘maternal blues’, ‘Post Partum Depression’ and ‘Post Partum Psychosis’. Though DSM IV does not associate PPD with other psychiatric illnesses, we must know that anxiety disorders, panic attacks, obsessive compulsive disorder (OCD) and fear can aggravate during the post-partum period. Studies suggest PPD as a significant health problem which affects 10% to 20% of new mothers annually. Interestingly, it’s been observed that around 10% of new fathers also experience PPD. However, PPD is not a sign that the mother doesn’t love the new born as they sometimes fear; the good news is that it can be treated with the help of psychiatrist, therapist, support groups and counselors.

Often we confuse PPD with general baby blues which many new parents face for a few days post delivery. The cause of concern arises when generally the mother fails to reassume her daily routine due to the blues accentuating long term depression. People fail to understand PPD, thinking it is just a transitionary phase which they are going through. But the support group comprising the family members and friends who are sharp enough to pick up on the signs of PPD should encourage the young couple to reach for medical help as soon as possible. Certain patients of PPD can have thoughts about harming their child (though it never happens), committing suicide or self harm and these thoughts are frightening and disturbing.

PPD can affect a couple in many ways. Some common signs and symptoms include: Baby blues or low mood that lasts longer than a week; Spells of crying; Feeling of guilt; Irritability; Frequent headaches and stomach aches; Blurred vision; An overwhelming feeling of inability to cope; Lack of appetite; Lack of motivation; Sleep disorders; Anxiety and panic attacks; Loss of desire; Lack of interest in themselves and also towards the baby; Preferring solitude/isolation for a longer time; Persistent fatigue; Hallucinations.

While depression is either functional or organic, the actual reason of PPD is still unclear. There are several factors which trigger stress in the patient leading to PPD which includes genetic inheritance, lack of family support, financial inadequacy, having a history of mental health problems, strained relationships, hormonal mayhem, difficulty in breast feeding, physical change during pregnancy, loneliness and changes in sleep cycle.

Like depression, the treatment of PPD also is a combination of psychotherapy and medications. The medico mostly suggests the same anti-depressants which are used to treat the other forms of depression. For the lactating mother, it is extremely important to know the effects of anti-depressant on breast milk, thus assessing the risk and benefits in the situation. The mother is likely to have questions about the possibility of passing the medication to the new born through the breast milk. There are wide disparities in the concentration of antidepressant in breast milk, which depends on such things as the dose, metabolism and when the baby feeds.

On treatment for PPD, Women’s Health writes that a number of psychotherapy techniques have been proven helpful depending on the nature of the stress, the cause of the depression and personal preference. Every woman with postpartum depression needs support as well as education about depression. Various types of psychological therapy are available:

  • Cognitive behavioral therapy is designed to examine and to help correct faulty, self-critical thought patterns.
  • Psychodynamic, insight-oriented or interpersonal psychotherapy can help a person sort out conflicts in important relationships or explore past events or issues that may have contributed to the symptoms.
  • Couples therapy can help the mother and father figure out how to manage possible areas of disagreement or how best to organize child care and muster support.

The patient might begin to feel relief soon after starting treatment, but it usually takes at least two to six weeks before a clear improvement can be seen. One needs to try few different approaches to psychotherapy or medication for finding which method is most helpful to the patient. For a new mother it is essential to contact the psychiatrist / therapist the moment she develops these symptoms. As mentioned earlier, there will be recurring thoughts of harming the baby or self and also inability in coping with caring for the infant.

The prognosis says that most mothers with postpartum depression recover completely. This is especially true if the illness is diagnosed and treated early. About 50% of women who recover from postpartum depression develop the illness again after future pregnancies. To decrease this risk, some doctors suggest that women with a history of postpartum depression should start antidepressants immediately after the baby is delivered, before the onset of depression symptoms. In case of severe PPD, the patient may need hospitalization where the doctor will decide if the infant can accompany the mother. If the doctors feel that the patient is on the verge of self-harm or harming the infant, she is admitted in a mental health clinic while other members of the family take care of the infant. The road to recovery may take several months but the good news is that in some cases it is absolutely treatable. The salient feature in treating and recuperation from PPD is to concede the problem. Support from family, friends, and social networking groups also aids in faster recovery.

Bio:
Rimli Bhattacharya 
completed Mechanical Engineering from National Institute of Technology. After obtaining an MBA, she worked in the corporate sector. Rimli is a trained Indian classical dancer, based out of Mumbai, India. She tweets at: @rimli76

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Cafe Dissensus Everyday is the blog of Cafe Dissensus magazine, based in New York City and India. All materials on the site are protected under Creative Commons License.

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Read the latest issue of Cafe Dissensus Magazine, “Hatred and Mass Violence: Lessons from History”, edited by Navras J. Aafreedi, Presidency University, Kolkata, India.

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