What Causes Postpartum Depression?
The expectation of parenthood can be overwhelming feelings on many levels. In addition to expecting a newborn to bring new joy and fulfillment, there is an unexpected illness that can affect the development of the baby at birth—a type of depression now widely known as Postpartum Depression (PPD).
Postpartum Depression, also known as Postnatal Depression is the onset of a depressed mood and associated features within one year after delivery. Whereas most new mothers have "baby blues" a very short period of emotional changes few other mothers develop persistent and severe symptoms that do not fade away on their own. Postpartum Blues and postpartum depression manifest as two different manifestations of the same underlying cause. However, while Postpartum Blues or "Baby Blues" are transient mood swings that begin within 2 to 3 days after the delivery and last for two weeks, in contrast, Postpartum Depression is a more long-lasting and grave condition.
Rebecca aged 37 years mother of a four-year-old girl describes irritability, sleep disorder, stress, and anger are some of those most bothering symptoms just after birth. She never got diagnosed with the disorder but also considers "Baby Blues" as the preferred description over "Postpartum Depression," considering the severity of her symptoms.
This just supports the fact of recognizing and trying to treat postpartum depression since this could distressfully hamper the well-being of the mother, the child, as well as the family. Using the right form of treatment, any woman can reduce the symptoms and develop a healthy attachment with the baby.
Causes of Postpartum Depression
Postpartum depression represents a complex interplay of emotional, environmental, biological, hormonal, and genetic factors. After childbirth, major changes in the levels of certain hormones are well-observed in women, including a sudden increase in reproductive hormones just before delivery and a sudden decrease postpartum.
This might account for the reasons triggering depressive symptoms. Others include marital problems and emotional issues; lack of assistance in newborn care; young maternal age; low income; immigrant status; complications during pregnancy and childbirth; and sleep deprivation. All these may enhance the chance of developing PPD.
That is to say, there are nearly 140 million births worldwide annually, and about 10-13 percent of new mothers from across the globe suffer from postpartum depression. A question arises: what makes some mothers vulnerable to postpartum depression and protects others against the same?
Risk Factors for Postpartum Depression
Some women are more prone to the phenomenon of postpartum depression. New mothers are vulnerable to PPD if they:
Had a history of depression before and during pregnancy
Authored a history of abuse during childhood
Have a family history of depression
Had a traumatic pregnancy previously
Do not have adequate support from the family, friends, or partners
Face domestic violence
Have financial problems
Face stressful events in life
Have a special needs baby
Planned the pregnancy unplanned
Age is below 20 years old
Genetics and Postpartum Depression
Studies have concluded that a family medical history of postpartum depression plays a major role in the development of this condition. PPD is a subtype of major depressive disorder. Major depressive disorder is more genetically heritable than any other psychiatric condition. A recently conducted large-scale meta-analysis of genome-wide association studies estimated that about 14% of cases of PPD are explained by common genetic factors.
The genetic architecture of PPD implicates major depression, anxiety disorders, bipolar disorder, insomnia, post-traumatic stress disorder, and polycystic ovary syndrome. This would mean that the manifestation of PPD symptoms likely is a result of a gene-disease interaction of the illness with any other hormone-related and psychiatric disorders.
Sleep Deprivation and Postpartum Depression
Chronic sleep deprivation enhances postpartum depression vulnerability. The quality of sleep significantly affects the capacity of a mother to restore physical energy and resilience. Chronic sleep deprivation tends to heighten symptoms of depression and anxiety, thus making day-to-day functioning difficult for new mothers.
Poor sleep quality can elevate the symptoms of depression and anxiety in mothers, especially at six months postpartum. Thus, good sleep hygiene practices are an essential step toward alleviating postpartum depression. During this period after her delivery, Rebecca exhibited insomnia conditions, whereby she could not sleep, and in another aspect, she could not get enough sleep. Since her recognition that the application of a few sleep hygiene procedures might have worked miracles in her life during that period.
Loss of Aspirations and Postpartum Depression
Becoming a mother brought commendable psychosocial stressing circumstances. The body of a woman undergoes tremendous changes. The extra roles and responsibilities available due to motherhood and attitudes within society regarding motherhood may mold a lady's perception and perceptions about themselves.
These overwhelming changes can lead to a loss of aspiration and motivation, worsening the symptoms of postpartum depression. New mothers usually experience many feelings, but not all of them welcome excitement and fulfillment versus frustration, anxiety, guilt, and sadness. This emotional rollercoaster can erode self-esteem and reduce aspirations in all aspects of life.
Rebecca remembers that right after giving birth she felt no ambition and was afraid of the future. She couldn't fit in some time for herself and wholly sacrificed her time for her child.
Relationship Discord and Postpartum Depression
The arrival of a baby will eventually drive a wedge between parents. But such a positive milestone can also be a cause of emotional upset and turmoil that could develop into postpartum depression in both parents. While not as fully vetted, about 10 percent of men also become depressed following the birth of a new child. In the instance that both parents develop postpartum depression, the risks to the child dramatically escalate. Discord in relationships may sometimes lead to child abuse and children's problems in development because this can disrupt the mother-child attachment bond.
Rebecca experienced such a devastating relationship conflict with her husband before and after childbirth for her first and only child that led her to divorce. Rebecca was a mother who had a tough time living the days alone but managed to cope with her psychological disorder with the good heart of her friends and family around her. She believes that co-parenting with both parents raising a child can be beneficial too.
Sheehan's Syndrome and Postpartum Depression
First summarized in the year 1937, Sheehan's Syndrome is a form of postpartum hypopituitarism that is caused by shock or massive hemorrhage in which the individual experiences a catastrophic reduction in blood supply to sectors of the pituitary gland. This may manifest as the failure of lactation, general weakness, cessation of menstrual periods, premature wrinkling, baldness, and dry skin.
Worldwide, this affects one in every 100,000 births, but the incidence is higher in underdeveloped nations due to poor medical care. Sheehan's Syndrome often produces symptoms similar to postpartum depression and is incorrectly diagnosed and treated. A clinician should be aware of this condition and keep it one of the differentials while dealing with a patient, especially a female, with symptoms of PPD.
History of Depression and Postpartum Depression
One vital risk factor for PPD is having been previously diagnosed with depression. In a survey of 70,000 births in Sweden during the period from 1997 to 2008, the probability of getting PPD was found to be 20 times higher in women previously diagnosed with depression as compared with the probability of getting PPD in people not previously diagnosed with depression.
The probability of contraction of PPD in the case of those who have already contracted it is also significantly higher than the probability of contraction in the case of people who have not contracted it.
Anemia and Postpartum Depression
Anemia is a condition in which the levels of red blood cells or hemoglobin are below normal, consequently leading to a low supply of oxygen to body tissues. When a woman is pregnant, she is vulnerable to many different types of anemia. Iron deficiency anemia is one of the most prevalent forms.
Anemia is also seen as a risk factor for postpartum depression. Research has indicated that anemic women have a considerably higher likelihood of experiencing PPD compared to those who are not anemic, thus highlighting the importance of proper maternal nutrition during and after pregnancy.
Heavy Workload and Postpartum Depression
High psychological demands of work, low perceived control, and low schedule autonomy increase the risk for postpartum depression. The layering of new motherhood on top of the stress of the workplace can further exacerbate the symptoms of PPD for working women.
Rebecca believes that being granted a temporary leave from work when she became a mother gave her adequate time to rest and recharge, enabling her to return to work in a more balanced alliance with her life.
Identity Loss and Postpartum Depression
Many new mothers feel themselves losing their identity after giving birth since parents get caught up in believing this role is all that defines them. There are potential loss of feelings that can be at risk for postpartum depression.
It leads to disrupted professional identities, low self-esteem, and limited social lives with a decline in the time spent on their personal activities. The solution to this lies in taking breaks, being self-caring, avoiding comparisons with other parents, and accepting oneself.
Difficult Pregnancy and Postpartum Depression
Pregnancy complications significantly increase the risk of postpartum depression. Events that may make for high-risk pregnancies include pre-existing health conditions, lifestyle choices, or other complications arising during the pregnancy, such as gestational diabetes, preeclampsia, or early labor. This further creates anxiety and calls for proactive steps to ensure a healthy pregnancy and adequate postpartum care.
Hormonal Imbalance and Postpartum Depression
Some have suggested that the dramatic swings in reproductive hormones, which are, in concert, estradiol, and progesterone, that occur during and after childbirth may be a cause of PPD.
Although not all studies have reported a direct association between these hormonal changes and the development of PPD, some report relief of depressive symptoms from hormone treatment in a study of the PPD group, and others have found a relationship between hormones and PPD using an indirect effect.
Nutritional Deficiency and Postpartum Depression
Nutrient deficiencies in vitamins B and D, omega-3 fatty acids, folate, and iron further vulnerabilities in PPD. For example, vitamin D, which is linked to the regulation of neurotransmitters, has been found in low levels among those with depression symptoms. Likewise, omega-3 fatty acids, considered the highest essential for the brain, are found at low levels in pregnant women, increasing even more risks of PPD.
Treatment of Postpartum Depression
PPD can be disastrous for both the mother and the child. For a mother, it interferes with proper breastfeeding, bonding with the child, as well as the performance of plain tasks in everyday life. If not managed well, this problem can lead to major mental health problems such as bipolar disorder and substance abuse, and, in worst cases, perpetrators may commit infanticide or suicide.
As Rebecca points out, "In a world where everyone is dismissive most of the time, a woman needs to get help for postpartum depression because women need to be aware that experiencing PPD is a normal happening and sometimes, it's unavoidable." She proposes getting in touch with a psychiatrist online or purchasing professional medical help to adjust the symptoms of postpartum depression to enjoy motherhood even more.
Gaba Telepsychiatry’s psychiatrists strive to provide a comprehensive approach to psychiatric care without compromising evidence-based medicine. Our online psychiatrists take into account a variety of factors, including genetics, developmental, trauma, nutritional factors, hormones, career difficulties, relationship difficulties, coping skills, concurrent medical illness, head injury, medication side effects, and more.
Visit Gaba Telepsychiatry to find out more!
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