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Postpartum depression (PPD) is a non-psychotic depression that women may experience shortly after childbirth.
Postpartum depression is different from the “baby blues,” which begin within the first three or four days of giving birth, require no treatment and lift within a few hours or days. PPD is a deeper depression that lasts much longer. It usually starts within the first month after childbirth (although it can occur any time within the first year) and can last weeks to months. In more serious cases, it can develop into chronic episodes of depression.
Apart from the fact that it happens soon after childbirth, PPD is clinically no different from a depressive episode that occurs at any other time in a woman’s life. PPD symptoms are the same as in general depression and must meet the same criteria for diagnosis. However, not surprisingly, the symptoms of PPD often focus on motherhood or infant care.
Postpartum psychosis refers to the sudden onset of psychotic symptoms after childbirth. This condition is rare—approximately 1-2 cases per 1000 births. Treatment recommendations are similar to those for other forms of psychosis.
Every woman is different, but these are some of the more common signs and symptoms of PPD:
Signs of depression are often missed in new mothers because significant changes in sleeping patterns, interests, cognitions, energy levels, moods and body weight are a normal part of new motherhood.
New mothers often resist acknowledging these signs even to themselves because of the pressure to meet societal expectations of what it means to be a “good mother,” including how she should be feeling, thinking and behaving.
There is no single cause of depression (and therefore PPD). Physical, hormonal, social, psychological and emotional factors may all play a part in triggering the illness. This is known as the biopsychosocial model of depression, and is accepted by most researchers and clinicians. The factor or factors that trigger PPD vary from one woman to another. For example, sleep deprivation resulting from having a new baby can make a woman vulnerable to other factors that trigger depression.
PPD if prolonged and untreated is detrimental to the mother’s health and can disrupt family relations, undermine infant-mother attachment and impair the child’s long-term development. Society’s messages that new motherhood should be a happy time can create barriers to getting help. A new mother may be reluctant to recognize that she needs help with depression or may not seek treatment because she fears admitting (even to herself) how she is feeling (or not feeling) about her baby.
Treatment of PPD is generally the same as that for depression that occurs any other time in a woman’s life.
Breastfeeding has significant health benefits for the infant and is psychologically important to many mothers. Mothers who take antidepressant medication and who wish to breastfeed may worry about the possible effects of the medication on the baby. Research is inconclusive, but we know that small amounts of the medications do pass into breast milk. Mothers are sometimes advised to wait eight or nine hours after taking antidepressants before breastfeeding.
Experiencing an episode of depression at any time in life increases the likelihood of experiencing further episodes. Research suggests that the minimum risk of experiencing a non–childbirth-related episode of illness is 25 per cent. The risk of having another postpartum episode may be as high as 40 per cent, with approximately 24 per cent of all recurrences occurring within the first two weeks postpartum.
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