I was so euphoric when Apple was born, and I assumed it would happen with Mosey and it just... it took a while. I really went into a dark place.

Those were the words of Gwyneth Paltrow when she recently opened up about her experience with postpartum depression (PPD) after giving birth to her son Moses in 2006. The Avengers: Infinity Wars star described it as one of the darkest and most painfully debilitating chapters of her life.

When a mother finally delivers her child, very often she would be hit by a variety of mixed emotions. On one hand, she would feel joy, bliss and elation on welcoming her newborn into the family.  On the other, she may also experience mood swings, sadness, and bouts of crying that are commonly known as the “baby blues”. Up to 80% of women experience baby blues after childbirth. Nevertheless, they are mild and will eventually resolve within a week or two without treatment. 

 

Up to 80% of women experience baby blues after childbirth.

Around 10-15% of new mothers, however, will experience something more extreme and debilitating known as postpartum depression (PPD). These women struggle with extreme sadness, anxiety, and exhaustion for up to several weeks or months. They feel an intense sense of worthlessness and are unable to eat or sleep well, all culminating to a point at which they feel like giving up on life altogether. PPD can happen any time within the first year after childbirth. It can happen to first-time mothers or those who’ve already given birth before such as what Gwyneth Paltrow went through.

What causes postpartum depression?

The exact cause remains unknown, but it is likely to be multifactorial, often triggered by a combination of physical, emotional, environmental, and genetic influences. While pregnant, a woman’s estrogen and progesterone levels are higher than usual. After childbirth, these pregnancy hormones will drop abruptly, which leads to biochemical changes in their brain that may trigger mood swings. Ever experience a bad pre-menstrual syndrome? Try multiplying it by 10 and you probably could imagine how it would feel for them.

Moreover, environmental factors such as constant sleep deprivation, inadequate diet, and lack of family support can further contribute to the development of PPD. In some cases, mothers are “emotionally burnt” by events in their lives. The recent loss of a close family member, the stress of being a single mother, financial struggles or having just delivered an abnormal or premature baby are issues that can only aggravate the matter.

Some women with a personal or family background of depression or other mental health conditions may pose a higher risk of developing PPD. A study conducted in USA in 2013 found that 14% of mothers screened positive for depression. Among them, 27% had onset of depression before pregnancy, 33% developed symptoms during pregnancy, while 40% noticed symptoms after childbirth. Hence, it is important for health personnel to screen for such history antenatally. Extra care needs to be given to prevent them from progressing into postpartum psychosis, a more serious condition that may lead to suicide attempts or harm against their babies.

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Extra care needs to be given to prevent them from progressing into postpartum psychosis, a more serious condition that may lead to suicide attempts or harm against their babies.

How to tell if a woman has PPD?

Some of the symptoms may mimic baby blues. However, if a new mother experiences the following symptoms almost every single day for at least two consecutive weeks, chances are high she is having PPD.

  • Feelings of extreme sadness, hopelessness, and emptiness
  • Overwhelming feelings of worthlessness or guilt
  • Loss of interest in activities that are usually enjoyable and withdrawal from interaction with close friends and family
  • Crying more often than usual for no apparent reason
  • Anger or rage over minor incidents
  • Oversleeping or insomnia
  • Eating too little or too much
  • Persistent doubt of ability to care for a baby
  • Restlessness as well as difficulty concentrating, remembering details or making decisions
  • Thoughts of self-harm or harming the baby

Can we tell if a woman is more likely going to experience PPD?

Postpartum depression can affect women of any age, ethnicity, and social background. However, some mothers with the following risk factors are more prone to develop PPD:

  • A pre-existing personal or family history of depression or other mood disorders
  • The occurrence of complications or traumatic events during pregnancy or childbirth such as delivering a baby with birth defects, preterm delivery, and going into prolonged labour without adequate analgesia
  • Unplanned or unwanted pregnancy
  • Known history of alcoholism, drug abuse or domestic violence by the partner
  • Very poor family support
  • Pre-existing medical disorders such as heart disease, chronic kidney disease, maternal obesity, etc.

It is important to note that these risk factors do not necessarily lead to PPD. Many women with multiple risk factors never experience symptoms, while others with just one risk factor (or even none) can end up with a diagnosis of PPD.

How do you treat PPD?

While PPD does at times resolve on its own, it is important to recognize and treat them early to avoid its devastating effect on the mother, baby, and her surrounding families. Often, it requires a multidisciplinary team approach involving a psychiatrist or psychologist, obstetrician, nurses, and social workers. The two main modalities of treatment that are effective in treating PPD are counselling and mood stabilizing medications.

The two most commonly used forms of counselling are cognitive behavioural therapy—aimed at helping mothers to recognize and change their negative thoughts and behaviors—and interpersonal therapy—a brief, attachment-focused psychotherapy that helps mothers to understand and work through problematic personal relationships.

In some cases, a psychiatrist may decide to commence mothers with PPD on antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs). These medications are generally safe in breastfeeding mothers. They act on the brain chemicals that are involved in mood regulation. Common side effects include dry mouth, nausea, dizziness, headaches and diarrhea. However, it is important to take note that they may take several weeks to take full effect, so patience and strict adherence to prescription are required.

In addition, making some adjustment to their lifestyle behaviour may help hasten their recovery. This include:

  • Getting extra help from family members or hiring maids/confinement ladies to look after the baby while they catch up with their much-needed sleep.
  • Exercise, going for a massage, meditating or attending yoga classes to help calm their emotions and enable them to sleep better
  • Joining support groups and sharing feelings with other mothers who went through a similar experience whereby they can offer advice and encouragement
  • Eating regular, nourishing meals
  • Being open to communication, allowing the mother to vent out negative feelings to people she trusts while also enabling her friends and family to detect depressing early and to seek treatment when necessary

Are mothers the only ones to experience PPD?

Interestingly, fathers do experience baby blues as well, seeing as there are reports that up to 25% of fathers experience a condition known as paternal postnatal depression (PPND)! The symptoms are similar to the ones experienced by women but may come more gradually in men. Studies are limited as to what causes dads to be depressed but the dominant hypothesis suggests changes in hormones including testosterone, estrogen, and cortisol may be biological risk factors in PPND. Moreover, they may be at higher risk of developing PPND if their partner is also suffering from depression. Treatment modalities are more or less the same as maternal PPD.

In summary, postpartum depression is a serious condition that cannot be taken lightly as it can affect anyone (including fathers!).  Health personnel, friends and family play an important role in providing new mothers with the support and care they need and identifying early symptoms of depression. The most important message that I would like to convey to mothers who are having symptoms: you may feel somehow responsible for having PPD, but depression does not happen because of something you did or didn’t do. Seek help early! It can be overcome through treatment.