"How much more grievous are the consequences of anger than the cause of it." Marcus Aurelius

July 24, 2018

Post-partum Depression

Post-partum Depression (courtesy of Maryville University)

Having a baby is typically described as a time of joy:

  • A time to celebrate a new little life that has been brought into this world.
  • A time to be thankful for the family unit that has now been increased by one or more.

However, for some women, this life-altering event brings about feelings that aren't quite as joyful, and begins a condition known as postpartum depression (PPD).

Postpartum Depression Defined

The National Institute of Mental Health (NIMH) defines PPD as a mood disorder that sometimes appears in women after giving birth. Additionally, they say that this disorder typically comes feelings of "extreme sadness, anxiety, and exhaustion," sometimes to the point where everyday activities are difficult to complete.

According to the American Psychological Association (APA), as many as one in seven women suffer from PPD, a condition that can present itself anywhere from a few days up to several months post-delivery. It has no boundaries, either, because it can affect any new mother without regard to her background, ethnicity, socioeconomic status, or whether it is her first time or fifth time giving birth.

It's important to note that feelings of sadness and anxiety directly after childbirth can occur without rising to the level of PPD. These are typically referred to as "postpartum blues." So, what's the difference?

Postpartum Depression Versus Postpartum Blues

One of the main differences is that the postpartum blues condition typically appears within 2-3 days of childbirth and disappears within a week or two, according to the American College of Obstetricians and Gynaecologists (ACOG). This is different than PPD, which generally sets in anywhere from one to three weeks post-birth but can take up to one full year before it presents itself.

Also, PPD often requires some type of intervention to begin to resolve, while postpartum blues generally disappears on its own. Additionally, the feelings associated with postpartum blues—sadness, anxiety, and being upset with the baby or a loved one—are usually much less intense than the feelings associated with PPD. With the latter, the new mother's emotions are typically fairly intense, possibly even reaching the point where they become totally debilitating.

Causes of Postpartum Depression

The ACOG says that there is no specific cause of PPD, but rather "a combination of factors." Some are physical and others are more emotional or mental in nature.
For example, the new mother's changes in hormones could act as a trigger for this mood disorder. Research has found that the reduction in oestrogen and progesterone that occur after delivery not only contribute to depression, but they are also linked to other cognitive changes as well. These include memory formation and difficulties related to learning.

Another factor that can increase depression risk is a history of depression, unsure feelings about the pregnancy, longer hospital stays, and general feelings of fatigue after giving birth, according to the ACOG.

The mother's life situation matters too, such as how much support she feels she has at home, whether she's had an illness or loss in her family that she's dealing with, or any other major life changes that have recently occurred. All of these situations can impact her emotional state post-delivery.

Postpartum Depression Symptoms

How does a new mother know if her postpartum blues is likely to go away on its own or if it's at the level of being classified as PPD?

The APA says that while "warning signs are different for everyone," some of the more common PPD symptoms include:

  • Extreme changes in eating behaviours, whether it's much more or less than usual
  • Feelings of anxiety almost all of the time, and sometimes experiencing full-blown panic attacks
  • Being excessively irritable or angry
  • Having fears associated with not being able to properly care for the child
  • Trouble getting and/or staying asleep, or sleeping too much
  • A sudden loss of interest in activities you used to enjoy
  • A lack of interest in caring for the child or spending time with family and friends
  • Having "scary thoughts" that include hurting yourself or your child

Postpartum Depression Treatment Options

If you or someone you love is struggling with PPD, what can be done? Fortunately, there are many options.

The first involves understanding that there is nothing you did that brought about this level of depression. Or, as the APA states, you must realize that "postpartum depression is not your fault—it is a real, but treatable, psychological disorder." In other words, don't belittle yourself if you believe you have PPD because it isn't a condition that appears due to something you did wrong or didn't do pre or post-pregnancy. It just happens sometimes.

Therapy can also help. The NIMH says that two types of counselling or talk therapy that often provide positive results are cognitive behavioural therapy (CBT) and interpersonal therapy (IPT).

CBT helps by increasing your awareness of your negative thoughts and behaviours, and then helps you work on changing them.

IPT is more relationship focused. It gives you a greater understanding of issues that may exist with those around you so you can find effective ways to resolve them.

Another option is medication.
According to Medicine Net, antidepressants can often help relieve the sometimes intense levels of depression that appear after giving birth, offering positive effects for two-thirds of the women who are prescribed them. Some of the most common antidepressants include fluoxetine (Prozac), sertraline (Zoloft), Paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), bupropion (Wellbutrin), venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq), but there are also several others.

It typically takes anywhere from one to six weeks for these medications to build up in the body enough to provide an improvement in mood, so Medicine Net recommends giving it at least that amount of time before stopping or changing to a new medication regimen. Also, if the prescription is an MAOI (monoamine oxidase inhibitor), it should not be taken with other medications or foods that contain a high level of the compound tyramine, which is often found in wine, aged cheese, and cured meat, as this can impact its effectiveness.

DIY Postpartum Relief

In addition to therapy and medication, there are some things you can do at home to help provide relief from postpartum depression. Healthline outlines a number of them, many of which are relatively simple to incorporate into your life.

Increase your omega-3 intake
Research published in the journal Depression Research and Treatment explains that both pregnancy and breastfeeding contribute to lower levels of docosahexaenoic acid (DHA) in the new mother's brain, a factor that has been correlated to increased feelings of depression. Eating more omega-3 fatty acids can help restore healthy DHA levels, which can then help alleviate the depression as a result.
The National Institutes of Health (NIH) report that adequate intakes of omega-3s for pregnant women is 1.4 grams daily and 1.3 grams for women who are lactating. Foods high in in these particular fatty acids include flaxseed (both seeds and oil), chia seeds, and English walnuts. Salmon, herring, sardines, mackerel, and rainbow trout are good sources of omega-3s too.

Practice self-care
Healthline says it's also important to practice various forms of self-care if you are struggling with PPD. This may include taking long walks, napping when you can, and taking some time every so often just for you.
The main objective is to find things that you enjoy doing and making it a priority to add them into your schedule on a regular basis. This may involve asking family and friends to care for your little one so you can have some much-needed time alone. Though this may seem relatively minor, you may notice that you feel better relatively quickly.

Stay away from alcohol
It also helps to abstain from drinking if you have PPD because there is a high likelihood that the two combined can potentially make the depression worse. In fact, one study published in International Scholarly Research Notices found that 63.8 percent of the alcohol-independent participants suffered from depression, which means that, more often than not, the two will go hand in hand.
If this is difficult for you, it may help to find a dual-diagnosis treatment centre can treat PPD and alcohol addiction at once, giving you a greater chance of overcoming both.

Talk to people you trust
Talking helps as well, and not just to a therapist but also to your close family and friends. Share your thoughts and concerns with those you trust. Open up to them and let them help you through your birth-related depression.

Alternatively, you could join a PPD support group to talk to as well. This connects you with women who have also struggled with the same issue. Or, if you're a spouse or family member of someone experiencing PPD, there are support groups for you, too.

PostpartumDepression.org says that benefits of this particular option include building a stronger social network, receiving emotional validation for how you feel, not being judged for your emotions, and developing a more thorough understanding of what postpartum depression is and how it affects you.
If you can't find a group near you, you can always join one online. For example, the What to Expect website hosts a postpartum depression forum that has more than 5,000 members. You can either start your own discussion or chime in on someone else's. Either way, it can help to connect with others who know what it's like to live with PPD.

PPD is very real, but it is also very treatable. The key is to find the remedies that provide the most relief and make your recovery a priority. Both you and your baby deserve that, and so much more.

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