Postpartum depression is an affective disorder caused by adaptation to the role of a mother and hormonal changes in a woman’s body. It is manifested by depressed mood, causeless tearfulness, anxiety, irritability, increased vulnerability, fears for the health of the child, uncertainty in their own skills of care and upbringing. Diagnosis is carried out with the help of clinical conversation and specific questionnaires to identify depression. The treatment is complex, includes taking antidepressants, tranquilizers, psychotherapy, counseling a psychologist.
ICD 10
F53.0
General information
The first descriptions of postpartum depression were found in the writings of Socrates (700 BC). However, official medicine has not recognized this disorder for a long time as an etiopathologically separate unit. Currently, psychotherapeutic support for women after the birth of a child is carried out on the basis of women’s consultations, neuropsychiatric dispensaries and private clinical centers. According to official statistics, the prevalence of depressive disorders in the postpartum period is 10-15%. But due to the fact that many cases go unnoticed by specialists, the real indicators may be higher. Presumably, emotional disorders occur in 50% of young mothers.
Causes
Disorders of the emotional sphere in the postpartum period develop under the influence of several factors. A woman’s body experiences stress during childbirth, the hormonal background changes dramatically, a new social role of the mother appears, there is a restructuring of everyday life and relationships within the family. There are many reasons for the formation of depression, the most common are:
- Heredity. This factor includes features of the nervous system that determine the body’s ability to adapt to physical and psychological stress. There is an inherited predisposition to melancholy and depression.
- Hormonal shifts. The production of progesterone and thyroid hormones decreases, prolactin synthesis increases. Active endocrine restructuring affects the work of the central nervous system, provoking emotional instability, decreased performance, depression.
- Changing the social situation. The role of the mother involves the performance of certain functions, the restructuring of lifestyle. The source of depression is the fear of not meeting the expectations of others and your own image of an ideal mother, the lack of interesting events and communication.
- Complication of everyday life. After the birth of a child, new duties are added to the usual duties of a woman: care, feeding, visiting doctors, upbringing. Exhaustion and depression are formed as a result of lack of time to restore moral and physical strength.
- Deterioration of marital relations. The baby requires constant attention, both parents get tired more often. During the recovery period of a woman’s body, the sexual sphere of life is limited. All this causes more frequent quarrels, emotional coldness of spouses and increases the risk of depression.
Pathogenesis
The origin and development of postpartum depression is considered within the framework of polyethological theory. According to this approach, emotional disorder is formed by the combined influence of three factors: heredity, specific physiological changes and psychosocial characteristics. The predominant number of mothers with depression have a constitutional predisposition – a weak unstable type of higher nervous activity, reduced production of neurotransmitters responsible for emotions and performance (serotonin, dopamine, norepinephrine).
The specific physiological mechanisms underlying the disorder are a sharp change in the hormonal background (termination of pregnancy), pain and other uncomfortable sensations associated with the process of childbirth. A common psychosocial factor provoking depression is a change in the role of a woman, a reduction in time for the usual pleasant activities, the need for round-the-clock care for the baby.
Symptoms of postpartum depression
Common manifestations of depressive disorder include mood depression, causeless variability of emotions, tearfulness, irritability, decreased motivation for any activity. Sleep disorders are manifested by insomnia or excessive drowsiness. The appetite becomes increased, up to gluttony, or completely disappears. Subjectively, women experience a sense of their own worthlessness, accuse themselves of being unable to perform the functions of a mother, in the absence of affection and love for the child. They are unable to concentrate on household chores, they cannot make decisions on their own in everyday affairs. They withdraw from the usual communication, from contacts with loved ones. With severe depression, thoughts of harming yourself and the child arise.
According to the nature of the course, there are several forms of postpartum depression. In the neurotic variant of the disorder, negative experiences that have manifested themselves during pregnancy and childbirth, for example, provoked by the threat of miscarriage, worsen. A characteristic symptom is increased anxiety. Patients are in constant expectation of a bad event (illness, death of a child, family breakdown). Tension is manifested by outbursts of irritability and dysphoria. Women become hot-tempered, sometimes aggressive. In severe cases, panic attacks, hypochondria, headaches and chest pains, attacks of tachycardia, sweating, shortness of breath are formed. The condition gradually worsens during the day, by the evening there is mental and physical exhaustion – loss of strength, weakness, apathy, inconsolable crying.
With depression with neurotic components, somatic disorders develop as the main symptoms. Emotional experiences are rejected by the patient as unacceptable, shameful. Insomnia, decreased appetite, and weight loss come to the fore. Often there is an obsessive fear of harming the child, hypercontrol of his condition. This disorder is based on the impact of traumatic situations before pregnancy and throughout it.
Another variant of depression is melancholia with a delusional component. The key symptoms are psychomotor retardation and guilt. Women are acutely experiencing imaginary insolvency, call themselves a “bad mother”. Super-valuable ideas that implement self-blame, self-deprecation, and suicidal tendencies prevail. This form of the disorder can turn into a more serious disease – postpartum psychosis.
The most common variant of depression among young mothers is a prolonged form. It proceeds in disguise, often perceived by patients as fatigue, melancholy, adaptation to the regime of the child and the role of mother. The development of symptoms is slow, so visits to specialists are extremely rare. Women experience weakness, exhaustion, which is mistakenly associated with childbirth, blood loss. Tearfulness and irritability increase, night awakenings for feeding a newborn are difficult to tolerate. Caring for a child is painful, but a critical attitude to one’s own experiences remains.
Complications
Any form of depression in the mother reduces the level of emotional intimacy between her and the baby. Alienation, lack of love and affection prevent the formation of a sense of basic security, which later serves as the basis for mental illness in a child. A woman’s concentration on her own experiences often leads to a lag in the mental development of the baby (lack of stimulation, organization of games). The most severe complications occur with untreated melancholic depression. Ideas of self–accusation and pathological fears develop into persistent delusional concepts, suicide attempts and mutilation of a child – postpartum psychosis develops.
Diagnostics
Postpartum depression is most often formed in the first months after childbirth, the duration of the disorder is individual: from several weeks to several years. The initial examination is carried out by a psychiatrist, in addition, a consultation of a psychologist and a gynecologist (endocrinologist) may be prescribed. With an integrated approach to diagnosis, the following methods are used:
- Clinical and anamnestic. The doctor finds out the anamnesis of life, analyzes complaints: asks about the presence of depressive manifestations before pregnancy, mental disorders in the patient herself, her closest relatives. Determines the financial situation of the family, the composition, the nature of the relationship, the peculiarities of the course of the prenatal and natal period. In favor of confirming the diagnosis are complaints of mood decline, anxiety, apathy, weakness, tearfulness.
- Psychodiagnostic. Among the specific instruments, the use of the Edinburgh Scale of postpartum (postnatal) depression is common. It refers to the methods of rapid diagnosis and allows you to identify the depth of emotional distress. To more accurately determine the nature of the patient’s experiences, the Montgomery-Asberg scale is used to assess depression, the Hamilton scale, the Beck scale for self-assessment of the severity of depression, personality questionnaires (Eysenck test and others).
- Laboratory. If endocrine disorders are suspected, the psychiatrist must confirm or exclude them as the cause of depression. An endocrinologist’s consultation, blood tests for thyroid and genital hormones are prescribed. Depression can be triggered by low levels of thyroxine, progesterone.
Treatment of postpartum depression
Assistance to mothers with depressive disorder is determined by its severity: in mild cases, consultations with a psychologist or psychotherapist are sufficient; in moderate symptoms, psychotherapy sessions and drug correction are recommended; in severe illness, hospitalization, intensive drug therapy and psychotherapy are required. The whole range of medical and psychological support includes:
- Psychological counseling. With mild symptoms of depression, the patient’s own resources are used – the ability to relax, maintain a high level of energy, and organize interesting pastimes. The patient is recommended to exercise, massage, delegation of part of the care of the baby to grandmothers, husband, nanny.
- Psychotherapy. Methods of cognitive-behavioral and psychodynamic direction are widely used. During the sessions, personal conflicts, destructive attitudes towards the functions and feelings of the mother are realized (always show love, think only about the child). The ways of restoring and optimizing marital relationships are discussed.
- Medical treatment. Antidepressants, tranquilizers and hormonal drugs are prescribed from medicines. The first normalize the emotional state, eliminate anxiety and depression. The need for hormonal medications is determined individually. Estrogens, thyroxine preparations are prescribed.
- Social support. With mild postpartum depression at the stage of recovery, women need psychological and social support in informal settings. For this purpose, it is recommended to attend group meetings of mothers, training courses on baby care, independent organization of joint walks by mothers. In part, this function can be performed by a patronage nurse, a district pediatrician.
Prognosis and prevention
Postpartum depression is successfully treatable, so the prognosis is more often favorable. Prevention should be started a few months before delivery. It is recommended to master relaxation techniques – breathing exercises, gymnastics, auto-training (autosuggestion). Regular classes should become a habit, since when depression approaches, there is no strength for new beginnings. It is worth discussing in advance with her husband, mother, mother-in-law the willingness to provide assistance (volume, frequency, duration). In the daily and weekly plan, time must be allocated for classes that bring pleasure, joy, promote self–esteem – dancing, massage, spa treatments, meetings with friends.
