Introduction: What is postpartum depression?

Postpartum depression is a type of depression that can affect a person after the birth of their baby. It is also called postnatal or perinatal depression. It usually starts within four weeks of birth, but can start at any time during the first year after birth. It’s important to know that postpartum depression doesn’t just happen to mothers, fathers can experience it too. It is true, however, that mothers are more likely to be affected than fathers, 3-4 times more likely in fact.

Postpartum depression is usually related to the effects it has on a mother and her postpartum period, i.e. after the birth. Onset is usually after childbirth or shortly after the start of breastfeeding.

A person with postpartum depression often feels sadness, hopelessness or loss of interest or pleasure in social activities. The feelings can cause stress, which can make it difficult or impossible to cope effectively with responsibilities at home, work or school. Levels of functioning can be drastically decreased in the period from early pregnancy to six months after birth (Seale 1998).

Symptoms of postpartum depression often vary in intensity, as many women experience more severe symptoms in the first month and then those symptoms gradually improve over time. The severity of maternal depression has been reported to be correlated with specific maternal characteristics, including race, educational level and social class, and (especially) personal experiences.

What are the symptoms of postpartum depression?

Postpartum depression can have a major impact on the health of the mother and her baby.

Symptoms of postpartum depression are different for everyone, but usually include:

• feeling sad most of the time or crying often
• feeling irritable, frustrated or angry
• having trouble sleeping
• having trouble concentrating
• losing interest in activities you used to enjoy
• feel guilty about things you did or didn’t do during pregnancy
• feel you are not a good mother
• feel overwhelmed or over-stimulated
• you have low self-esteem, feel all sorts of insecurities and fears about raising your child
• you have thoughts about something bad happening to your baby or you are obsessed with the thought of harming your baby
• you have thoughts about harming yourself
• chronic headaches and other pain without medical basis

It can be difficult to enjoy pregnancy when you are experiencing any of these symptoms, but by working through them and knowing that there is treatment for them, you will be able to more easily accept the changes in your life and enjoy the parenting experience as you should.

Causes of postpartum depression

Postpartum depression isn’t just a passing phase all the time, it’s often a condition that needs to be treated seriously. The symptoms of postpartum depression are similar to other types of depression, but they are more intense and last longer.

The causes of postpartum depression are not fully understood, but there are some factors that may increase the risk of developing it. These can be divided into physical factors and emotional factors.

Physical factors include:

• a history of postpartum depression (have you had it in the past)
• a history of other mental health problems
• a difficult labour or pregnancy or premature birth of the baby
• sleep deprivation
• drug, alcohol or medication abuse
• you are a single parent or/and are under 20 years of age
• a child with special needs or who cries a lot

Emotional factors include:

• stressful life events during pregnancy or in the first year after birth
• low social support
• ambivalence about pregnancy

Other types of postpartum depression

There are also several particular types of postpartum depression, each with its own characteristics. These are:

Postpartum blues

Postpartum blues affects between 50% and 70% of mothers. It manifests itself in seemingly motiveless outbursts of crying, sadness and anxiety. The condition usually starts within the first 3-4 days after childbirth and goes away on its own in about 2 weeks without specific treatment.

Postpartum psychosis

Postpartum psychosis is the most severe form of postpartum depression. It is a rare condition, affecting between 1 and 2% of women who have given birth. The onset of symptoms is sudden, usually within a few weeks of giving birth.

Early symptoms are irritability, restlessness, agitation and insomnia. Hallucinations are a very common symptom in these cases.

Postpartum psychosis is considered a psychiatric emergency, as the risk of harm to mother or child is extremely high in these situations.

Postpartum anxiety

Postpartum anxiety affects between 20 and 25% of new mothers and often occurs together with postpartum depression. It can occur at any time in the first year after giving birth.

The most common symptoms are episodes of hyperventilation and panic attacks.

Other symptoms are:

• trouble concentrating
• palpitations
• chest pain
• constant or excessive worry
• insomnia
• profuse sweating
• tremors
• irritability

Postpartum obsessive-compulsive disorder

Postpartum OCD occurs in 2 to 9% of new mothers and usually develops during the first week after childbirth.

The obsessions that occur can be related to anything, but they are usually related to the safety of the baby. Those affected by postpartum OCD may engage in rituals related to these concerns, such as:

• excessive organizing and cleaning
• extreme concern about the dangers of germs
• excessive checking on the baby at night

Postpartum depression in men

Fathers can also develop a particular form of postpartum depression, called paternal postpartum depression.

Men are less likely to notice or complain about symptoms of this disorder, but studies have shown that between 8 and 10% of new fathers are affected by these symptoms.

First-time fathers in particular tend to be more anxious in the weeks following the birth of their baby.

Can postpartum depression affect the baby?

Unfortunately, yes. It is important that those affected by postpartum depression get help as soon as possible, both for their own sake and for the sake of the baby.

Studies show that postpartum depression can affect the baby in one or more of the following ways:

• postpartum depression prevents the formation of an emotional bond with the baby
• the child may develop developmental or behavioural disorders
• the child may have eating or sleeping disorders
• the child has a higher risk of obesity
• the child may have developmental deficits in social skills
• the parent may neglect the child or the child’s needs

How to treat postpartum depression?

If you have symptoms of postpartum depression, the best thing you can do is to contact a psychotherapist as soon as possible to get the help you need from a mental health specialist.

Treatment for postpartum depression includes psychotherapy and, in more severe cases such as postpartum psychosis, certain medications prescribed by a psychiatrist. In these more severe cases, the combination of psychotherapy and medication is most effective, according to numerous studies. In other less severe cases, psychotherapy is sufficient to relieve the condition and eliminate symptoms.

Without intervention, postpartum depression can continue and develop into chronic depression. That’s why it’s important to continue treatment even after you start to feel better, to prevent symptoms from returning.

You should seek help if any of the following apply:

• symptoms have been present for more than 2 weeks
• you feel frightened or tense most of the time
• you cannot function normally during the day
• you think about harming yourself or your child