Postnatal depression (PND) is a significant public health problem affecting 10%-15% of women in the six months following delivery. Unfortunately, it’s often under-recognised and undertreated. PND actually refers to moderate cases of depression following childbirth as more severe cases are encompassed within the concept of postpartum (or puerperal) psychosis.
Onset of PND is usually within 3-4 weeks of delivery but generally within 12 weeks, and about 90% of cases last less than one month. Most patients recover within 2-6 months but in about 4% of cases symptoms last beyond one year. Of mothers that suffer PND, 20%- 30% will have recurrence in future and 50% may have depression not related to childbirth.
Common symptoms include depressed mood (pervasive feeling of sadness), marked anxiety, poor sleep, tiredness and irritability. It is also important to understand that some mothers with PND may have thoughts of killing their babies in an attempt to save the babies from the agonies that lay ahead. This has to be explored in all mothers with PND so that decisions about child care and custody will be informed by safety considerations.
Previous suggestions that PND may be attributable to hormonal changes in the postnatal period remain unconfirmed as the hormonal changes in sufferers of PND do not appear to be any different from those in non-depressed mothers. It is now believed that PND is precipitated in vulnerable mothers (especially first time mothers) by adverse social and psychological conditions such as awareness of increased responsibility of parenthood and the changes it entails, disturbance of sleep, unemployment, presence of marital conflict, and absence of personal support from spouse, family and friends.
Risk factors for PND include personal or family history of depression, poor relationship with own mother, unwanted pregnancy, older age, single motherhood and poor social support. Birth complications are now considered significant risk factors only in mothers with past history of depression.
PND impacts negatively on both mother and child. Some of the effects include impaired (mother-child) bonding and (child-mother) attachment, difficulty with child feeding, and impairment in child’s later emotional, cognitive and social development.
Different treatment modalities are available for PND depending on patient peculiarities such as urgency of action needed, severity of symptoms and client preferences. In most cases of mild to moderate PND, counseling and medications are almost equally effective. A shock therapy known as electroconvulsive therapy (ECT) is the treatment of choice when rapid resolution of symptoms is desired.
Studies have shown that treatment of PND is associated with significant improvement in maternal reports of infant problems, both immediately after treatment and at 18 months post partum. In addition, early treatment and remission from depression were related to a reduced rate of insecure infant attachment at 18 months. Adverse child outcome arising in the context of postnatal depression is driven by disturbances in the mother-child relationship, which begin in the early postpartum days or weeks. Early detection and treatment of PND is, therefore, of essence.
Article was written for TBHI by Dr. Babagana Kundi Machina,Consultant Psychiatrist