Postpartum depression: symptoms, treatment, how to help?

What is and how long postpartum depression lasts? What could they be symptoms of postpartum depression and how to distinguish it from baby blues? And above all, how to helpwhen there is a suspicion postpartum depressionto avoid its most negative effects? Knowing how important the answers to these and other related questions are depression pregnant and after childbirth, we have prepared a special guide for you. You will also find information on how and how the diagnosis works treatment of postpartum depression, taking into account the possible ones drugs. 

By definition, postpartum depression is a situation in which a depressive episode occurs 4-6 weeks after childbirth. It is the most common complication of pregnancy or puerperium and contributes to many negative consequences - both short-term and long-term - for the mother and her child.

Postnatal depression: symptoms

The axial symptoms of postpartum depression are considered persistent depression and fatigue, combined with fear for the development and health of the child. There may also be intrusive thoughts, most often related to the desire to abandon or harm a child. Fear and excessive and inadequate concern for the offspring's health are often observed.

To the rest symptoms of postpartum depression, in addition to depressed mood, include:

• dissatisfaction with the actions taken;
• lowering the drive;
• insomnia;
• weight fluctuations;
• feelings of loss and futility;
• lowering intellectual efficiency and concentration of attention;
• recurring thoughts of suicide.

The occurrence and severity of these ailments may vary, but the persistence of some of them for at least two weeks is a criterion for diagnosing the disease.

Postpartum depression a baby blues

From the point of view of the need for treatment, it is important to differentiate with postpartum depression, called baby blueswhich he experiences from 30 to 80% of postpartum women.

The condition is characterized by a depressed mood, a tendency to cry, and increased levels of anxiety. Most often it resolves by the 10th day of the postpartum period, up to a maximum of 3 months, and does not require treatment.

The reason is the intensification of hormonal changes in the mother's body during this period. Although the symptoms do not impair the woman's ability to function normally, then it needs support, increased sense of security and help in everyday activities. In rare cases, baby blues can develop into postnatal depression.

Contributing factors postpartum depression

An increased risk of depression can already be found in pregnancy. It is good to analyze the presence of factors contributing to the development of postpartum depression, which include:

• earlier depression in pregnancy - women who have an episode of postpartum depression for the first time have a double risk of developing it in subsequent pregnancies;
• episodes of depression not related to pregnancy or a history of bipolar disorder - there are studies showing that one-third of disorders diagnosed as childbirth depression begin during or before pregnancy;
• baby blues;
• depression or other mental disorders in the family history;
• recent stressful life events;
• socio-economic factors (low income, unemployment, lack of social support, single motherhood, young age, poor marriage, lack of support or violence from a partner, unplanned or unwanted pregnancy);
• past experience of mental or physical abuse;
• the presence of antenatal or gestational diabetes;
• complications during the current pregnancy, such as threatening miscarriage, fetal defects.

Postnatal depression: how long it lasts?

The onset of an episode of depression most often occurs 4-6 weeks after giving birth, but it is believed that the disease may appear up to 12 months after the baby is born. An episode of depression usually lasts from 3 to 9 months, if not treated longer. In some cases of postnatal depression, symptoms resolve spontaneously within a few months, however, in about 30% of women the symptoms may last longer and there is a 40% risk of recurrence.

Depression during pregnancy and after childbirth: possible consequences

Research confirms that the consequence of chronic stress in the course of depression in pregnancy may be higher risk of low birth weight and premature birth. The relationship between maternal depression and delayed speech and psychomotor development in a child.

The mental state of the mother can directly affect the newborn, manifesting itself anxiety, irritation and disturbed expression of emotions. There was also an association of postpartum depression with long-term consequences in various forms psychiatric disorders in children. Proper diagnosis and treatment of this disease has a direct impact on the improvement of the child's psychomotor state.

Postnatal depression: treatment

If depression is suspected, it may be helpful to be widely available Edinburgh Postnatal Depression Scale Questionnaire. It is a screening test that determines the likelihood of developing this disorder based on the answers to 10 questions. With a maximum of 30 points possible, a score of more than 12 is considered an alarming condition and requires consultation with a specialist.

The decision to diagnose and start treatment of postpartum depression may be made by a general practitioner, pediatrician or gynecologist. In some cases, however, it is necessary to consult a psychiatrist. As with other depressive disorders, there are various methods of effective treatment of postnatal depression. These include pharmacological and psychotherapeutic procedures.

Depression pregnant and postpartum: what leki? 

Drug treatment of depression in pregnancy is a challenge because on the one hand, there is a risk associated with fetal exposure to the drug, and on the other hand, the potential consequences of discontinuing treatment should be considered. Such consequences include, for example, eating disorders, poorer prenatal care, greater risk of smoking and abuse of psychoactive substances, and disruption of the mother-child relationship.

As part of pharmacotherapy the safest in postpartum depression is considered leki from the group of serotonin reuptake inhibitors (SSRIs).

Other ways treatment of postpartum depression

For the treatment of mild to moderate postpartum depression Cognitive-behavioral or interpersonal therapy in an individual or group form has proven effective. Other treatments, such as: neurostimulation, mindfulness training, couples therapy, supportive psychotherapy and psychodynamic psychotherapy, can perform auxiliary functions.

According to some authors, in the treatment of severe depression during pregnancy, electroconvulsive therapy is the method of choice, considered to be an effective and safe therapy.

Postnatal Depression: How Can You Help?

Answering the question of how to help in the case of suspected postpartum depression is important for both the woman and her relatives. Many factors influence the decision to start therapy. The time of puerperium and the neonatal period is specific for several reasons.

• First, the woman is most often breastfeeding, which limits the choice of pharmacotherapy, and is often associated with a subjective aversion to drugs in general.
• Secondly, no time to meet basic life needs - like eating, sleeping, resting - may be an obstacle in undertaking relatively time-consuming psychotherapy.
• Third, finally, the view of a "bad mother" present in some circleswho cannot cope with their natural parenting situation may make it impossible to seek help.

That is why it is important to one hand find risk factors for depressionbefore the disease fully develops. It is good to take care of yourself before pregnancy, when the possibilities of obtaining support and implementing therapy are much simpler. On the other hand, to reach people who, despite indications, delay starting treatment for various reasons.

More awareness, less stigma

Fortunately, the knowledge about depression is becoming more and more common, and the diagnosis of the disease, thanks to greater social awareness, becomes less and less stigmatizing. Still though too often the disorder goes undiagnosed, with all its consequences for the sick woman, her relatives and the environment.

Źródła:

Recommendations for the prevention and treatment of postpartum depression drug. Monika Dominiak, dr Anna Z. Antosik-Wójcińska, mgr Marta Baron, prof. dr hab. Paweł Mierzejewski, prof. dr hab. Łukasz Święcicki; Institute of Psychiatry and Neurology in Warsaw;
Recommendations of the Polish Psychiatric Association regarding the treatment of affective disorders in women of reproductive age; Recommendations of the Polish Psychiatric Association for treatment of affective disorders in women of childbearing age.
Part I: Treatment of depression Part I: Treatment of depression Jerzy Samochowiec 1, Janusz Rybakowski 2,3, Piotr Gałecki 4, Agata Szulc 5, Joanna Rymaszewska 6, Wiesław Jerzy Cubała 7, Dominika Dudek 8; 1 Pomeranian Medical University in Szczecin, Chair and Department of Psychiatry 2 Medical University in Poznań, Department of Adult Psychiatry 3 Medical University in Poznań, Department of Psychiatric Nursing 4 Medical University of Lodz, Department of Adult Psychiatry 5 Medical University of Warsaw, Department of Psychiatry, Faculty of Health Sciences 6 Wroclaw Medical University, Department and Clinic of Psychiatry 7 Medical University of Gdańsk, Department of Adult Psychiatry 8 Jagiellonian University Medical College, Department of Adult Psychiatry.