Postpartum depression or postnatal depression is a widespread problem occuring in the mother, but also affecting father and child.
INTRODUCTION
Postpartum depression is one of the most common problems occur in the women after giving birth to their offspring. A study has shown that in developed countries 10-20% of mothers were affected by PPD. It can be last for about a year (Beck, 2006). Postpartum depression not only affect mother, but it also imparts detrimental impacts on corporal and cognitive development of infants (Gaynes et al, 2005). It is proved that the older women having age 30 and more are at high risk of postpartum depressions as compared to women with 20 to 25 years old (Silverman et al, 2017).
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There are several factors that trigger the PPD, but the prolonged stress is the biggest cause of PPD, which accelerate the production of cortisol that eventually trigger the negative regulation of hypothalamic pituitary adrenal (HPA) via blocking of receptors. Not only this the impairment in HPA regulation disrupt the body’s capability to decrease the cortisol level (Aasheim et al, 2012).
SIGN & SYMPTOMS
It usually occurs in the first year of postpartum. Symptoms are divided into categories like Emotional, cognition & behavioral (“Postpartum Depression”, n.d.).
Behavioral
- Not able to perform daily activities
- Lack of energy
- Change or lack of appetite
- Sleep disturbance
- Fatigue
Cognition
- Inability to think
- Poor memory
- Inability to concentrate on a particular thing
Emotional
- Sadness
- Mood swings
- Numbness
- Guilt or shame
- Unable to have a good bond with baby
To meet social expectation, a mostly new mother ignores these signs which worsen their depression.
Postpartum depression can interfere with mother – infant relationship which can affect child development from acute to long term. Improper routine of feeding a baby, maintenance of health, not enjoying with baby can worse the bonding of mother – baby (Field, 2010).
CAUSES
There is no particular cause for postpartum depression. Change in hormones like estrogen, thyroid hormone, cortisol etc., (Soares & Zitek, 2008) can cause postpartum depression. Physical or social and emotional sign can elevate this depression.
Some risk factor like depression history ongoing in his/her family, prenatal depression, smoking, violence between mother and father, depletion in oxytocin, etc.,. Financial status of the family can also trigger this depression.
DIAGNOSIS
If symptoms like sadness, lack of energy, weight loss, change in appetite, insomnia, suicidal thoughts, lack of interest in daily activities, etc., occur in a period of 2 weeks then that person undergo for postpartum depression diagnosis.
The aim of doctor to rule out the baby blues A person with suspect PPD to complete depression screening questionnaire. If a person has yes to PPD symptoms. Then the person has mild PPD. The doctor also performs some diagnostic test such as a blood test. This test determines whether there are any hormonal problems such as those caused by an underactive thyroid gland or anemia.
TREATMENT
Medication for post-partum depression:
The primary step in treatment is to resolve the problems such as sleep and appetite changes. Antidepressants are common and effective for this. So, the use and choice of antidepressants must be careful. If a women is breastfeeding, then they do not use the antidepressants because it will concern to the infant toxicity. Some antidepressants ,including the serotonin uptake inhibitors like Paxil, Zoloft and Prozac. These have been associated with cranial or cardiac defects when women take early in the pregnancy. The use of antidepressants depends on the history of symptoms of the postpartum depression. Hormone therapy can also be used to treat PPD as estrogen level and progesterone level get imbalanced after delivery of a baby can trigger PPD (Johnson, 2018; Fitelson & Kim, 2010).
Psychological Therapies:
Cognitive Behavioral Therapy is successful in moderate cases of PPD. It is effective for only some people. This therapy is based on principle which deal with the thoughts that can trigger depression. In this therapy, individual is taught how to manage the relationship between state of mind and her thoughts. The main aim of this therapy to change the thoughts of a person. So, that they become positive. For more severe depression this therapy is less effective. It is only used for moderate PPD. Other therapy like interpersonal psychotherapy is also effective in treating PPD (Johnson, 2018; Fitelson & Kim, 2010).
Other like Electroconvulsive therapy (ECT), bright light therapy, massage, social support from family.
EMERGING RESEARCH IN PPD
There are many research ongoing on PPD. Identifying GABAA receptor for PPD, identification of biomarker are recent ongoing research on PPD. Therapy based research without any drug intervention is the hot topic ongoing today.
To treat PPD, there are many therapies but few of them show significant decrease of depression. One of researcher conducted an experiment on the intervention for management of PPD. For the study, mother population was taken who were in a period of 12 months after baby delivery. A tool used was a patient health questionnaire (PHQ-9) which act as primary care for patients (Reindolf et al, 2018).
PHQ-9 is divided into 4 sections that include characteristics, intervention duration and impact of interventions in reducing the depression. For the management of PPD following was used:
- Psychosocial support
- Home visits by professional
- Interpersonal psychotherapy
- Cognitive therapy
The result shows that cognitive therapy, interpersonal psychotherapy and home visit have no great impact on PPD whereas psychosocial support have a greater ability to reduce PPD (Reindolf et al, 2018).
References
- Aasheim, V., Waldenstrom, U., Hjelmstedt, A., Rasmussen, S., Pettersson, H., & Schytt, E. (2012). Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum. BJOG, 119(9), 1108-1116. doi: 10.1111/j.1471-0528.2012.03411.x
- Beck, C.T. (2006). Postpartum depression. The American Journal of Nursing, 105(5), 40-50.
- Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior and Development, 33(1), 1-6. doi: 10.1016/i.infbeh.2009.10.005
- Fitelson, E., & Kim, S. (2010, December 30). Treatment of postpartum depression: clinical, psychological and pharmacological options. International journal of women's health, 3, 1-14.
- Gaynes, B.N., Gavin, N., & Meltzer- Brody, S. (2005). Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Agency for Healthcare Research and Quality Evidence Report/Technology Assessment no. 119. Rockville, MD.
- Johnson, T. (2018, April 11). Understanding postpartum depression: Diagnosis and treatment. Retrieved from http://www.webmd.com
- Postpartum Depression. (n.d.). Retrieved from https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617
- Silverman, M.E., Reichenberg, A., & Savitz, D.A. (2017). The risk factor for postpartum depression: A population - based study. Depression and anxiety, 34(2), 178-187.
- Soares, C.N., & Zitek, B. (2008). Reproductive hormone sensitivity and risk for depression across the female life cycle: A continuum of vulnerability?. Journal of Psychiatry and Neuroscience, 33(4), 331-343.
- Reindolf, A., Enoch, A., Amy, B.A., Edmund, I.O., & Adjei, G.A. (2018). Prevalence of postpartum depression and interventions utilized for its management. Annals of General Psychiatry, 17, 18. doi: 10.1186/s12991-018-0188-0
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