Depression is a pathological state of emotions, manifested by a process of inhibiting all mental activities. Postpartum depression is a condition in which a mother experiences depression immediately after giving birth. In general, most reports indicate that about 10-20% of new mothers will suffer from postpartum depression. This is a medical condition rather than a sign that the mother does not love her child. Untreated severe postpartum depression can lead to negative short-term and long-term consequences for both the mother and the newborn. Therefore, understanding some basic knowledge related to postpartum depression is truly essential.
Causes:
The pathogenesis of postpartum depression is not clearly understood. Research suggests that factors potentially related to postpartum depression include genetic susceptibility, hormonal changes, abnormalities in neurotransmitter levels/activity, psychological and social issues, and stressors in life.
Additionally, there are many factors that increase the risk of postpartum depression in women. Summarized from various studies, these risk factors can be grouped as follows:
- Individual Factors of the Mother: Poor physical health; young age; low educational level; low income/unemployment; anxiety and stress during pregnancy; history of depression.
- Family-Related Factors: Domestic violence, including emotional, physical, and sexual abuse; lack of family support; a preference for male children; poor marital and family relationships.
- Cultural and Social Factors: Lack of social support; gender bias and inequality; societal stigma and prejudice against people with depression.
- Reproductive History Factors: History of abortion, stillbirth, miscarriage, unintended pregnancy, having many children.
- Postpartum Factors: Resting and dietary restrictions after childbirth; the baby’s gender (including the preference for male children, which is considered a common issue in Vietnam) creates significant pressure and affects the mother’s mental health; lack of family and social support after childbirth; preterm birth; lack of knowledge about childcare.
Signs:
It can be difficult to determine if someone has postpartum depression because some signs and symptoms may also result from the stress of caring for a newborn. After giving birth, many mothers experience a mild form of depression known as “postpartum blues” or “baby blues”. Within 2-3 days after childbirth, these mothers often feel mood swings, irritability or anxiety, difficulty concentrating, trouble sleeping, or crying easily. These symptoms are not severe and typically disappear within 2 weeks. However, in those with postpartum depression, the symptoms are more severe and last longer, including one or more signs in the following groups:
Major Signs:
- Depressed Mood: Persistent low mood that changes little from day to day and is often disproportionate to circumstances, lasting for at least 2 weeks.
- Loss of Interest: Loss of interest or pleasure in activities once enjoyed.
- Reduced Energy: Decreased energy and increased fatigue.
Common Signs:
- Decreased Concentration: Reduced ability to concentrate or make decisions.
- Low Self-Esteem: Decreased self-esteem and confidence, with difficulty making decisions.
- Guilt and Worthlessness: Feelings of guilt and worthlessness.
- Pessimism: A bleak and pessimistic outlook on the future.
- Self-Harm Thoughts: Thoughts or behaviors of self-harm or suicide.
- Sleep Disorders: Disrupted sleep patterns.
- Appetite Changes: Changes in appetite (increased or decreased) with corresponding changes in body weight.
Physical Signs:
- Loss of Interest: Loss of interest or pleasure in usual enjoyable activities.
- Emotional Numbness: Lack of emotional response to events and surroundings that would typically bring joy.
- Early Morning Awakening: Waking up 2 hours earlier than usual.
- Morning Depression: Depression is worse in the morning.
- Psychomotor Changes: Observable psychomotor retardation or agitation (noticed or reported by others).
- Appetite Loss: Decreased appetite.
- Weight Loss: Weight loss (5% or more of body weight compared to the previous month).
- Reduced Libido: Noticeable decrease in sexual desire.
Psychotic Signs:
- Delusions and Hallucinations: Delusions or hallucinations may or may not be present.
Treatment:
The principles in treating depression in general, and postpartum depression in particular, are to address the underlying causes of depression (if any), alleviate and completely eliminate symptoms, and prevent recurrence and relapse of depression. In the treatment of postpartum depression, there are generally two main treatment methods: medication and psychotherapy. The choice of treatment depends on the severity of the symptoms and whether the mother experienced depression before pregnancy, with a preference for non-drug treatments when appropriate.
Psychotherapy (Counseling):
For this method, the patient will talk with a psychologist about their emotions, thoughts, and behaviors. There are various types of psychotherapy, such as:
- Cognitive Behavioral Therapy (CBT): Focuses on changing negative thought patterns and behaviors.
- Family Therapy: Involves family members to improve relationships and communication.
- Individual Therapy: Focuses on the individual’s issues and personal growth.
- Relaxation and Training Therapy: Techniques for reducing stress and improving mental health.
Each case may involve a combination of multiple therapies to achieve optimal results.
Medication:
The decision to use medication depends on the individual case. If necessary, the doctor will decide to use single or combination therapy involving the following drug groups:
- Antidepressants: To balance chemicals in the brain that affect mood.
- Antipsychotics: For severe symptoms involving psychosis.
- Anxiolytics: To reduce anxiety.
- Sedatives: To aid with sleep.
- Medications to Enhance Brain Circulation and Neuronal Nutrition: To support overall brain health.
- Vitamins and Trace Elements: To support overall health.
Especially if the mother is breastfeeding, the doctor will carefully consider and choose medications with minimal risk to the baby.
Prevention:
Absolute Prevention:
There are no definitive measures due to the complex and intertwined causes of depression.
Relative Prevention:
- History of Depression: If the mother has previously experienced depression (related or unrelated to postpartum depression), there is a high likelihood of recurrence of postpartum depression. In this case, consulting with a therapist is essential to develop a preventive plan for postpartum depression, which may include the use of preventive medication if necessary.
- Psychotherapy Counseling: Seek advice from a doctor about psychological therapy methods to prevent perinatal depression in women at high risk.
- Physical Activity: Engage in moderate physical activity during pregnancy; postpartum exercise can help reduce the risk of developing postpartum depression symptoms.
- Prenatal Classes: Participate in prenatal classes, especially for first-time mothers, to gain knowledge related to maternal and infant care, and what new mothers need to know, etc.
- Rest and Self-Care: Ensure sufficient time for rest, maintain a proper diet, get adequate sleep, and find healthy ways to cope with stress.
- Manage Parenting Stress: Do not put excessive pressure on oneself for baby care. Be ready to seek and accept help from others, especially during pregnancy and after childbirth.
Specialist level 2 doctor. Nguyen Chi Thanh
References:
- Guidelines for Diagnosing and Treating Common Mental Disorders (Decision No. 2058/QĐ-BYT, dated May 14, 2020, by the Ministry of Health).
- Postpartum depression: Adverse consequences in mothers and their children – UpToDate. Accessed: May 14, 2024.
- Mild to moderate postpartum unipolar major depression: Treatment – UpToDate. Accessed: May 14, 2024.
- Postpartum unipolar major depression: Epidemiology, clinical features, assessment, and diagnosis – UpToDate. Accessed: May 15, 2024.
- Patient education: Depression during and after pregnancy (The Basics) – UpToDate. Accessed: May 14, 2024.
- Postnatal depression – BMJ Best Practice. Accessed: May 15, 2024.
