It is now believed postpartum depression is more common than previously thought. Some statistics indicate that they concern as much as 15% of women who give birth, and this statistic applies to depression without psychotic symptoms. It has been assumed that considerable depression, apathy and sadness occurring within 4 weeks after delivery are recognized as postnatal depression.
The physiological causes of this ailment
The post-natal period can be treated as an example of a sudden drop in sex hormones and the consequences of this decline. During pregnancy, progesterone and estrogens (the basic female sex hormones) reach the highest possible level physiologically, and the sudden separation of the placenta causes their rapid decline. This decrease disrupts hormone homeostasis and may eventually result in depression.
How often does it occur?
A slight despondency sometimes manifested only in the form of "superhuman fatigue" occurs in more than half of women after childbirth. It occurs within the first 6 months after the birth of the child. It usually comes out between the second and fourth week after giving birth and the first obvious symptom will be less interest in the child. According to Australian studies, postnatal depression is significantly more common in women who only gave birth to one child than in multiparous women.
What is the reaction and feelings of the sick?
The emergence of depression after delivery is usually incomprehensible. It occurs, after all, in the joyful life of a woman and the whole family. The appearance of depression is explained by the hardships of pregnancy and delivery. The mother considers her depression as an incomprehensible state, it arouses her anxiety and guilt towards a born child. A depressed patient can not enjoy a newborn baby and has remorse for it. The difficulty of treatment during this period is the need for breastfeeding, when it is known that most drugs pass into the mother's food.
Doctor's report:
I have been repeatedly called upon for patients who have fallen into postpartum depression. Here is a description of one of the visits I have had recently: I was summoned by my husband's patient to their flat in one of the districts of Warsaw. The gentleman was concerned about the change that had taken place in his wife's behavior last week. "She is still crying, unable to take care of the child, her mother had to come to take care of the wife of an older child and a newborn baby," he reported on the phone. Mr. M. lived in a nice, modern apartment. Both intelligentsia, both of them had good competitions and it seems that they lived prosperously. The flat was well-maintained, well-equipped. They already had one, an older child - a daughter who at that time went to kindergarten. A 35-year-old woman has never been seriously ill. After the birth of her first daughter she did not have any anxieties and after a short leave and with the help of her mother, she returned to work. She liked her very much - she was an accountant in a good company. They had been married for nine years and the relationship was in line. Pregnancy with her second daughter went without complications, childbirth was about time, the forces of nature. The child was born healthy and received 10 Abgar points. From the second day after the birth, her husband realized that his wife was "bothering" something. She did not enjoy the first time, and her sadness deepened day by day. It soon turned out that she was not able to manage at home and even though her husband took vacation during that time, she felt worse and worse. She complained about the lack of feelings, the inner emptiness. She was very concerned about her reaction. She did not enjoy children. She claimed that her births had "finished" her. She felt sorry for her husband that he wanted one more child. She stopped sleeping, she cried more and more often, neglected the time of her child's meals.Always very caring about her appearance, now it was hard to persuade her to wash. She began to mention the meaninglessness of life. She did not want to see any of her friends, she did not agree to visit her family. The pediatrician who visited the newborn recommended the psychiatrist's request, claiming that the patient had "postpartum psychosis".
During my visit she behaved as described above. Physically, the patient was healthy. She admitted that "something is wrong with her". She had a sense of change and was afraid of it. She did not hallucinate or utter delusions. She was crying because she was afraid that she neglected the child, that "somewhere all her feelings were going through". She was physically slowing down. She did not talk about suicide, but she did not enjoy life. Suddenly it seemed difficult to her. She was convinced that she would not cope with the duties that would disappoint her husband and family. I diagnosed postpartum depression in the patient. I was even considering the possibility of hospitalization, but since she had good care - a mother who had come especially to her and her husband on leave, I decided to leave the patient at home. Rapid improvement after antidepressant treatment has additionally confirmed "ex juvantibus" diagnosis of postpartum depression.
In the postnatal period, we can distinguish basically three types of mood disorders: Short-term mood depression. It is sometimes called "baby blues". It is characterized by a changeable mood, sadness, crying and insomnia. It occurs quite often, because up to half of women giving birth. Fortunately, it lasts for a short time, only a day or two and passes spontaneously, without treatment. Proper postnatal depression is characterized by more significant mood depressions, irritability, fears about the somatic state of the child and the obstetrician. It is believed that it occurs in 15% of women who give birth. The duration of this depression is quite long - it can be several months. Usually, psychotherapy and sometimes pharmacological treatment are necessary in such cases. Postpartum psychosis may seem depressive at first. In the patient, however, there is usually confusion, anxiety, delusions and sometimes even hallucinations. This illness appears fortunately rarely, only in a fraction of a percent of the giving birth of women. However, it always requires hospital treatment due to the possibility of complications and the risk of suicide.
The risk of recurrence of depression at subsequent births
Women with previous postnatal depression have an increased risk of another depression during the next labor. Family counseling and psychotherapy could significantly reduce this risk. Until now, however, the effectiveness of prophylactic treatment in the prevention of postnatal depression has not been clearly established.
Warning! The consequences of untreated postnatal depression can be very detrimental to the mother, the child and the whole family.
A message from the author for the reader
Depression is an emotional state characterized by sadness, less activity and the inability to enjoy life. It is one of the most common psychological problems. The presented study presents typical symptoms of depression as well as its various variants. In the following chapters, we also describe how to deal with this disease and how to deal with a person suffering from depression. The characteristics of depression are enriched by authentic statements of patients, descriptions of their ailments and difficulties in overcoming the disease. The author has been conducting extensive private practice for years, in which depressive patients make up the majority of applicants.
Ph.D., MD Janusz Krzyżowski. Psychiatrist
