What is postpartum depression?

Having a baby is such an exciting experience but tiring and overwhelming as a parent. It's quite common to feel worried or unsure of yourself if it is your first child. Still, if your feelings of sorrow or loneliness are severe and your mood swings or you often cry, you could have postpartum depression.

Postpartum depression, or PPD, is a form of depression that occurs after childbirth. People often think of postpartum depression affecting the mother who has delivered the baby. However, PPD affects surrogates and adoptive parents as well. For most people, changes occur within their body, in their relationships, financially, physically, emotionally, and socially. These changes can cause symptoms of PPD.

If you are experiencing postpartum depression, remember that you are not alone; it is not your fault and help is out there. Your healthcare provider can treat your symptoms and get you to a better place.

How many classes are there for postpartum depression?

There are three forms of postpartum mood disturbance:

• Baby blues or postpartum blues: This postpartum mood disturbance affects around 50%-75% in women and appears as an increased incidence of unrelated crying episodes, sadness, and anxiety. Symptoms develop in the first week after childbirth and remit themselves within two weeks after unmedicated treatment. The support network should consist of friends, family, and partners.
• Postpartum Depression: Around 1 in 7 new parents experiences postpartum depression, which occurs about one-third of the time during a single pregnancy. Signs include alternating highs and lows, crying spells and irritability, fatigue, guilt and anxiety, and in severe cases, the inability to care for the baby or oneself. It is effectively treated with psychotherapy and/or antidepressants.
• Postpartum Psychosis: Postpartum psychosis is the much worse version of very severe postpartum depression. It occurs among 1 in 1000 individuals post-delivery. Symptoms include agitation, confusion, the feeling of hopelessness, insomnia, paranoia, delusions, hyperactivity, and manic behavior such as increased energy levels. It is uncommon and requires immediate medical attention as there is a higher degree of suicidal and baby harm risk.

Who is affected by postpartum depression?

It is very common to have postpartum depression. As much as 75% of people suffer from baby blues after having their babies. Of these, about 15% go on to develop postpartum depression. One in 1,000 people develop postpartum psychosis.

What are the symptoms of postpartum depression?

Most of them feel that they are terrible parents or feel ashamed about symptoms. Postpartum depression is common, as if you are not alone in this way. It does not signify that you are a bad person.

Someone may have postpartum depression if that someone experiences some of the following:

• Feeling sad, worthless, hopeless, or guilty
• Worrying too much or feeling anxious.
• Losing interest in things you loved doing.
• Changes in your eating habits or refusal to eat.
• Loss of energy or motivation.
• Difficulty sleeping or having a desire to sleep more.
• Crying for no reason at all, and maybe you cannot stop crying.
• Difficulty in concentrating your mind.
• Thoughts that you would rather die.
• Avoiding your baby or feeling scared around your baby.
• Thoughts of harming your baby or you feel you no longer want your baby.

If you think you have postpartum depression, contact your doctor. This can be your obstetrician, primary care provider or mental health provider. Your baby can also get help from their pediatrician.

What causes postpartum depression?

The relation between the dramatic fall of hormones after delivery and depression has to be more researched. Tenfold increases occur in levels of estrogen and progesterone during pregnancy but rapidly fall after delivery. These hormones' levels come back to the pre-pregnancy stage by three days postpartum.

Other than the chemical changes, having a baby is associated with many social and psychological changes, all of which increase the risk of postpartum depression. Such changes include changes in the physical form of your body, loss of sleep, and fear about parenting or changes in your relationships.

If you have had any of the following symptoms, report them to your healthcare provider immediately.

• Thoughts about harming yourself or your baby.
• Recurrent thoughts of death or suicide.
• Depressed mood most of the day, almost every day for the last two weeks.
• Feel anxious, guilty, hopeless, scared, panicked, or worthless.
• Difficulty thinking, concentrating, making decisions, or functioning in other ways.
• Loss of interest or pleasure in most activities, nearly every day, for at least two weeks.

How is postpartum depression diagnosed?

There is no one test that will diagnose postpartum depression. Your provider will assess you during your postpartum visit. This may include talking about your history of health, how you have felt since giving birth, a physical examination, pelvic examination and laboratory studies. Most providers schedule postpartum visits at two to three weeks after delivery in order to screen for depression, so you can be seen and get the support you need right away.

They may conduct a depression screening or ask you a set of questions to evaluate whether you have postpartum depression. They will ask how you are feeling and how your baby is doing. Openly communicate with your provider to ensure that they can obtain an accurate picture of your emotions and thoughts. They can differentiate between normal feelings and symptoms of postpartum depression.

Your doctor may request a blood test. Postpartum depression can have symptoms that mimic many types of thyroid disorders.

Remember, your doctor is there to support and care for you, keeping you healthy. So go ahead and be honest-there is no judgment made. You are not the only one who feels the way you do.

What does a doctor do to screen for postpartum depression?

It may be difficult to recognize mild cases of postpartum depression. Healthcare providers rely on your answers to their questions.

Many healthcare providers use the Edinburgh Postnatal Depression Scale as a screening tool for postpartum depression. The Edinburgh Postnatal Depression Scale contains 10 questions, most of which have a connection to symptoms of depression: feeling unhappy, anxious or guilty. You're asked to check the response that comes closest to how you've felt the last seven days. A higher score means possible postpartum depression.

In case your provider detects that you have postpartum depression symptoms, then they will treat you appropriately.

How is postpartum depression treated?

Postpartum depression is treated based on the particular symptoms and their severity. For example, treatment may involve anti-anxiety or antidepressant medicines, psychotherapy (talk therapy or cognitive-behavioral therapy), and participation in support groups.

Medications used for treatment of postpartum psychosis may include those that treat depression, anxiety, and psychosis. In addition, you may also get admitted to a treatment facility for several days until you are stable. However, if you don't respond to this treatment, then electroconvulsive therapy (ECT) may prove useful.

If you are breastfeeding (or chestfeeding), prescription for medicines that will manage your symptoms of depression, anxiety, or even psychosis will not be ruled out. Consult your health care provider for options.

What antidepressants can I take for postpartum depression?

While some antidepressants may be prescribed by your health care providers to help alleviate some of your postpartum depression symptoms, antidepressants are used predominantly to balance the chemicals in one's brain that affect the moods.

If you're breast feeding, talk to your healthcare provider about the risks and benefits of taking an antidepressant. Medications transfer to your baby through your milk. However, the transfer level is generally low, and many antidepressant medications are considered safe. Your provider can help you decide what medicine is right for you based on your symptoms and if you're nursing.

Here are some of the commonest antidepressant forms that are given in cases of postpartum depression:

• Selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft®) and fluoxetine (Prozac®).
• Examples of serotonin and norepinephrine reuptake inhibitors (SNRIs) are duloxetine (Cymbalta®) and desvenlafaxine (Pristiq®).
• Bupropion (Wellbutrin® or Zyban®).
• Amitriptyline (Elavil®) or imipramine (Tofranil®).

Understand that antidepressant medications typically take a minimum of three to four weeks to spend their effects. Before stopping medication, it is essential to talk to your health professional regarding it. Stopping medications too soon may cause symptoms to resurface. Most providers will recommend tapering the dose before actually stopping.

If your provider finds that you have postpartum depression while still in the hospital, t he next step perhaps would be starting you up on IV brexanolone.

What happens if you don't treat postpartum depression?

Untreated postpartum depression is hazardous and affects you, your baby, and those who love you. It can make you:

• Feel drainedof energy
• Moody
• Believe that you can't take care of your baby
• Inabilityto focus or make decisions
• Thoughts of harming

Can postpartum depression be prevented?

Postpartum depression is not entirely preventable. Knowing warning signs of the condition and what risk factors you have can go a long way. The following tips may help prevent postpartum depression:

• Reasonable expectations for self and infant.
• Try to limit the number of visitors for the first few days at home.
• Ask for help from others — spread the word about what kind of help you can use.
• Sleep when the baby sleeps.
• Walk and get outside for some sun and fresh air.
• Stay in touch with family and friends — don't become isolated.
• Nurture your relationship with your partner — visit each other.
• Much good and bad is at least to be expected.

What is the prognosis for women with postpartum depression?

With appropriate treatment, virtually all patients with postpartum depression are able to overcome their symptoms.

When should I consult a doctor for symptoms of postpartum depression?

You should consult a doctor if:

• Symptoms continue beyond two weeks.
• You cannot function normally or deal with daily situations.
• You have ideas of harming yourself or your baby.
• You are feeling extremely anxious, fearful and panicked much of the day.

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