By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Postpartum Depression abbreviated as PPD is a kind of mood disorder and a type of depression. It comprises of a complex mix of physical, emotional and behavioral changes that occur in some women following the child birth. It also describes a range of physical and emotional changes which are experienced by new mothers. It usually begins within 4 weeks after delivery and is a form of major depression (DSM-5) and will not occur in all women. Combination of medication and therapy / counseling can be used to treat this condition effectively.
Read – Depression Causes, Ayurvedic Treatment, Tips And Remedies
Diagnosis of PPD is based on mainly 2 factors –
- length of time between delivery of the child and development of symptoms of depression
- severity of depression
PPD is linked to the following changes and influence that happen in a woman when having a baby –
- chemical changes – sudden and rapid drop in hormones post-delivery
- social changes (of having a baby)
- psychological changes (of having a baby)
Baby Blues and Postpartum Psychosis – Many new mothers experience the so called ‘baby blues’ after delivery of their child. Severe and long-lasting depression form is seen in 1 out of 10 women who experience ‘baby blues’ after delivery of the child. A more serious condition called postpartum psychosis has been seen to develop in about 1 in 1000 of these women. Research also shows that even 1 in 10 new fathers too experience depression during the first year of the birth of their child.
Read – Postpartum Afterpains – Causes, Symptoms, Treatment
Table of Contents
Signs and Symptoms
The below mentioned symptoms may be present in women following childbirth –
- Frequent changes in mood
- Severe fatigue
- Finding difficulty in sleeping
- Changes in appetite
- Low libido
Below mentioned symptoms are found along with other symptoms of major depression (not typical following childbirth) –
- not showing any interest towards the child
- absence of bond with the baby
- crying all time without any reason
- depressed mood
- feeling of helplessness, hopelessness and worthlessness
- finding trouble to make decisions or concentrating on things
- loss of pleasure
- severe anger
- thoughts of suicide / death
- thoughts of hurting others
Symptoms of OCD are rare in PPD. When present the obsessions are usually related to concerns about health of their baby or irrational fears of harming their own baby. Panic disorder may also occur.
Read – Obsessive compulsive disorder: Ayurvedic Treatment, Tips
When to take professional help?
One should seek professional help in the below mentioned conditions –
- symptoms should have been persisted for more than 2 weeks
- when she is not able to function normally
- she cannot cope up with day-to-day activities / situations
- she feels extremely anxious, scared or is in panic for most of the day
- when she develops thoughts of harming herself or her own baby
Read – Anxiety Tips, Ayurvedic Treatment, Herbs, Home Remedies
Causes, Risk Factors
The causative factors for PPD are different for different people. Below mentioned are some of the reasons which might raise the chances of PPD in a woman –
- having history of depression before pregnancy or during pregnancy
- younger age at the time of pregnancy
- ambivalence about pregnancy
- a woman having more children is more likely to be depressed in a later pregnancy
- having a strong family history of mood disorders
- undergoing stressful event (job loss, health crisis etc)
- having twins or triplets
- having child with health problems
- history of depression or PMDD (premenstrual dysphoric disorder)
- having limited social support
- singly living
- having conflicts in married life
The below mentioned physical and emotional issues may contribute towards the causation of PPD –
- Hormones – drastic drop in estrogen and progesterone after childbirth might play a great role in causation of PPD. Thyroid hormones also might drop sharply following childbirth. This might make the woman to feel depressed, tired, fatigued and sluggish.
- Deficit sleep (will cause trouble in handling the child)
- Anxiety (self doubt about caring the newborn child)
- Feel of having lost control over the life or struggle with her sense of identity
Read – Ayurvedic Post Natal Mother Care Based On Season And Place
Types of PPD
Baby Blues – might occur in about 70% women immediately after the child birth, for few days. The woman may experience sudden mood swings. This may include
- feeling very happy and then feeling very sad
- crying for no apparent reason
- feel impatient
- being cranky and restless
- being anxious and lonely
Baby blues usually last for few hours or 1-2 weeks after delivery. This condition usually doesn’t need treatment. Joining support groups or talking to other mothers would help in recovering from this condition.
Postpartum Depression (PPD) – This would happen a few days or even months after childbirth. This condition is not limited for the birth of first child but might also happen during or after next child birth. Similar symptoms as of those mentioned in baby blues may be experienced but in a stronger way. It might prevent the woman from doing the daily activities which she normally does. This condition needs medical attention and the woman needs to see a healthcare provider / mental healthcare professional if the PPD and its symptoms is affecting her ability to function. She may also consult experts like an obstetrician / gynecologist or primary care doctor. If PPD is not treated promptly the symptoms might get worse. It is a serious condition and needs to be treated with skillful combination of medication and counseling.
Postpartum Psychosis – It is a serious mental illness. It affects new mothers. It can happen within the first 3 months after childbirth. Women can get detached from reality and have auditory hallucinations, and delusions. Visual hallucinations may also occur but are less common. Other symptoms include –
- feeling agitated and angry
- strange feelings and behaviors
These women need immediate treatment and almost always need medication. Hospitalization may be required in cases wherein the women are at risk for hurting themselves or someone else.
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If PPD is not treated promptly it can weaken the ability of the mother to bond with her baby and might also affect her whole family. Untreated depression last for many months or even longer. It can even turn into a chronic depressive disorder. In spite of the PPD being treated it can make the woman more likely to have episodes and symptoms of depression in the future. The father of the new baby may also have depression just like the new mother. The problems of the mother may also envelop her children. They are more likely to have problems related to eating and sleeping. They are cranky and cry more than usual. Language development in these children is often delayed.
If the expectant mother has a history of depression she should intimate her doctor once she gets pregnant or as and when she plans to become pregnant.
During pregnancy the woman having depression or history of depression should be in touch with her doctor and intimate as and when she feels or experiences the symptoms of the disease. She can manage mild symptoms of depression with the help of support groups, counseling or other therapies. She might have to take some medications and her doctor might prescribe some medicines to manage the symptoms.
Once the baby is delivered she might plan for an early postpartum checkup with the help of her doctor. This will help her to lookout for her symptoms of depression and keep a check on it. The earlier PPD is diagnosed, the earlier her doctor can recommend and begin the treatment. Diagnosis and treatment should not be delayed at any cost and should be done as soon as possible. If the mother has a history of PPD her doctor may recommend treatment as soon as she delivers her baby.
Read – Counselling – Types, Benefits, Myths And Facts
- The woman should not hesitate to explain her problem and ask for help. She should allow others including her family to know that she has depression so that they can help her coping up with her condition.
- She needs to be realistic about her expectations towards herself and also towards her newborn baby.
- Exercise regularly, walk everyday and take break from regular household chores every day. Make time to step out of home and do some activities which interests her.
- She needs to know and expect that she might have some good days and some bad days. Accept the fact and face each day as and how it comes.
- Follow a wholesome and balanced diet. Avoid alcohol and caffeine.
- Do not stress. Take rest when baby sleeps.
- Do not stay alone and isolated. Be in company of family and friends.
- Screen and be choosy about phone calls.
- Limit the visitors and avoid over indulgence in unnecessary conversations with unwanted and toxic people. Avoid gossip mongers.
Read – 24 Stress Management Tips: Pranayama, Meditation, Lifestyle Changes
Treatment of PPD
- Medications – antidepressant or anti-anxiety medications
- Participation in a support group – for education and emotional support
- Intravenous administration of brexanolone in severe cases of PPD
- Drugs used to treat psychoses – added in cases of postpartum psychoses and hospitalization is done if necessary
Women may also need medication for depression, anxiety or psychoses even while breastfeeding. They need to talk to their doctor and should not refrain from medication or seeking help all by themselves.
Read – 9 Methods to Enhance The Effect Of Meditation On Your Mind And Body
Research on Postpartum Depression
One study shows that the financial difficulties, prematurity, lack of family support and poor marital relationships are the main risk factors for developing PPD. (Read more)
In a survey based research related to PPD symptoms using a new study model the findings indicated that 76% of variances stemmed out from a variety of factors which include socio-demographics, lifestyle, healthy food, unhealthy food and BMI. Since the prevalence of postpartum women with depression symptoms in the study was considerably high it was concluded that postpartum women seek medical help to prevent PPD symptoms from worsening. (Read more)
In another study it was found that a quarter of women in the study suffered from PPD. The independent predictors of PPD were found out to be marital status, unwanted pregnancy, unwanted infant sex, infant illness and low social support. Therefore integration of mental illness with maternal and child health care was found to be important. (Read more)
Ayurveda Concept of PostPartum Depression
PPD is also a depression. Depression is called as avasada or mano avasada in Ayurveda. It can also be treated on the lines of unmada / bhutonmada (psychoses), kaphavrita pitta and kaphavrita vata.
The other principles of treating this disorder will be on the lines of –
- Nidana parivarjana – keeping away the etiological factors which might cause or trigger episodes of depression
- Treating the mental disorders – manasika roga chikitsa
- Treating the contamination of mind channels – manovaha sroto dushti janya vikaras
- Measures to decrease tamo guna quality – since the increase in this quality causes depression
- Kapha balancing measures – since increase in kapha will have a depressive effect on all the activities of the body and mind and can cause depression
- Sattvavajaya chikitsa – mind strengthening therapies / counseling
- Daiva vyapashraya chikitsa – non medicinal remedies including meditation, prayers, penance, sacrifices and other rituals
- Medhya rasayanas – use of brain and nerve calming tonics
- Properly following the postpartum measures – sutika charya explained in Ayurveda and keeping a good bonding with her child