Definition

The arrival of a new baby can trigger a range of intense emotions in the mother, from feelings of happiness and excitement to anxiety and fear. It's not uncommon for women to experience depression unexpectedly, despite the expectation that the birth of a long-awaited baby would bring joy and fulfillment.

Most new moms experience postpartum “baby blues”, which usually starts within 2 to 3 days after delivery and may last for up to two weeks then usually resolves itself without treatment. One in seven of these mothers will experience a more severe and prolonged form of depression called postpartum depression. Postpartum depression is defined as complex physical, emotional, and behavioral changes in women that occur after childbirth. It is a serious condition that can harm both mother and child, but it is treatable.

Not only mothers, but new fathers can also experience postpartum depression. This can occur from the time of pregnancy until the child is born. Research shows that about 1 in 10 new fathers get depression during the year their child is born.

Causes

Pregnancy and childbirth are vulnerable times for women where biological, emotional, financial, and social changes occur. The mechanisms by which this happens are:

• Hormones. The dramatic drop in estrogen and progesterone after childbirth may contribute to postpartum depression. During pregnancy, estrogen and progesterone increase up to ten times and then drop sharply after childbirth. The hormone levels return to pre-pregnancy levels by the third day after delivery. In addition, thyroid hormones also play a role in feelings of tiredness and moodiness.
• Physical changes. All mothers will feel anxious about the ability to care for a newborn and feel unattractive as mothers. In addition, mothers lose their previous lives and now have to live a new life after the birth of a baby, so mothers often feel overwhelmed and sleep-deprived due to taking care of the baby. When a person is sleep-deprived, their ability to process feelings and deal with problems will be reduced. Any of these issues can contribute to postpartum depression.

Risk factor

Several factors can increase the risk of developing postpartum depression, such as:

• Age at the time of pregnancy (the younger you are, the higher the chance)
• Giving birth to a first child (but not only new mothers can develop postpartum depression)
• Previous history of depression
• Having bipolar disorder
• Family history of depression or other mood disorders
• Marital conflict
• Limited social support
• Single mother
• Economic problems
• Stressors in the past year such as pregnancy complications, illness, job loss, loss of a loved one, etc.
• Having a child with special needs or health problems
• Having twins or triplets
• Having difficulty breastfeeding
• The pregnancy was unplanned or unwanted

Symptoms

Symptoms of depression after childbirth vary, and they can range from mild to severe and often go unnoticed by mothers. Mild symptoms are called baby blues, while severe ones are called postpartum depression.

Postpartum depression symptoms may include:

• Depressed mood
• Severe mood swings
• Difficulty bonding emotionally with the baby and being uninterest in the baby
• Withdrawing from family and friends
• Loss of appetite or overeating
• Inability to sleep or sleeping to much
• Overwhelming tiredness or loss of energy
• Lower libido
• Less interest and pleasure in activities you used to enjoy
• Intense irritability and anger
• Crying all the time, often for no reason
• Fear that you're not a good mother
• Hopelessness
• Feelings of worthlessness, shame, guilt or inadequacy
• Reduced ability to think clearly, concentrate or make decisions
• Restlessness
• Severe anxiety and panic attacks
• Thoughts of harming yourself or your baby
• Thoughts of death or suicide

Diagnosis

Your doctor will talk with you about your feelings, thoughts, and medical history to diagnose postpartum depression and differentiate it from the milder baby blues. Postpartum depression is usually diagnosed if it occurs within 4 weeks of giving birth. However, the diagnosis is based on the time frame of occurrence and the severity of the symptoms experienced.

As part of your evaluation, the doctor may also perform other tests to rule out other medical conditions that may cause depression-like symptoms such as thyroid disorders and vitamin deficiencies.

Management

There are several treatments for postpartum depression, depending on the severity. Recovery time may also vary. The most common treatments are psychotherapy, medication, or both.

• Psychotherapy, helps you find the best way to deal positively with your feelings, thoughts and problems. Sometimes, therapy with family can also help
• Antidepressant medication to help reduce symptoms of depression, usually for severe symptoms. Most antidepressants can be taken while breastfeeding and have few side effects on the baby. Your doctor will decide if this medication is necessary and what type is safe for you
• Reaching out to people you trust

If treated appropriately, symptoms of postpartum depression usually improve. Therefore, it is important to continue the therapy according to the doctor's advice and not stop the therapy when you feel better to avoid relapse.

In addition to the therapy provided by the doctor, there are several things you can do at home to help speed up healing, including:

• Practice healthy living habits, such as exercise (a leisurely walk with your baby), adequate rest, and a healthy diet. Avoid cigarettes and alcohol.
• Make realistic goals and not pressure yourself to be the perfect mom because no mom is perfect. It is normal to take short breaks and need help from others. Postpartum depression is not a failure, weakness, or flaw in a mother, rather it is usually just a complication of the birthing process.
• Make time for yourself by going out to meet friends, doing hobbies, or caring for yourself. You can leave the baby with your partner or someone you trust for a while.
• Don't keep everything to yourself but open up to your partner or those closest to you.
• Join a new mom or mom with a postpartum depression group.

If you are a partner or someone close to a mom with postpartum depression, what you can do is:

• Recognize the signs and symptoms. If there are any, encourage her to see a doctor.
• Listen to her concerns.
• Provide support and let her know that she is not alone and that you are here to help, whether emotionally, helping with housework, or watching the baby.
• Offer to sign her up for a doctor's consultation.

Complications

Postpartum depression affects not only the mother but also the father and baby.

• The mothers. Postpartum depression that’s not treated can last for months or longer, even turning into a chronic depressive disorder. Even with treatment, postpartum depression can make you more likely to have episodes of depression in the future
• The baby’s father. When a new mother has depression, the father may be more likely to have depression too
• Children. Children of mothers with untreated depression have a higher risk of experiencing emotional and behavioral problems, such as problems with sleeping and eating, crying more than usual, and delays in language development. The long-term impact is a lack of cognitive, emotional, communication, and social skills.

Prevention

Prevention of postpartum depression can be done during pregnancy planning for mothers who have a history of depression, by consulting a doctor when planning a pregnancy or as soon as you find out you’re pregnant, or if you’re planning to become pregnant.

When to see a doctor?

If you are experiencing symptoms of postpartum depression, don't feel embarrassed to admit it. You are advised to consult a doctor as prompt and appropriate therapy can help you to control your symptoms. If possible, bring your partner or someone you trust to accompany you.

It's important to call your provider as soon as possible if the symptoms of depression have any of these features:

• Don't fade after two weeks
• Are getting worse
• Make it hard for you to care for your baby
• Make it hard to complete everyday tasks
• Include thoughts of harming yourself or your baby

Suppose you have a friend or loved one who is showing symptoms of postpartum depression. In that case, you should help them seek medical attention because they may not recognize or admit the symptoms of depression or deny that they are experiencing them. It is not advisable to wait and hope the symptoms disappear.

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