Postpartum Depression: Is it more than baby blues?

Happiness. Sadness. Excitement. Worry. Overwhelming love. Fear. Bringing a bundle of joy into the world is an immense responsibility, and experiencing an influx of emotions is normal. However, there are a subset of new mothers who experience more than just the “baby blues.” They suffer from a condition called postpartum depression in which they feel intense symptoms of depression.

Postpartum depression
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What Is Postpartum Depression?

Postpartum depression is a type of depression occurring after childbirth. The serious condition ranges from mild to severe and its symptoms vary in intensity. Postpartum depression may develop immediately after childbirth, but it commonly presents within the first three months.

While it is normal to have a period of sadness, nervousness, mood swings, and excessive crying postpartum, these symptoms should dissipate within a few weeks with rest and care. However, one and seven women have symptoms that progressively worsen. These women have postpartum depression.

Signs and Symptoms of Postpartum Depression

As already noted, anxiety, crying, irritability, restlessness, and fatigue are common for new mothers. These symptoms are called the “baby blues” and develop within the first three weeks after giving birth. When symptoms persist and worsen over time rather than improving, that is a sign of postpartum depression.

  • Unexplained sadness—Signs of unexplained sadness are excessive crying and hopelessness.
  • Mood swings—Mood swings associated with postpartum depression include irritability and anger.
  • Insomnia—The inability to fall asleep or remain asleep cause extreme fatigue (i.e. tiredness, lack of energy).
  • Feelings of inadequacy—Feeling inadequate as a mother is a common fear, but mothers with postpartum depression have feelings of inadequacy that interfere with them caring for their child.
  • Suicide ideation—Recurring thoughts of death or suicide is a dangerous symptom of postpartum depression.
  • Negative thoughts of the baby—Some women with postpartum depression have thoughts of harming their baby.
  • Panic attacks—Episodes of intense fear that cause physical symptoms (i.e. racing heart, sweating, shortness of breath).
  • Apathy—Lack of interest in activities, friends, and family.
  • Poor concentration—The inability to perform mental functions clearly.

Causes of Postpartum Depression

The body undergoes a series of physiological changes thought to cause postpartum depression. During pregnancy, female reproductive hormones such as estrogen and progesterone increase. Upon giving birth, estrogen and progesterone rapidly drop to pre-pregnancy levels within one to three days. The hormonal fluctuation is very similar to the changes a woman undergoes prior to mensuration, but more extreme. The drastic shift in hormones leads to postpartum depression in women who are susceptible.

Aside from shifts in reproductive hormones, thyroid hormones also decrease after birth. The thyroid is a gland in the neck that controls the body’s metabolism. Researchers have attributed depression symptoms from low thyroid function.

Risk Factors for Postpartum Depression

Most new mothers experience situational stressors with pregnancy and birth that increase the risk of postpartum depression. For example, they have to accept the physical changes pregnancy has on their body, are exhausted from caring for the baby, have little time to themselves, and their day-to-day social and work life are disrupted.

Women younger than 20 years of age, who consume drugs or alcohol after giving birth, have a history of depression, or have family members who suffer from depression are at a higher risk. Additional stressors outside of also contribute to the cause of postpartum depression. These include an unplanned pregnancy, financial difficulties, and lack of support.

Postpartum Depression Comorbidities

Postpartum depression often goes hand in hand with postpartum anxiety, postpartum obsessive compulsive disorder, and postpartum psychosis. All three have similar symptoms and are sometimes used interchangeably, but they are separate conditions.

Postpartum Psychosis

Postpartum psychosis is a rare condition related to postpartum depression. Its symptoms develop within the first week of giving birth. While some of the signs are similar to postpartum depression, they are considerably more severe and include:

  • Hallucinations —Seeing or hearing things that are not there
  • Delusions—Strange believes that are untrue
  • Hyperactivity—An increase in energy perceived as restlessness and agitation
  • Paranoia—The mother feels everyone is against them
  • Sleep disturbance—Repeated disrupted sleep, longer time to fall asleep, and inability to sleep
  • Confusion—Not able to concentrate or think clearly. This impacts decision making.
  • Obsessive thoughts about the baby—A mother with postpartum psychosis may have thoughts of harming their baby.

Immediate treatment for postpartum psychosis is necessary. According to Postpartum Support International, postpartum psychosis has a 4 percent infanticide rate and a 5 percent suicide rate.

Postpartum Anxiety

Postpartum anxiety is characterized by feelings of unwarranted worry and fear over work, school, health, finances, relationships, and other aspects of life that interferes with daily functioning. These symptoms arise after giving birth. Experts claim up to 50 percent of women with postpartum depression report signs and symptoms of postpartum anxiety.

Postpartum Obsessive Compulsive Disorder

Similarly, postpartum depression is often diagnosed with postpartum obsessive compulsive disorder. Unlike traditional obsessive compulsive disorder with obsessions and compulsions involving cleaning and contamination, symmetry and ordering, and harmful thoughts and impulses, postpartum obsessive compulsive disorder is characterized by thoughts and behaviors about the newborn baby. It affects up to 5 percent of women.

Cognitive Impairment and Postpartum Depression

Cognitive function refers to the skills one applies to perform mental thinking tasks. Learning, memory, attention, concentration are all examples of cognitive skills. Poor concentration is a particularly bothersome symptom of postpartum depression.

During pregnancy, cortisol (i.e. a stress hormone) doubles as the placenta releases corticotropin-releasing hormone (CRH). Increased cortisol is associated with depression, and some studies show the cognitive impairment secondary to depression improves by lowering cortisol (Hinkleman, 2018) . It can take up to six weeks for cortisol levels to normalize after pregnancy, which is the time frame postpartum depression is most likely.

The Brain Matter in Postpartum Depression

Pregnancy physically alters the brain. For example, the gray matter in the hippocampus shrinks during pregnancy and returns to normal size postpartum. Additionally, the brain’s plasticity is supposed to increase to prepare the new mother for the caregiving duties of motherhood. The majority of the brain changes occur within the medial preoptic area which controls caregiving behavior.

Brain imaging in those with postpartum depression present with various structural changes such as weaker neural sensitivity. The brain does not adapt as well. Brain areas associated with motivation and reward like the thalamus and nucleus accumbens are weaker (Barba-Müller et al., 2019). Glutamate, a brain chemical associated with memory and learning, is seen in higher amounts in women in postpartum depression yet is decreased in individuals with major depression. These findings suggest postpartum depression is unique in comparison to other forms of depression.   

How To Diagnose Postpartum Depression

Diagnosing postpartum depression requires the input from a trained medical professional. Firstly, the physician obtains a thorough medical and family history. Next, the patient undergoes a postpartum depression screening periodically beginning with their 6-week postpartum visit and up to a year after giving birth.

The most accurate test to screen for postpartum depression is the Edinburgh Postnatal Depression Scale (EPDS). The EPDS is specifically for postpartum depression and consists of a 10-question questionnaire assesses the patient’s mood over the last week. Each question receives a score of 0 through 3. Any score exceeding 12 indicates the need for a complete depression assessment.

Does Postpartum Depression Impact the Child?

Postpartum depression can impact the baby in the short-term and the long-term. Sometimes postpartum depression entails negative thoughts about the baby. New mothers with postpartum depression may feel like they are unable to care for their baby in their emotional state. This potentially leads to the neglect of the child. In the worst-case scenario, especially when postpartum depression progresses into postpartum psychosis, infanticide can occur in which the mother unknowingly murders their baby in a psychosis episode.  

Postpartum Depression: Is it more than baby blues?
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Netsi (2018) investigated the long-term effects of severe, untreated postpartum depression. There is evidence that postpartum depression of the mother is connected to cognitive impairment of the child. Children in the study had delayed language development, insecure attachment, lower grades, and behavioral problems. When the children were interviewed years later, they had an increased risk of psychopathologies. Many developed anxiety, depression, and attention deficit hyperactivity disorder.  

Postpartum Depression Treatment

Therapy and medication are the first-line treatments for postpartum depression. The chosen treatment depends on the severity of the symptoms. Those who develop postpartum psychosis require extensive treatment, but mild postpartum depression symptoms respond to therapy only.

Psychotherapy

Women with postpartum depression may find relief in group therapy, as voicing their struggles is a reminder that they are not alone. In addition to group therapy, individual psychotherapy (i.e. talk therapy) has its benefits.

Medication

Antidepressant medications stabilize mood and regulate sleep. If breastfeeding, certain antidepressants are excreted through breastmilk. It is important to follow the recommendation of a medical professional to ensure the medication is safe for both mother and baby. Occasionally, in very severe cases, antidepressants are taken in combination with lithium, benzodiazepines, and antipsychotic drugs. These target mood, hallucinations and delusions, and anxiety.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy is electrical stimulation of the brain intended to improve symptoms of depression and bipolar disorders. Under anesthesia, shocks to the brain delivered through electrodes placed on the scalp. This induces a temporary seizure. The process alters brain chemistry.

When therapy and medication are ineffective for treating postpartum depression, and symptoms have developed into postpartum psychosis, electroconvulsive therapy is an option. Research shows that after receiving electroconvulsive therapy, all women with postpartum depression and suicidal ideation responded within three to six electroconvulsive treatments (Levy 2012).

Postpartum Depression Tips

Postpartum depression is a difficult battle. However, managing the condition is possible! Do not be afraid of asking for help. It is important new mothers care for themselves. Visit friends and family; be open about the struggle of postpartum depression. The most important tip is to remember loved ones are there for support.

References

Barba-Müller, E., Craddock, S., Carmona, S., & Hoekzema, E. (2019). Brain plasticity in pregnancy and the postpartum period: links to maternal caregiving and mental health. Archives of women’s mental health22(2), 289–299. https://doi.org/10.1007/s00737-018-0889-z

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