Postpartum Depression

Postpartum Depression; Risk Factors, Diagnosis & Treatment

If you sense that you might have postpartum depression, you can read its symptoms to compare with yours and get help in the form of therapy.

PPD should never be confused with baby blues because the first one is a depressive disorder of the mind that is a complex mix of physical, emotional, and behavioral changes that happens in a woman after giving birth. The effects of PPD are severe and they can affect the whole family. PPD is prevalent enough that it creates problems with the infant that manifest over the course of life of the child.

So what causes PPD? How can it be diagnosed? What are the treatment options?

Risk Factors

The major risk factor is the mother’s history of anxiety and depression, personal notions about pregnancy, difficulty conceiving, multiple deliveries, difficulty feeding the baby, or have a colic baby puts you at a higher risk.

A traumatic pregnancy or birth is another risk factor for having PPD.

Major stressors like loss of job, financial hardship, expected divorce or strain in a relationship or even a move can impact your emotional health.

Mothers that have inadequate system of support from spouses and society tend to feel overwhelmed and alone which can lead to PPD.

Lastly, it can also occur if the relationship of the parents is not healthy and their ideas about having children are not in congruence.

Diagnosis

In order to avoid the severe outcomes of PPD, there are screening tests to detect depression during or after the pregnancy. Mental health professionals are better equipped at identifying PPD which can be hard to do due to the common baby blues symptoms but many women prefer to consult their gynecologists or primary care physicians. It is important for women to be better educated about their symptoms so they are better able to differentiate.

The screening test should be done after 4 weeks of delivery as it will easily rule out postpartum blues. The most successful screening tool is the Edinburgh Postnatal Depression Scale (EPDS) and it consists of 10 items and is in the form of a self-report. There are other screening tools available like Postpartum Depression Screening Scale (PDSS) and 9-item Physician’s Health Questionnaire (PHQ-9).  PPD can be hard to detect which is why you should consult with a Psychologist or a Psychiatrist.

Treatment Options

If you have PPD, your treatment options would vary depending on the degree of your depression. If you have mild to moderate PPD, you can look into psychotherapy but if you are suffering from moderate to severe PPD, we highly recommend that you consider pharmacotherapy as that is the best option for you.

For mild and moderate PPD, mothers will need to consult a psychologist who is licensed to practice psychotherapy. The most successful ways of treating mild PPD are Inter Personal Therapy, Cognitive Behavior Therapy and family therapy.

Interpersonal Therapy (IPT) will focus on any one of the mother’s 4 problematic areas of PPD i.e. changing of her role from a single woman to a mother, internal disagreement about the transition or deficiency of interpersonal relationship. IPT is effective enough that the mother will be able to see a difference in as few as 8 to 10 sessions of IPT.

Cognitive Behavior Therapy (CBT) might be a form of therapy that you have heard of before as it is very common and effective when it comes to treating depression. CBT will focus on changing the negative thought pattern and process of the mother about the world, herself and the child. It will help provide her with coping tricks and reduce her stress actively.

Family or group therapy has shown to work as it not only involves the mother but it focuses on strengthening the bonds of the family. It removes the isolation factor from the mother’s life and helps to create a strong social network for the mother to thrive in and get support from.

About 10% of women will have thyroiditis during the postpartum period. Thyroid disorders can cause anxiety and depression. In order to rule out thyroiditis, a thyroid test is recommended after six months postpartum if the woman is experiencing symptoms of depression or anxiety.

Omega-3 fatty acids have been shown to prevent and treat mild to moderate depression and anxiety in perinatal women at a dosage of 1000-3000mg combined DHA and EPA, and are considered safe for nursing. Some practitioners may recommend up to 9000mg depending on severity. They can be used along with psychotropic medications safely.

Recent research also supports the use of acupuncture, bright light therapy, and yoga as effective treatments of mild to moderate depression in pregnant and postpartum women. St. John’s Wort, has been shown to be effective in treating mild to moderate symptoms in postpartum women but warrants further research on safety during pregnancy. Other approaches include amino acid therapy. Both 5-HTP and SAM-E are evidenced based treatments for depression and anxiety and do not require a prescription. Like many anti-depressants, they have not been well studied in nursing women. Ask your healthcare provider for more information.

Severe PPD is not only harmful to the mother but to the infant as well because it might involve severe depressive symptoms along with suicide ideation. Mothers often do not want to take antidepressants because they do want to put their child at the risk of side effects but medication works the best in treating severe PPD. A psychiatrist would administer antidepressants in such a way that the child will run less of a risk of negative side effects. It is highly advisable that you attend each of your appointment so that your treatment can progress and your child can be observed to detect any early signs of side effects.


References

Fitelson, E., Kim, S., Baker, A. S., &Leight, K. (2011). Treatment of postpartum depression: clinical, psychological and pharmacological options. International Journal of Women’s Health, 3, 1–14. http://doi.org/10.2147/IJWH.S6938

Field T (2017) Postpartum Depression Effects, Risk Factors and Interventions: A Review. Clin Depress 3: 122. doi:10.4172/2572-0791.1000122

Ohara, M. W. (2009). Postpartum depression: What we know. Journal of Clinical Psychology, 65(12), 1258-1269. doi:10.1002/jclp.20644

Thurgood, S., Avery, D. M. & Williamson, L. (2009). Postpartum Depression (PPD). American Journal of Clinical Medicine. Retrieved from http://www.aapsus.org/wp-content/uploads/Postpartum-Depression.pdf

Thompson, K. S., & Fox, J. E. (2010, December). Post‐partum depression: A comprehensive approach to evaluation and treatment. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083254/

White, A. (N.A). PPD Treatment Options. Retrieved from http://www.aapsus.org/wp-content/uploads/Postpartum-Depression.pdf

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