Postpartum Depression Definition: 9 Risk Factors

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Postpartum Depression Definition

Postpartum depression is a mood disease that begins after childbirth in some women and usually lasts at least six weeks.

Description

Postpartum depression definition, or PPD, affects nearly 20% of all childbearing women.

The depression symptoms begin gradually and can persist for many months or occur a second time after a subsequent pregnancy.Postpartum Depression Definition

Mellow to moderate cases are sometimes unrecognized by women who have postpartum depression. Many women feel ashamed and might obscure their difficulties.

It is a serious problem that disrupts women’s lives and can affect the baby, other children, partners, and other relationships.

Up to 10% of fathers also are said to have a type of postpartum depression.

Postpartum depression might begin soon after delivery or later. Early-onset PPD often appears like the “blues,” a benign, short episode during the first few days or weeks after birth. 

Throughout the first week after the birth, up to 80% of mothers face the “baby blues.”

This term is usually a period of extreme sensitivity; symptoms combine tearfulness, irritability, anxiety, and mood swings, which tend to peak between 3 to 5 days after child delivery.

The symptoms usually vanish within 2 weeks with no need of requiring particular treatment aside from understanding, support, skills, and practice.

Certain depression, fatigue, and anxiety episodes may fall inside the “normal” span of reactions following birth.

Late-outbreak PPD shows a couple of weeks after childbirth. It associates with slowly spreading sensations of sadness, depression, shortness of energy, chronic fatigue, inability to sleep, swings in appetite, significant weight loss or gain, and difficulty caring for the baby.

Demographics

There is a 20–30% risk chance of postpartum depression for women who experienced previous depressive onset that was not connected with pregnancy. 

Plus, there is an increased risk of recurrence in subsequent pregnancies since more than half of patients will have more than one episode.

Causes and Symptoms

The cause of postpartum depression has been studied extensively.

Changes in hormone grades of prolactin, progesterone, estrogen, and cortisol are not meaningful diverse from those of patients not suffering from postpartum depression. 

Anyhow, some research indicates a change in a brain chemical that controls the release of cortisol.

Research has indicated that postpartum depression is not likely to develop in a subject with usually psychologically non-complicated pregnancy and former history.

There is no connection between postpartum depression with the marital condition, social status, or the number of children born.

Anyhow, there seems to be an increased chance to develop this disorder after pregnancy loss.

A 2017 study by neuroscientists at Tufts University School of Medicine in Boston appeared to find a cause.

The researchers tied depression to disturbance of the neuroendocrine, or stress, a system in mice.

A stress response normally in the mice is blunted to help protect offspring from stress at birth.

The research suggests that something goes wrong with this stress system in women with postpartum depression, but more research is needed to find markers that tell which women are more likely to get the depression.

Some characteristics have been associated with an increased risk of developing postpartum depression. These risk factors include:

  • being unmarried or lacking in emotional support from a partner or family
  • suffering separation from one or both parents in childhood or adolescence
  • a history of depression or bipolar disorder
  • symptoms of depression during a previous pregnancy
  • poor relationship with husband or boyfriend
  • economic problems or other stressful events, such as domestic violence or death of a loved one
  • medical complexity during childbirth such as premature delivery
  • abuse of alcohol or drugs
  • family past of depression or other mood disorder

Even if identifying a physical cause of depression might be near, some women are more vulnerable to depression because their child is born prematurely or with medical problems.

Fresh mothers usually experience a few degrees of depression amid the first week’s post-birth. Pregnancy and birth are followed by abrupt hormonal swings that impact feelings.

Furthermore, the 24-hour liability for a newborn baby presents a vital psychological and lifestyle adaptation for most mothers, even after the firstborn child.

Both physical and emotional strain is commonly associated with unequal rest till the baby’s routine stabilize, so exhaustion and depression are not common.

Adding to hormonal changes and disorder of sleep, particular cultural expectations seem to place women of those cultures at heightened risk of postpartum depression. 

For instance, women who bear daughters in societies with a strong preference for sons (such as Communist China) are at high risk of postpartum depression.

In another culture, an affected relationship with the husband’s family is also a risk factor. 

In the Western hemisphere, domestic violence is aligned with an increased rate of PPD.

Incidents of PPD vary considerably but usually include several symptoms.

Feelings:

  • continuous low mood
  • inadequacy, failure, hopelessness, helplessness
  • exhaustion, emptiness, sadness, tearfulness
  • guilt, shame, worthlessness
  • confusion, anxiety, and panic
  • fear for the baby and of the baby
  • fear of being alone or going out Behaviors:
  • lack of interest or pleasure in usual activities
  • insomnia or excessive sleep, nightmares
  • not eating or overeating
  • decreased energy and motivation
  • withdrawal from social contact
  • poor self-care
  • inability to cope with routine tasks

Thoughts

  • inability to think clearly and make decisions
  • lack of concentration and poor memory
  • running away from everything
  • fear of being rejected by the partner
  • worry about harm or death to partner or baby
  • ideas about suicide

Certain symptoms might not indicate a serious problem. Anyhow, permanent low mood or lack of interest or pleasure in activities, along with 4 other symptoms appearing together for a period of at least two weeks, indicate clinical depression and require adequate treatment.

Diagnosis

Diagnosis of postpartum depression involves an interview of the patient by a medical provider or mental health provider to assess symptoms.

The professional might ask the mother about thoughts and feelings and take a detailed personal history.

A psychologist or psychiatrist can consult to determine risk factors and diagnose the condition.

The Diagnostic and Statistical Manual of Mental Disorders classifies postpartum depression with bipolar disorders or depression but clarifies that the depression begins after giving birth.

A comprehensive psychological assessment interview could reveal a previous depressive cycle or a family history of depression—important risk factors.

Besides, nearly half of women with postpartum depression show symptoms such as anxiety or panic attacks before the infant is born.

The highest widely used standard for diagnosing the Edinburgh Postnatal Depression Scale (EPDS).

 This is a plain and short ten-question scale. A result score of 12 or greater on the EPDS is considered a high risk for postpartum depression.

Treatment

A few treatment options exist, including medication, psychotherapy, counseling, and group treatment and support strategies.

Medication should begin as soon as the diagnosis is established. One effective medication combines anti-depressant medication along with psychotherapy. 

These sorts of medication are frequently effective when applied for three to four weeks. 

Any medication usage must be carefully considered if the woman is breastfeeding, but with some medications, continuing breastfeeding is safe.

There are many classes of antidepressant medications.

Two of the most commonly prescribed for PPD are selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft), and tricyclics, such as amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), and nortriptyline (Aventyl, Pamelor).

Nevertheless, medication alone is not sufficient and should always be accompanied by counseling or other support services. Also, many women with postpartum depression feel isolated.

These women need to know that they are not alone in their feelings. There are various postpartum depression support groups available in local communities, often sponsored by non-profit organizations or hospitals.

For women who have thoughts of suicide, it is imperative to seek help immediately.

If medications are mixed with psychological therapy, the rates for successful treatment are elevated.

Interpersonal therapy and cognitive-behavioral therapy are found to be effective. In 2017, a study revealed that the most effective treatments offer options specific to each woman’s circumstances.

Adjunct therapies such as Acupuncture, traditional Chinese medicine, yoga, meditation, and herbs may be considered to help the mother suffering from postpartum depression.

Some strategies that can aid fresh mothers deal with the stress of parenthood include:

  • valuing her role as a mother and trusting her own judgment
  • making each day as simple as possible
  • avoiding extra pressures or unnecessary tasks
  • trying to involve her partner more in the care of the baby from the beginning
  • discussing with her partner how both can share the household chores and responsibilities
  • scheduling frequent outings, such as walks and short visits with friends
  • sharing her feelings with her partner or a friend who is a good listener
  • talking with other mothers to help keep problems in perspective
  • trying to sleep or rest when the baby is sleeping
  • taking care of her health and well-being

Exercise, including yoga, can help enhance a new mother’s emotional wellbeing. Fresh mothers should as well try to cultivate solid sleeping habits and also learn to rest if they feel physically or emotionally exhausted.

A woman needs to learn to recognize her own warning signs of fatigue and respond to them by taking a break.

Prognosis

When a woman has supportive friends and family, mild postpartum depression usually disappears quickly.

If depression becomes severe and a mother cannot care for herself and the baby, she might have to be hospitalized briefly.

Medication, counseling, and support from others usually resolve even severe depression in three to six months.

The prognosis for postpartum depression is better if it is detected early during its clinical course, and a combination of SSRIs and psychotherapy is available and initiated.

Prevention

Mothers should be advised before leaving the hospital that if the “maternity blues” last longer than two weeks or pose tough difficulties with family interactions, they should call the hospital where their baby was delivered and pursue a referral for a psychological evaluation.

Education concerning risk factors and the reduction of these is important.

Prophylactic (preventive) use of SSRIs is indicated two to three weeks before delivery to prevent the disorder in a patient with a history of depression since recurrence rates are high if the mother had a previous depressive episode.

Resources

Postpartum depression definition

BOOKS

Cowan, Kristina. When Postpartum Packs a Punch: Fighting Back and Finding Joy. Amarillo, TX: Praeclarus Press, 2017.

Kleiman, Karen. The Art of Holding in Therapy: An Essential Intervention for Postpartum Depression and Anxiety. New York: Routledge Publishers, 2017.

PERIODICALS

Abdollahi, Fatemeh, et al. “Perspective of postpartum depression theories: A narrative literature review.” North American Journal of Medical Sciences, vol. 8, no. 6, 2016, p. 232.

Gutierrez-Zones, Alfonso, et al. “Coping strategies for postpartum depression: a multi-centric study of 1626 women.” Archives of Women’s Mental Health, vol. 19, no. 3, 2016, p. 455+.

Hadfield, H., and A. Wittkowski. “Women’s Experiences of Seeking and Receiving Psychological and Psychosocial Interventions for Postpartum Depression: A Systematic Review and Thematic Synthesis of the Qualitative Literature.” Journal of Midwifery and Women’s Health 62, no. 6 (2017): 723–36.

Kumar, Sheena V., John L. Oliffe, and Mary T. Kelly. “Promoting Postpartum Health in Fathers: Recommendations for Nurse Practitioners.” American Journal of Men’s Health (November 1, 2017) [epub ahead of print]. Also available online at http://journals.sagepub.com/doi/pdf/10.1177/1557988317744712 (accessed January 3, 2018).

WEBSITES

Grohol, John M. “Postpartum Depression.” Psych Central. October 4, 2017. https://psychcentral.com/disorders/postpartum-depression (accessed January 3, 2018).

Pietrangelo, Ann. “Postpartum Depression: Symptoms, Treatment, and More.” Healthline. December 7, 2016. https://www.healthline.com/health/depression/postpartum-depression (accessed February 7, 2018).

Postpartum Depression.” MedlinePlus. October 11, 2017. https://medlineplus.gov/postpartumdepression.html (accessed February 7, 2018).

Postpartum Depression Facts.” National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml (accessed January 3, 2018).

ORGANIZATIONS

National Institute of Mental Health, 6001 Executive Blvd., Room 8184, MSC 9663, Bethesda, MD 20892, (866) 615-6464, http://www.nimh.nih.gov.

Postpartum Support International., 6706 SW 54th Avenue, Portland, OR 97219, (503) 894-9453, (800) 944-4773, http://www.postpartum.net .fvv