Postpartum Depression

There are six types of postpartum depression or mood disorders that can affect you after the birth of your child. Each of these types has unique progressions, complications and treatments, so proper diagnosis by a trained and experienced mental health care professional is key.

Ample support from family and friends is needed for all these disorders, but a few severe cases also require suicide support. In some cases, women can experience major depressive episodes that may not have sadness as a symptom. These episodes can be alarming but a woman who has had a major depressive episode is in urgent need of medical help.

The following are the six types of postpartum depression you should be aware of:

Getting the specific diagnosis of which type of postpartum depression a new mother is suffering from is of the utmost importance. Such a specialised diagnosis can only be done by a trained and experienced mental health care professional.

People around a new mother should, however, be aware of the most common symptoms of postpartum depression. Once these symptoms are identified, the postpartum mother should be provided with ample help, support, care and treatment so that her recovery can be speeded up. The following are some of the common symptoms of postpartum depression:

• Feeling sad, hopeless, overwhelmed or empty
• Worrying or feeling excessively anxious
• Feeling irritable, moody or restless
• Crying for no apparent reason 
• Sleeping too much or not being able to sleep when the baby is sleeping
• Experiencing excessive anger or rage
• Eating too little or too much
• Having trouble concentrating or making decisions
• Lack of interest in routine activities or activities which previously gave pleasure
• Eating too little or overeating
• Withdrawal from family and friends
• Suffering from persistent headaches, body aches and indigestion
• Trouble bonding with the baby
• Persistent doubts about being able to take care of the baby or being a perfect mother
• Thinking about harming self or the baby

Postpartum depression isn’t necessarily caused by one factor. It can occur due to a combination of multiple factors which can be physical, biological and emotional in nature. It’s important to remember that postpartum depression does not happen because of something that a mother does or does not do. The following are some of the common causes of postpartum depression.

• Hormonal changes: The levels of female hormones like estrogen and progesterone are the highest they’ll ever be during pregnancy. Within hours of giving birth, these hormone levels rapidly drop. Levels of thyroid hormones are also likely to drop after giving birth. These changes can lead to depression just like hormone changes during menstruation lead to mood swings. Only, the postpartum changes are more drastic.
• Fatigue: Childbirth can be very tiring. Add to that the need to care for a newborn baby, and the mother can become sleep- and rest-deprived. too. This inevitably leads to fatigue, and regaining normal strength and stamina can become more difficult. This can also lead to body aches, inability to concentrate or eat, sadness and frustration and may lead to postpartum depression.
• Emotional factors: Whether a pregnancy was planned or unplanned, being a new mother can emotionally overwhelm or exhaust a mother. There are life changes to deal with, and making a baby the primary centre of attention can take time to get used to. The added pressure of being a perfect mother can aggravate this feeling of inadequacy. Parents of babies who are born sick, premature or with other complications also go through feelings of sadness, anger and guilt. These emotions can take a toll and lead to postpartum depression.
• History of depression: Women who have had depression, anxiety and panic attacks at any time before or during the pregnancy - or those who are being currently treated for depression - are more at risk of suffering from postpartum depression.
• Lifestyle factors: Lack of support or care from the spouse, family and friends can increase feelings of inadequacy, persecution and guilt. Critical remarks about the mother’s appearance or the baby’s gender or looks can also trigger these feelings and ultimately lead to postpartum depression.

Postpartum depression can affect any mother of any age, race, region or economic status. It’s important to remember that though the condition of a woman suffering from postpartum depression is serious, there are effective treatments available for this disorder. Depending on the postpartum woman’s diagnosis, either of the following two methods of treatment (or a combination of both) can be prescribed to her by a mental health care professional.

• Talk therapy: This is one of the non-invasive types of therapy which involves one-on-one counselling provided by a qualified counsellor, therapist, psychologist or psychiatrist. There are two types of talk therapy that have been found to be effective in treating postpartum depression. Cognitive behavioural therapy (CBT) helps people recognise and change their negative thoughts and behaviours. Interpersonal therapy (IPT) helps people understand and work through problematic interpersonal relationships. 
• Antidepressants: Antidepressants are medications that can balance the chemicals in the brain that determine moods. These drugs are prescribed to women with postpartum depression only in the most severe cases, since antidepressants can be transferred to the baby during breastfeeding. This is the reason why antidepressants should only be taken when a doctor prescribes them, and in the precise dose prescribed. It’s important to remember that antidepressants can take three to four weeks to take effect, so patience is important in the meantime.

Some women are at a greater risk of developing postpartum depression after giving birth. These women and their loved ones should be aware of this risk and take precautions to prevent triggers, enable the quick diagnosis of depression and get treatment without any delay. The following are some of the risk factors associated with postpartum depression.

• If the new mom showed any symptoms of depression during and after a previous pregnancy.
• If the new mom has a history of depression, bipolar disorder or any other mental illness.
• If a close family member has suffered from depression or a mental illness.
• If the new mom had a stressful life event before, during or right after childbirth, like personal illness, loss of job, death of a loved one or domestic violence.
• If the new mom had medical complications during childbirth, like premature labour.
• If there are any health problems in the child, including birth defects like spina bifida or congenital heart defect.
• If the new mom had mixed feelings about pregnancy, whether it was planned or unplanned.
• If there is a lack of strong and consistent support from spouse, partner, family and friends.
• Alcohol abuse or drug abuse prior to or during pregnancy.

Many women who suffer from postpartum depression choose talk therapy over antidepressants because of the belief that all medications that new mothers take are secreted into the breast milk and a breastfed baby can get affected by them. This is true. 

All medications - antidepressants, antipsychotic agents, mood stabilizers and benzodiazepines - do indeed make their way to the breast milk, although the precise concentrations of these agents can vary. The amount of medication to which a breastfed infant can get exposed depends on the following factors:

• The specific medication
• Dosage of the medication
• Frequency of dosing
• Frequency of infant feedings
• Rate of maternal drug metabolism

Despite these factors, antidepressants - especially selective serotonin reuptake inhibitors (SSRIs) like sertraline and paroxetine - are considered to be relatively safe for use during breastfeeding when clinically prescribed. These drugs have been tested in multiple clinical trials, and very low levels could be detected in breast milk and in the blood of infants. 

It’s also important to remember that postpartum depression can turn very severe if not treated, which can ultimately harm the baby. So, it is up to the doctor to diagnose the severity of postpartum depression in the mother, recommend a course of treatment, and check if antidepressants are needed. If the doctor believes your case needs a higher dose of these drugs for appropriate treatment, he or she can ask you to stop breastfeeding and shift to formula if needed. In other cases, medications can be started after four to six months, when the baby can be weaned anyway if needed.

No, fathers do not go through pregnancy and labour and they don’t have to breastfeed. But this does not mean that men are not at risk of developing postpartum depression, too. Unfortunately, there isn't much research available on postpartum depression in men.

Postpartum depression in fathers can be equally debilitating and can have just as much of an effect on the family's short- and long-term well-being as postpartum depression in mothers. Here are a few things we know about postpartum depression in men. 

Postpartum depression affects about 10% of all new moms and new dads. Therefore, it is a good idea to be informed about the types of postpartum depression - from baby blues to psychosis. There are also some other ways to create a safe and secure home environment where all issues related to parenthood can be addressed without fear and judgements. Here are a few tips that both parents can use for this:

• Create an emotional bond with your child by increasing interactions and skin-to-skin contact for both parents. Mothers can do so while breastfeeding, but fathers - instead of feeling excluded - should learn how to change diapers, bathe the baby, soothe him or her and put the baby to sleep. Both parents should play with the baby as often as possible.
• Lean on each other as well as family members and friends for support. Exhaustion, sleep deprivation, unhealthy eating habits or lack of nutrition, lack of exercise and social isolation can all be prevented if you create a circle of support after childbirth. 
• Take care of yourself and your partner. It can seem difficult to manage, especially with a newborn in the house. But just making sure that you both eat, sleep, exercise and maintain personal hygiene can go a long way to help you feel less overwhelmed. The postpartum stage is full of many changes that can be overwhelming, but forming a routine as soon as possible can make adapting to your new life much easier. (Read more: Baby bedtime routine)
• Make time for each other. Simply because you have a baby now does not mean either of you should feel neglected or unloved. While it’s not recommended to have penetrative sex until six weeks after delivery, both parents should be intimate and feel secure with each other. Keep communicating with each other, and plan the future together. (Read more: Sex after pregnancy)
• Take some time off from work to focus on just the family. This focus is very important in the initial months and should be done by both parents. Maternity and paternity leaves should both be fully utilised to ensure that both parents feel engaged in the upbringing of the baby, while feeling loved and content on the home front before rejoining work.
• If any signs of postpartum depression show up in either parent, both should seek help to treat the condition. Remember, you are a unit and no issue can be dealt with just on the individual level any more. Getting therapy as a couple can also minimise the chances of either parent getting worse or suffering from postpartum depression for a prolonged period.