Postpartum Depression

Postpartum period is mentioned as the most sensitive and is regarded as a time of high risk for various psychiatric disorders. One of these emotional disturbances is postnatal depression. Accumulated fatigue, lethargy, the lack of sleep, the lack of real understanding and effective help from friends and relatives, poor emotional background mood – these are symptoms of the state which have the majority of young mothers.

Wolman W., Chalmers B., Hofmeyr J., and Nikodem V. (1993) define postnatal depression as a state of depression, despair, emptiness, indifference to everything that appears in women shortly after childbirth and lasts from three days to several months and may occur over several years.

Psycho-emotional disorders associated with childbirth may be divided into three main categories: postpartum stress, postpartum depression, and postpartum psychosis (Murray & Cooper, 1999). These conditions were described since the dawn of medicine, but only in recent decades, they have become the object of serious researches and practical health care developments. It should be noted that although 80% of women may experience mood swings during both prenatal and postnatal periods, only 10-20% of these mood changes reach the degree of severity when they can be qualified as a so-called affective-disorder (Murray & Cooper, 1999).

 Postpartum stress or baby blues is observed in 50-70% of women. Its symptoms appear on the third day after birth, most evident on the fifth – seventh day (which coincides with the peak of hormonal shift) and, in most cases, disappear by tenth – twelfth day (Rosenfield, 2006). Women experience mood swings, often cry, become anxious, restless or irritable and have sleep disturbances. Why do emotional lift and euphoria arising immediately after birth in the vast majority of women replaced by lower mood, confusion, anxiety, uncertainty, and sadness appear on the third day after birth? Fast and powerful changes in hormonal levels are traditionally regarded as the leading biological cause. Psychologically, after a long time of pregnancy, a woman gets used to her condition and after birth, a sense of loss of something important and valuable occurs. For the woman, who becomes a mother for the first time, a new role carries with it new responsibilities, anxieties, and worries. If we consider in this case the existing physical discomfort - pain after episiotomy, bloating and breast tenderness, nausea, then emotional discomfort becomes clearer (Rosenfield, 2006).

The causes of postnatal depression are different. These disorders occur as a result of hormonal changes, increased physical activity, individual characteristics, and changes of personality during the period of adaptation to new social and psychological conditions.

The neurotic state of a woman links to powerful hormonal changes in the body both during pregnancy and after childbirth. Because of hormonal changes, there are tearfulness, mood swings, fatigue, anxiety, sleep disturbances, the lack of adequate response to the words of others (due to the high inability of the nervous system) during the postnatal depression. All of these superimpose with a constant strain of worrying about the child, the lack of sleep and a perfectly natural concern for the baby. Hormones in the body are directly related to the emotional state and psychological factors (Murray & Cooper, 1999). Psychological factors have a direct impact on the mother after birth. Having a baby is a period of global changes, both biological and life cycle associated with the advent of a new social role.

Immediately after birth, the hormonal balance is disturbed. Levels of progesterone, estradiol, and free estriol drop dramatically, as much as 90-95% (Murray & Cooper, 1999). Hormonal factors play a very important etiological role in postpartum depression. The level of thyroid hormones also decreases sharply which leads to fatigue, a sense of losing oneself and, as a consequence, to depression. Research by Rosenfield (2006) suggests that thyroid dysfunction may be sequelae of the rigors of pregnancy as 40% of women had abnormally high levels at 6 weeks postpartum and 5% developed thyroid abnormalities. Postpartum depression was identified in 38% of a sample of women who developed postpartum thyroid disorders which was resolved by thyroid treatment. Changes of metabolism and blood pressure also have a negative impact on a mental state of a young mother after birth. The change of hormonal status, which usually stabilizes within the first week after birth, has a strong effect on the nervous system that affects the well-being, mood, and psycho-emotional state of women. Of course, it depends on personal characteristics, the woman’s temper, and her ability to respond to what is happening around her.

There is no particular age or other criteria that would determine the susceptibility to postpartum depression. Women of all ages are exposed to it. It does not also depend on how many times the woman becomes a mother. It can occur after the birth of the first or the fourth child. Especially the following symptoms are disposed to postpartum depression: diathesis to depression in family and cases of postpartum in particular, such experience after giving birth in the past, heavily following premenstrual syndrome, the lack of appropriate care and support from a husband or a partner, mental illness, severe stress during pregnancy or after childbirth, alcoholism, separation from the child immediately after birth (Rosenfield, 2006)

 From the normal temporary depression which occurs during the first days after childbirth postpartum depression is deeper and more lingering. There is a gradual fading of the main symptoms and a tendency to chronic course in the future since the disease is not recognized; and neither the mother nor her surroundings consider it should be treated as the birth of a child, by definition, must be a happy event. Approximately 20% of women even a year after the birth of a child are still in the doldrums (Murray& Cooper, 1999).

In most cases, postpartum depression remains undetected during the initial period. At the same time, depression can grow for several months, and treatment of this condition is delayed until the appearance of indications for emergency hospitalization. Symptoms of postpartum depression correspond to diagnosis criteria of depressive disorders. The patient suffers from worsening of mood, reduction of energy, activity, and inability to be happy. Fatigue, even after minimum effort, is usual. Self-esteem and self-confidence are almost always reduced, even in the slightness forms of the disease. Thoughts of guilt and worthlessness may appear. Low mood does not depend on the circumstances and may be accompanied by symptoms such as loss of interest and loss of pleasurable sensation. The awakening in the morning for a few hours earlier than usual, increased depression in the morning, marked psychomotor retardation, anxiety, and loss of appetite, weight loss, and decreased libido are also usual symptoms of postnatal depression (Wiegartz & Gyoerkoe, 2009).

The major consequence to a woman of having experienced a postpartum depression is a risk for future depression. Murray& Cooper (1999) reported that 80% of postpartum depressed women experienced a subsequent major or minor depression during a 4 and a half year follow-up compared to 42% of postpartum non-depressed women.

One of the typical signs of postpartum depression is a complete failure of mothers to seek help. This can be explained by a deep sense of guilt that they feel when faced with difficulties related to child care. Many mothers expect that "mother love" with which they will be covered after birth will solve the problems of adaptation to the child, whereas the formation of this relationship depends on long-term (several months) mutual learning. Mothers become frustrated, which can lead to feelings of guilt that form the basis of depression. In addition, some mothers believe that they are the only ones who should take care of their children. Daily care of them require physical and mental strength and cause a feeling of helplessness, the increasing isolation. New moms often doubt their ability to handle the challenges of motherhood (Clark, 2010).

 The easier pregnancy is tolerated, the quieter post-partum period will be. It depends on the degree of psychological preparedness to childbirth and how it was successful. An important factor is the support of the husband, relatives, and friends. This will determine how the adaptation to the new way of life and rehabilitation after psychophysiological stress and hormonal crisis will host.

Postpartum depression can be treated with the help of psychological counseling and antidepressants (Wiegartz & Gyoerkoe, 2009). If depression is not very serious, antidepressants may not be necessary. Psychotherapy is a therapy for a woman and her partner. It is effective in treating not very serious depression. This therapy helps women control feelings and thoughts. It is based on the relationship between partners and their personal changes associated with childbirth. This treatment will give a sense of emotional support and help solve problems. More severe depression involves the prescription of antidepressants. There are modern antidepressants that are safe for breastfeeding women. Considering the nature of the pathogenesis of postpartum depression, we must assume that the probability of a positive therapeutic response to serotoninergic antidepressants is much higher than the predominantly noradrenergic tricyclic antidepressants. A woman should have a proper diet and perform daily physical exercises, have a good sleep and rest (Wiegartz & Gyoerkoe, 2009).

Children whose mothers suffer from depression do not feel the connection with the mother and can lag in behavioral and mental development (Murray & Cooper, 1999). Babies of moms who suffer from anxiety during pregnancy have been found more difficulty in new situations and behavioral and emotional problems in preschool years (Wiegartz & Gyoerkoe, 2009). It should be noted that emotional disorders, personality development, and self-esteem of children are closely linked with the state of the mother. So, very often, children whose mothers had postnatal depression have difficulty in expressing feelings and a tendency to depression and states of high anxiety. Early treatment of postpartum depression is not only important to the health of the woman, but also for the welfare of the child.