INTEGRATED CARE CENTRE for Children, Adolescents, Adults & Families Home Contact Us Blog Our Practitioners News & Events BLOG POSTED ON 2 MAY 2020 Tips for Parenting During COVID-19 Pandemic COVID19_Parent Support_ICC POSTED ON 16 MAR 2020 Coronavirus Update Some child-friendly info about Coronavirus: POSTED ON 9 SEP 2019 Postpartum Depression Dr Zenaida Tenea Pregnancy is associated with multiple physiological, psychological and social changes, and these occur throughout its course. Postpartum depression (PPD) is a complex mix of physical and emotional changes that happen in a woman after giving birth. The Causes of Postpartum Depression Postpartum depression is not character flaw or a weakness. It encompasses a range of chemical, social, and psychological changes associated with having a baby. The chemical changes involve a rapid drop in hormones after delivery. Levels of oestrogen and progesterone increase tenfold during pregnancy and then drop sharply after delivery. By three days post-delivery these hormones drop back to pre-pregnancy levels. This sharp decrease in hormone levels leads to changes in mood. In addition to these biological factors, social and psychological changes associated with having a baby create an increased risk of depression. These include: sleeplessness, a change in lifestyle to accommodate the needs of a new-born and adjustment to care-giving role. Symptoms of Postpartum Depression Symptoms of PPD may difficult to distinguish from what happens normally after childbirth, for example: insomnia, appetite changes fatigue poor concentration mood swings However, in PPD these are accompanied by other symptoms of depression (which are not normal after childbirth) and may include: depressed mood most days loss of pleasure feelings of hopelessness and helplessness feelings of worthlessness, shame, guilt or inadequacy withdrawing from family or friends thoughts of death/suicide thoughts of harming the new-born infant Risk Factors for Postpartum Depression The following are associated with an increased risk of developing PPD: A history of depression or bipolar disorder prior to falling pregnant or during pregnancy Discontinuation of antidepressant medication during pregnancy (x5 relapse risk) Age at the time of pregnancy, with younger females being at increased risk Unplanned or unwanted pregnancies Ambivalence about the pregnancy Poor social support Prior diagnosis of a chronic medical condition Being single or involved in inter-relationship conflict Increased care-giver burden e.g. having other (older) children or current being twins/multiple birth Baby has health problems or other special needs Family history of mood disorders Financial stressors Prevalence of Postpartum Depression There is a significant increase in new mood episodes in the first three months following delivery. Most new mothers experience ‘baby blues’ after delivery; this is common and self-limiting. About one out of every 10 of these women will develop a more severe and longer-lasting depression after delivery (PPD). About one in 1000 women develops a more serious condition called postpartum psychosis. The Different Types of Postpartum Disorders The following mood changes can occur after a woman gives birth: Baby blues occurs in most women in the days right after childbirth. A new mother has sudden mood swings; she may be tearful and feel irritable, anxious and sad. This may last only a few hours or as long as one to two weeks after delivery. Baby blues do not usually require treatment from a health care provider. Some new mothers find that going a support group helps. Postpartum depression can happen a few days or even months after childbirth. PPD can happen after the birth of any child (and not just the first child). A woman can have feelings similar to those of baby blues but these are of a much stronger intensity and start to impact on her day-to-day function. If a woman does not get treatment for PPD, symptoms can worsen. While PPD is a serious condition, it generally responds well to both medication and psychotherapy. Postpartum psychosis is a very serious mental illness that can affect new mothers. This illness can happen quickly, often within the first three months after childbirth. Women can lose touch with reality, and start having psychotic symptoms, such as auditory hallucinations (hearing things that are not actually happening, like a person talking) and delusions (strongly believing things that are clearly irrational). Other symptoms include: insomnia, agitation, irritability, restlessness and obsessive thoughts about the baby. Postpartum psychosis is often a symptom of bipolar disorder, which may present with either a depressive episode or a manic episode. Women who have postpartum psychosis need urgent medical treatment and often require hospital admission. Risks of Untreated Postpartum Depression The mental health of the mother influences foetal well-being, obstetric outcome and child development. Untreated maternal depression is associated with a host of negative factors, including: poor self-care and nutrition inattention to perinatal care more physical complaints more over-the-counter medication and substance use Postpartum, untreated maternal depression is associated with: child neglect increased irritability and sleep problems in the new-born poor mother-infant bonding/attachment (and subsequent increase in risk for later psychiatric and physical illness in the child) behavioural problems in the child poorer motor and cognitive development of child The most serious outcomes are suicide and infanticide. Treatment for Postpartum Depression Postpartum depression is treated differently depending on the type and severity symptoms. Treatment options include antidepressant medications (such as fluoxetine and sertraline), psychotherapy, and participation in a support group for emotional support and education. In very severe, life-threatening cases, electroconvulsive therapy (ECT) may be required. Despite stigma associated with this treatment modality it is extremely effective, fast-acting and associated with minimal side effects. In the case of postpartum psychosis, antipsychotic medications (such as olanzapine or aripiprazole) are usually added. Postpartum psychosis is commonly associated with bipolar disorder. The treatment of this condition requires a mood-stabiliser (such as lamotrigine or lithium) rather than antidepressant medication. Hospital admission is often necessary. A new mother who is suffering from moderate-severe depression will likely require medication. The sooner the condition is addressed the better the outcome and discussion with her treating doctor is warranted in the early stages. Many women safely take medication while breastfeeding. Some medications are safer than others – for example, antidepressants are relatively safe. The risk of untreated illness must be weighed against the risk of infant exposure to psychotropic medication, and therefore all clinical decisions need to be a joint collaboration between the doctor and the patient. Posts navigation Page 1 Next page Search for: Search RECENT POSTS Tips for Parenting During COVID-19 Pandemic Coronavirus Update Postpartum Depression Depression and Bipolar Disorder ARCHIVES May 2020 Mar 2020 Sep 2019 Jul 2019 CATEGORIES Mood disorder Parent Advice Uncategorised TAGS bipolar (1) Coronavirus (1) depression (2) postpartum (1) Proudly powered by WordPress