Baby blues is a form of psychoemotional disorders that appears a few days after childbirth. She is characterized by a depressed mood, apathy, a feeling of constant causeless anxiety. Some women feel guilty for their usual actions. Symptoms have different degrees of severity: from mild apathy to severe forms and thoughts of suicide. Diagnosis is often difficult due to a woman’s unwillingness to see a doctor and denial of her condition. The condition is often stopped on its own, but psychotherapy, medication may be required.
F53.0 Mild mental and behavioral disorders associated with the postpartum period
Baby blues (postpartum melancholy, baby blues) occurs, according to various data, in 50-70% of maternity patients. However, this diagnosis is established only by 3% of them. Women with a low social level who do not have the support of a spouse or close people are more prone to melancholy and depression after childbirth. More often baby blues occurs in women living in developing countries, less often in developed countries of Western Europe. But statistics do not always fully reflect the true picture due to the use of different approaches to data collection and analysis.
The causes of baby blues are not precisely established. The main importance is attached to neuroendocrine shifts that occur at the time of birth, as well as unfavorable social and living conditions. Studies allow us to identify factors that are most often identified in the diagnosis of baby blues:
- Disorders of neuroendocrine regulation. After childbirth, there is a decrease in the level of progesterone, which is a neurosteroid and a precursor of allopregnanolone. The latter regulates the activity of GABA receptors and has an antidepressant effect. The psychoemotional status is also affected by a decrease in the level of dopamine, which is synthesized less when the nipple mechanoreceptors are irritated.
- Changes in sodium concentration. A decrease in progesterone production leads to an increase in the activity of the hormone aldosterone and sodium retention from primary urine by the kidneys. As a result, fluid retention increases, intercellular edema occurs, including in brain tissues. This disrupts the transmission of nerve impulses and can lead to depressive disorders.
- Stress and mental stress. Lack of support after childbirth, the effect of stress factors in the third trimester, social disorder do not allow a young mother to feel protected. This interferes with the formation of attachment to the child, disrupts family relationships.
Additionally, there are factors in the presence of which the risk of developing baby blues increases. There is a high probability in women who gave birth before the age of 18 or in the late reproductive period. Unwanted pregnancy, low family incomes and complications during gestation or childbirth can affect the emotional sphere of the maternity hospital.
Baby blues is not characterized by morphological and pathophysiological changes in the structure of the brain. The diagnosis is not given to women who use psychoactive substances, suffer from alcoholism or drug addiction. In the last months of pregnancy, the mental state is aggravated by relative deprivation – a woman is less able to independently satisfy her needs. If complications arise, this period is prolonged, which leads to an increase in psychological tension. Childbirth, especially complicated, hormonal changes act as a trigger that triggers the symptoms of baby blues.
Symptoms of baby blues
The first signs appear 3-5 days after the birth of the child. A woman may feel tired, low mood, which is accompanied by unreasonable tearfulness. Any domestic, social failures, careless word of a loved one can lead to tears. Emotions can change dramatically, a calm mood suddenly turns into an aggressive one, any event can cause irritation. Sleep disorders appear, which are more often represented by nocturnal insomnia or pathological drowsiness in the morning. Fatigue, lack of sleep lead to a decrease in attention, forgetfulness.
Baby blues often occurs in women with low self-esteem and further aggravates this condition. A young mother believes that she cannot cope with new responsibilities, does not pay enough attention to the child. She perceives attempts to help as a threat to her independence. If the baby blues progresses, a woman may stop communicating with loved ones who are trying to interfere in her life. Mental tension leads to headaches, decreased appetite, decreased lactation, weight loss.
In the absence of treatment or psychological help, a woman’s condition may gradually worsen. The risk of complications increases with the duration of baby blues for more than 2 weeks. Melancholy can turn into postpartum depression or psychosis, which will require hospitalization in the department of psychiatry. These conditions are often accompanied by the appearance of suicidal thoughts. In some cases, the mother’s behavior becomes dangerous for the health and life of the newborn and requires her isolation from the child. Also, baby blues without timely help can persist in the form of a depressive disorder.
In the anamnesis, women with baby blues have episodes of depression in half of the cases. Baby blues should be differentiated from the onset of schizophrenia, post-schizophrenic depression or the consequences of alcohol and drug abuse. The diagnosis is carried out by a psychotherapist, if necessary, a psychiatrist’s consultation is appointed. There are no specific laboratory changes, therefore, methods of mental assessment of the condition are used.
- Hamilton scale. During the clinical interview, the woman is asked to answer 21 questions about her condition. Well-being, appetite, sleep, thoughts, mood and other indicators are evaluated, each answer is assigned its own number of points. The amount determines the severity of depression: 0-7 points corresponds to the norm, and more than 23 points – a severe disorder.
- Laboratory tests. A clinical blood test, a culture for sterility are necessary to determine the inflammatory process. Postpartum sepsis can have an areactive course, and its first symptom is baby blues.
- Instrumental research. MRI, CT of the brain are necessary if organic pathologies of the brain, ischemia, which debuted after childbirth, are suspected. Studies are shown with the gradual development of the clinic, the appearance of symptoms of irritation of the meninges or intracranial hypertension.
Treatment of baby blues
Often baby blues does not require specific treatment and is stopped within 2 weeks. With the progression of the condition, it is necessary to prescribe medication therapy and carefully monitor the condition. At the initial stages, the basis for the treatment of baby blues is non–drug methods, lifestyle changes, sleep and rest.
- Psychotherapy. A woman can attend individual classes with a psychotherapist. Sometimes group sessions are effective. The spouse or close relatives should also be trained in the rules of behavior in order to effectively help the maternity hospital at home.
- Phytotherapy. With mild manifestations of baby blues, the doctor may prescribe herbal preparations that affect the emotional and mental state. Herbal teas with melissa, hawthorn fruits, motherwort grass, valerian help. Some women prefer ready-made plant extracts in liquid form or in tablets.
- Antidepressants. They are used for severe manifestations of baby blues. The dose and type of drug is selected individually depending on the prevailing symptoms. Drugs can have a stimulating or sedative effect. At the time of their reception, it is necessary to stop breastfeeding.
Prognosis and prevention
With baby blues, the prognosis is favorable. Timely treatment improves the emotional state and does not allow the pathology to go into more severe forms. To prevent melancholy, it is necessary to avoid stressful situations during pregnancy, especially in the late term. A woman needs a full rest during the day, a night’s sleep, a balanced diet. Sometimes the husband should take care of the child in order to allow the young mother to distract herself from household chores. The support of loved ones and a safe psychological situation in the family will prevent the appearance of unpleasant symptoms after childbirth.