Managing post-partum depression

MANY women, in the days or week immediately following childbirth, experience an emotional roller coaster — from feelings of anxiety and frustration to unexplained crying and loss of appetite, and sometimes difficulty sleeping.

For others, obstetrician gynaecologist at ICON Medical Centre, Dr Keisha Buchanan, said a similar group of symptoms is experienced with greater severity and over much longer periods, sometimes resulting in desires to selfhurt and abandon or hurt the newborn if it goes undetected and untreated.

“Post-partum depression (PPD) is a mood disorder that is associated with pregnancy and childbirth. It develops after having a baby and usually develops within the first week to a month after delivery.

PPD can affect both males and females, but is much more common in females with an incidence of approximately 15 per cent reported,” Dr Buchanan said.

She said that the condition — which is associated with low energy, unexplained crying, a feeling of hopelessness, sadness, irritability, insomnia or hypersomnolence (recurrent episodes of excessive daytime sleepiness or prolonged night-time sleep), changes in appetite such as excessive eating or anorexia and under eating — can severely affect bonding between mother and child as well as breastfeeding.

Other symptoms of PPD include sadness, mood swings, anger, frustration, a feeling of inadequacy, low self-esteem, shame and worthlessness, feeling overwhelmed and unable to care for the baby.

There may also be a feeling of being unable to manage the situation, a feeling of guilt, a hollow feeling, and continuous exhaustion. “In addition to those symptoms, the woman may also become socially withdrawn, having a lack of interest in social activities.

There may also be a lack of self- care, low libido, low motivation to do day-to-day tasks such as work or caring for the baby or household chores.

There is also the possibility of no sexual appetite, deterioration in the relationship with the spouse or family, the ability to concentrate and to make decisions may be affected, memory lapses may occur frequently affecting day-today function, as well as the mother may feel a sense of an inability to care for her baby or a fear of harming the baby,” Dr Buchanan shared.

She explained that while the reasons for the offset of depression may vary, some natural and genetic factors may increase the risk of development.

“Post-partum depression can stem from the natural withdrawal of hormones from the body that occurs with childbirth and the physical stresses of insomnia that occurs with childbirth.

Factors which increases a woman’s risk of developing the condition postchildbirth include a prior history of depression or post-partum depression, anxiety disorder, a family history of mental illness, substance abuse such as cocaine or alcohol use, a complicated pregnancy, death of the foetus or infant, domestic abuse, or an unsupportive spouse or lack of a supportive family,” Dr Buchanan outlined.

But even with the increased possibility of the new mother developing the illness, Dr Buchanan said that prevention, even in the case of geneticrelated risks, is attainable.

“A simple screening test called the Edinburgh Depression Score can be done during pregnancy to discover patients at risk for post-partum depression. It can also be done after pregnancy to help to identify patients who have post-partum depression. This screening test is a 10-point questionnaire which gives the medical practitioner an idea of your mental state,” Dr Buchanan explained.

In addition to this, health-care professionals will also need to identify other risk factors for depression such as a prior history or family history of depression, and social factors such as lack of spousal support or domestic abuse.

This type of information, Dr Buchanan pointed out, will facilitate putting steps in place to provide intervention which will contribute to preventing depression.

She notes early intervention, in particular, is very important and some of the things that family can do include assisting with the baby’s care, nannies or nurses visiting and assisting, and providing counselling groups for the mom.

Pharmacological and nonpharmacological treatments can be explored especially when support and counselling doesn’t work or when dealing with more severe cases of postpartum depression, which takes the form of psychosis and involves scenarios where the mother desires to harm, abandons, or acts on the desire to abandon or harm the baby.

“Treatment of depression includes non-pharmacological and pharmacological. Interpersonal psychotherapy, cognitive behaviour therapy, home visits, counselling groups and meditation are included in non-pharmacological therapy.

Exercise can elevate mood and is encouraged in treating post-partum depression as soon as exercise can be done post-delivery.

Some alternative therapies may be beneficial, including massage therapy and acupuncture. At times medication will be needed to improve mood or assist with insomnia,” Dr Buchanan advised.

In extreme cases, where depression does not respond to other forms of therapy, medical professionals may resort to electroconvulsive therapy.

This is a procedure in which a shock wave is applied to the brain to induce short seizures. Though often used as a last resort, the treatment is completely safe post-delivery.