Postpartum depression (PPD) [प्रसवोत्तर अवसाद], also called postnatal depression, is a type of mood disorder associated with childbirth, which can affect both sexes. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. Onset is typically between one week and one month following childbirth. PPD can also negatively affect the newborn child. The risk factors, being of more concern, Siddha Spirituality of Swami Hardas Life System consider that our readers to read this article and try to prevent the postpartum depression.
Postpartum depression Definition
A depression suffered by a mother following childbirth, typically arising from the combination of hormonal changes, psychological adjustment to motherhood, and fatigue; postnatal depression.
Postpartum depression Symptoms
Symptoms of PPD can occur at any time in the first year postpartum. Typically, a diagnosis of postpartum depression is considered after symptoms persist for at least two weeks. These symptoms include, but are not limited to:
- Persistent sadness, anxiousness or “empty” mood
- Severe mood swings
- Frustration, irritability, restlessness, anger
- Feelings of hopelessness or helplessness
- Guilt, shame, worthlessness
- Low self-esteem
- Numbness, emptiness
- Inability to be comforted
- Trouble bonding with the baby
- Feeling inadequate in taking care of the baby
- Lack of interest or pleasure in usual activities
- Low or no energy
- Low libido
- Changes in appetite
- Fatigue decreased energy and motivation
- Poor self-care
- Social withdrawal
- Insomnia or excessive sleep
- Diminished ability to make decisions and think clearly
- Lack of concentration and poor memory
- Fear that you can not care for the baby or fear of the baby
- Worry about harming self, baby, or partner
Onset and duration
Postpartum depression onset usually begins between two weeks to a month after delivery. PPD may last several months or even a year. Postpartum depression can also occur in women who have suffered a miscarriage.
For fathers, several studies show that men experience the highest levels of postpartum depression between 3–6 months postpartum.
Postpartum depression can interfere with normal maternal-infant bonding and adversely affect acute and long-term child development. Postpartum depression may lead mothers to be inconsistent with childcare. These childcare inconsistencies may include feeding routines, sleep routines, and health maintenance.
In rare cases or about 1 to 2 per 1,000, the postpartum depression appears as postpartum psychosis. In the United States, postpartum depression is one of the leading causes of the annual reported infanticide incidence rate of about 8 per 100,000 births.
Postpartum depression Causes
The cause of PPD is not well understood. Hormonal changes, genetics, and major life events have been hypothesized as potential causes.
Fathers, who are not undergoing profound hormonal changes, can also have postpartum depression. The cause may be distinct in males.
Profound lifestyle changes that are brought about by caring for the infant are also frequently hypothesized to cause PPD. Mothers who have had several previous children without suffering PPD can nonetheless suffer it with their latest child.
Despite the biological and psychosocial changes that may accompany pregnancy and the postpartum period, most women are not diagnosed with postpartum depression.
Postpartum depression Risk factors
While the causes of PPD are not understood, a number of factors have been suggested to increase the risk:
- Prenatal depression or anxiety
- A personal or family history of depression
- Moderate to severe premenstrual symptoms
- Stressful life events experienced during pregnancy
- Maternity blues
- Birth-related psychological trauma
- Birth-related physical trauma
- Previous stillbirth or miscarriage
- Formula-feeding rather than breastfeeding
- Cigarette smoking
- Low self-esteem
- Childcare or life stress
- Low social support
- Poor marital relationship or single marital status
- Low socioeconomic status
- Infant temperament problems/colic
- Unplanned/unwanted pregnancy
- Elevated prolactin levels
- Oxytocin depletion
Not surprisingly, women with fewer resources indicate a higher level of postpartum depression and stress than those women with more resources, such as financial. Rates of PPD have been shown to decrease as income increases.
Women with fewer resources may be more likely to have an unintended or unwanted pregnancy, increasing the risk of PPD. Women with fewer resources may also include single mothers of low income. Single mothers of low income may have more limited access to resources while transitioning into motherhood.
A meta-analysis reviewing research on the association of violence and postpartum depression showed that violence against women increases the incidence of postpartum depression. About one-third of women throughout the world will experience physical or sexual violence at some point in their lives.
Violence against women occurs in conflict, post-conflict, and non-conflict areas. It is important to note that the research reviewed only looked at violence experienced by women from male perpetrators, but did not consider violence inflicted on men or women by women. Further, violence against women was defined as “any act of gender-based violence that results in, or is likely to result in, physical, sexual, or psychological harm or suffering to women”.
Psychological and cultural factors associated with an increased incidence of postpartum depression include a family history of depression, stressful life events during early puberty or pregnancy, anxiety or depression during pregnancy, and low social support. Violence against women is a chronic stressor, so depression may occur when someone is no longer able to respond to the violence.
Postpartum depression Diagnosis
Postpartum depression in the DSM-5 is known as “depressive disorder with peripartum onset”. Peripartum onset is defined as starting anytime during pregnancy or within the four weeks following delivery.
The criteria required for the diagnosis of postpartum depression are the same as those required to make a diagnosis of non-childbirth related major depression or minor depression. The criteria include at least five of the following nine symptoms, within a two-week period:
- Feelings of sadness, emptiness, or hopelessness, nearly every day, for most of the day or the observation of a depressed mood made by others
- Loss of interest or pleasure in activities
- Weight loss or decreased appetite
- Changes in sleep patterns
- Feelings of restlessness
- Loss of energy
- Feelings of worthlessness or guilt
- Loss of concentration or increased indecisiveness
- Recurrent thoughts of death, with or without plans of suicide
Postpartum depression Screening
In the US, the American College of Obstetricians and Gynecologists suggests healthcare providers consider depression screening for perinatal women. Additionally, the American Academy of Pediatrics recommends pediatricians screen mothers for PPD at 1-month, 2-month and 4-month visits.
Postpartum depression Prevention
A 2013 Cochrane review found evidence that psychosocial or psychological intervention after childbirth helped reduce the risk of postnatal depression. These interventions included home visits, telephone-based peer support, and interpersonal psychotherapy.
Support is an important aspect of prevention, as depressed mothers commonly state that their feelings of depression were brought on by “lack of support” and “feeling isolated.”
In couples, emotional closeness and global support by the partner protect against both perinatal depression and anxiety. Further factors such as communication between the couple and relationship satisfaction have a protective effect against anxiety alone.
In those who are at risk, counseling is recommended. In 2018, 24% of areas in the UK have no access to perinatal mental health specialist services.
Postpartum depression Treatment
Treatment for mild to moderate postpartum depression includes psychological interventions or antidepressants. Women with moderate to severe PPD would likely experience a greater benefit with a combination of psychological and medical interventions. Exercise has been found to be useful for mild and moderate cases.
Postpartum depression Therapy
Both individual social and psychological interventions appear equally effective in the treatment of PPD. Social interventions include individual counseling and peer support, while psychological interventions include cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). Other forms of therapy, such as group therapy and home visits, are also effective treatments.
Internet-based cognitive-behavioral therapy (iCBT) has shown promising results with lower negative parenting behavior scores and lower rates of anxiety, stress, and depression. iCBT may be beneficial for mothers who have limitations in accessing person CBT.
Postpartum depression Medication
A 2010 review found few studies of medications for treating PPD noting small sample sizes and generally weak evidence. Some evidence suggests that mothers with postpartum depression will respond similarly to people with major depressive disorder. There is evidence which suggests that selective serotonin reuptake inhibitors (SSRIs) are an effective treatment for PPD.
However, a recent study has found that adding sertraline, an SSRI, to psychotherapy does not appear to confer any additional benefit. Therefore, it is not completely clear which antidepressants, if any, are most effective for the treatment of PPD, and for whom antidepressants would be a better option than non-pharmacotherapy.
There are no antidepressants that are FDA approved for use during lactation. Most antidepressants are excreted in breast milk. However, there are limited studies showing the effects and safety of these antidepressants on breastfed babies. Regarding allopregnanolone, very limited data did not indicate a risk for the infant.
Electroconvulsive therapy (ECT) has shown efficacy in women with severe PPD that have either failed multiple trials of medication-based treatment or cannot tolerate the available antidepressants.
As of 2013, it is unclear if acupuncture, massage, bright lights, or taking omega-3 fatty acids are useful.
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