My name is Dr. Aparna Deshmukh. I am a consultant psychiatrist sexologist. Today I will be talking on postpartum depression or postnatal depression. Postpartum depression is a mood disorder which is characterised by depressive symptoms in the period that follows childbirth in either of the parents. More commonly in mothers. It is important to know about postpartum depression because no.1 is common. About 15% of women suffer from postpartum depression in the postnatal period. Secondly, not only it is important from the point of view mother’s mental health but mother who suffers postpartum depression is unable to care for her infant effectively.
And it leads to profound effect, mental health and well-being of the child in the future too. And thirdly, in postpartum depression in its severe form which is postpartum psychosis, the mothers may have thoughts of harming their infants. And they may actually act upon this thought leading to actual harm to an infant and in some cases even death. So how do patients with postpartum depression presents. The postpartum depression onset is usually 2 weeks to 1 month after delivery or sometimes even miscarriage. Some professional even diagnose it after 1 year of child birth. Here the patient typically presents with behaviour and cognitive symptoms. The emotional symptoms include the patient saying that they are sad, sometimes they feel empty inside.
Some patients are irritable, and they get angry on trivial issues. On the other hands. Some patients become lethargic and complaint of low energy or loss of pleasure, loss of interest, loss of enthusiasm. And some patients become withdrawn, non-communicative. In different towards their infant. And in general, they have this fear and worry that they would not be able to care for their infant which leads to a feeling of inadequacy. And sometimes inappropriate guilt and sheen. Many patient’s complaints about a loss of concentration, poor memory that they are not able to take their decisions. The decision-making capacity has been reduced. Or they are unable to think clearly. Some have thoughts of hopelessness or helplessness. And even worklessness. And some patients in their severe illnesses may also have thoughts of humming themselves or even others.
The relatives might notice that the patient has either become withdrawn or non-communicative or they may feel that the patient is overwhelmed and anxious. They may notice that the patient is very lethargic. Or some patients, they sleep a lot. Mostly the whole day. And some patients do not sleep at all. So, sleep patterns may vary depending on the patient. Even the appetite changes are noticed in some patient. The severe form of postpartum depression that I was saying formally postpartum psychosis. Now in postpartum psychosis other than these symptoms, there is also presence of psychotic symptoms. These includes suspiciousness towards family member that they will harm them which leads to an agitative and aggressive behaviour of the patients. Sometimes the patient hallucinates i.e. the hear of voices that are inaudible to others. And the relatives may notice that the patient muttering to self, talking to self. Sometimes patient may also have excessive physical activities. Or they may talk excessively or there is the running of thoughts in their mind. So, these symptoms may also be the part of postpartum psychosis.
Another entity, that needs to be differentiated postpartum depression is postpartum blues or baby blues. Now this entity is more common. But fortunately, it is a milder form. And the depressive symptoms are milder. Patient may complaint of depressed mood, fluctuating moods, irritability, change in sleep and appetite pattern. But the good thing is that it is self-limiting. However, in some cases postpartum blues may progress to postpartum depression. So, how common is postpartum depression? Like I said 15% of women in their postnatal period suffer from postnatal depression. However, postpartum psychosis is rarer. Postpartum blues on the other hand much more common. Affecting 50-70% of the women in the postnatal period. What causes postnatal depression?
There are multiple factors: biological, psychological, social factors. Usually it is an interplay between these factors. Sometimes the combination of these factors that leads to postpartum depression. So, the hormonal changes that occur during and after pregnancy, the sleep deprivation, the emotional and physical stress of childbirth, the added responsibility of the child and poor social and family support can lead to postpartum depression. So, how do we treat postpartum depression? In mild cases, like psychotherapy like counseling helps but modern to severe cases the anti-depressants are the main stay of treatment. In postpartum psychosis. Antipsychotic medication is also prescribed. In severe cases, electroconvulsive therapy is also recommended.
Psychotherapy can be combining with the biological therapy. Mainly cognitive behavioral therapy and interpersonal therapy helps. Counseling and peer support group are also recommended. So, these were the some of the basic questions that I tried to answer about postpartum depression.
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