Postpartum Depression is a serious psychiatric disorder which impacts both the mother and the infant. The incidence of psychiatric disorders in postpartum women demonstrated an elevated risk of depression (including anxiety symptoms ) when compared to nonpregnant women

The likelihood of depressive episodes in postpartum can be twice as high as during other periods of a woman’s life and they often go undetected .

Mothers suffering from Postpartum Depression often display hostility ,negligence, lower tolerance and less responsive to their infants needs.

It negatively impacts the mother with suicide, accounting for approximately 20% of postpartum deaths in mothers.

Extended suicide have also been documented in literature (mother killing the child and attempting death by suicide)

Prevalence of Postpartum Depression

A study was conducted in 2018 on prevalence and incidence of PPD among healthy mothers without prior history of depression including Postpartum Depression and who gave birth to healthy full term babies. In this review 58 articles were included, 37294 women participated in it.

The incidence of Postpartum Depression is 12%

The prevalence of Postpartum Depression is 17 % among healthy mothers without prior history of depression.

Impact of Postpartum Depression

Postpartum depression (PPD) is a complex condition that can have significant impacts on the health and well-being of new mothers, their infants, and their families. Here are some vital points about the impact of PPD.

For the Mother: PPD can lead to severe mood swings, feelings of inadequacy,anxiety and difficulty bonding with the baby. Maternal health became poor associated with suicidal ideas, attempt and death Mother also have weight loss and poor quality of life.It increases the risk of future episodes of major depression and can affect a woman’s ability to function daily.

For the Infant : This condition can affect a child’s growth and development. It may also impact the infant’s attachment to the mother and contribute to behavioral, emotional and cognitive challenges later in life. Mother baby bonding became too poor, the health of infants and children is intimately associated with the health of their mothers.

For the Family: It also paved the way for family conflict and poor quality of life. PPD can cause emotional distress for everyone close to a new baby. It can also increase the risk of mental health of the baby’s other parent and close relatives. Depressed women are caught in a vicious circle in which they become depressed,irritable, angry and family discord. It also affects sexual health and life becomes more difficult to move smoothly with an emotional bond.

Economic Impact: PPD can increase healthcare costs. It contributes to the mother Poor quality of life and she is unable to do her work within the family and the professional settings.

Longitudinal studies have shown that PPD can have long-term effects on a woman’s mental, physical, social and economic health, and may influence her willingness to have more children.It is important to recognize PPD and seek professional help as early as possible.

How does ICD 11 diagnose postpartum depression?

According to ICD-11 PPD may experience at least five of the following 10 symptoms occurring most of the day during two weeks

At least one symptom should be depressed mood or loss of interest or pleasure in activities are must for diagnosis.

Affective Cluster: Affective disorders encompass a range of conditions where the primary symptom is a disturbance in mood. In the context of PPD, the mood disturbance is significant enough to impact social and occupational functioning and is directly related to the postpartum period.

1.Depressed mood (sad, irritable)

2.Diminished interest

Cognitive behavioral Cluster:Cognitive behavioral clusters in PPD refers to patterns of negative thoughts, feelings and behaviors that can contribute to and maintain the condition.These cluster may include

3.Reduced Concentration

4.Low of self-worth and inappropriate guilt

5.Hopelessness

6.Recurring thoughts of death

Neurovegetative cluster: Neurovegetative symptoms are a significant aspect of postpartum depression, affecting the physical functioning and quality of life of new mothers. Symptoms may include

7.disturbed sleep

8.Change in appetite

9.Psychomotor agitation

10. Reduced energy.

PPD is a serious condition that affects approximately 13% of new mothers, often within the 12 weeks after delivery. Itis important for healthcare providers to recognize and address these symptoms as part of a comprehensive approach to the treatment and prevention of postpartum depression

How does DSM V diagnose Postpartum depression?

Having depression during the postpartum or perinatal is considered as postpartum depression. Depression must occur the first four weeks of delivery of the child.They experience five or more symptoms at least for three weeks and should have one symptom that is either depressed mood or loss of interest or loss of pleasure.

MAJOR depressive disorder occurring within the first four weeks following delivery.

The individual must be experiencing five or more symptoms, during the same two week period and at least one of the symptoms should be either

1.depressed mood

.2. Loss of interest or pleasure

3. Significant weight loss

4. A slowing down of thoughts and a reduction of physical movement

5.Fatigue or loss of energy

6. Feelings of worthlessness , excessive or inappropriate guilt

7.Diminished ability to think or concentrate or indecisiveness

8. Recurrent thoughts of death, recurrent suicidal ideational attempt

Course specifier is with peripartum in onset

Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure in all

Baby Blues

The birth of a baby gives a mom powerful emotions, from excitement and joy to fear and anxiety.

But it can also result in something you might not expect -depression

Most new moms experience postpartum “ baby blues” after childbirth,which commonly include

mood swings, crying spells, anxiety and difficulty sleeping. Baby blues usually begins with in the

first two to three days after delivery and may last for up to two weeks.

The baby blues are common experience for new mothers,affecting about 80% postpartum

Moms. It is a mild, transient and self limiting condition that begins shortly after childbirth.

Presents with a variety of symptoms such as altered mood, mood swings, irritability, dysphoria, insomnia, anxiety, decreased appetite and tearful..

It is not pervasive and lasts for less than two weeks.

If it is more than two weeks one need to consider Postpartum Depression

These feelings typically emerge within a few days of giving birth and can last up to one week to two weeks may include .The reality of baby blues are unknown, it is thought that due to the hormonal imbalance during pregnancy and after baby’s birth. Baby Blues symptoms may include

1.Weepiness or crying: Always tearing up or crying without a clear reason.

2.Irritability: Feeling irritable and impatient is common during this period.

3.Restlessness:You might feel restless and unable to settle down.

4.Anxiety: Worrying about your baby’s health and safety can be overwhelming

5.Fatigue: Despite exhaustion you may experience insomnia and restlessness.

6.Feeling unattached: Some moms report feeling unattached or in need of their newborn.

7.Missing your old Life: Longing for the freedom you had before the baby arrived

But some new moms experience a more severe, long lasting form of depression known as

postpartum depression , it is also called peripartum depression because it can start during

pregnancy and continue after childbirth. Rarely, an extreme mood disorder called postpartum

Psychosis also may develop after childbirth. Postpartum psychosis may lead to life-threatening

thoughts or behaviors and requires immediate treatment.Postpartum depression is not a character flaw or a weakness. Sometimes it is simply a complication of giving birth.

Treatment is education about Postpartum Depression for both the patient and spouse

Validation of symptoms ,Reassurance and family support.

The treatment of Baby blues is self limiting such as educating the mother and family members about the postpartum blues. Validation of symptoms telling them about t it is very common , self limiting, reassuring, validating the symptoms and asking for family support will do major wonder the treatment of postpartum blues.

Risk factors of Postpartum depression

Various studies which looked into the risk factors of PPD. one of the studies which was published in 2020 by zia hui and his colleagues. It is a metaanalysis of 48 studies and further there was one more study which was published in 2020 It is also looking for the risk factors of PPD and it is scopint for an umbrella review. It reviewed 21 articles. Here included the combination of both of these studies meta-analyses. These studies reveals the risk factors of PPD are Prenatal depression,childcare stress,lack of social support,prenatal anxiety,maternity blues, history of depression,family income, women’s occupation,pregnancy and birth complications,neuroticism,negative cognitive attributional style,current abuse or violence, infant temperament, self-esteem,unpleasant or unwanted pregnancy,substance abuse,obesity,sleep disturbance,breastfeeding body image dissatisfaction,preeclampsia, child sexual abuse, HPA axis dysregulation,inflamatory process, genetic vulnerability.

Associated with various studies the major risk factors are

Antenatal depression
Life stress
Poor social support
Prenatal anxiety
Maternity blues
Family income
Marital discord
Current abuse or domestic violence
Infant temperament
Unwanted pregnancy
Substance abuse
Sleep disturbance
Genetic vulnerability
Past history of depression.

Postpartum Depression causes

Genetic and epigenetic factors: A history of depression in the family may predispose someone to postpartum depression.

Biochemical factors: Death, diseases ,accidents and illnesses in the family during pregnancy and at the time of delivery can accelerate to postpartum depression.

Neurobiological changes: PPD appears to impact neurobiological pathways linked to socio-emotional regulation, cognitive and executive function, and physiologic stress response systems, also associated with negative stress and negative health trajectories across the life course.

HPA Axis dysfunction: When cortisol level enhanced Hypothalamus and Pituitary axis function collapsed. stress and anxiety in thinking and behavior can contribute to the production of cortisol led to PPD

Neurohormones: A drop in hormone levels after delivery can contribute to postpartum depression

Circuit level changes : Neural plasticity in pregnancy and the postpartum period links to maternal caregiving and mental health. The female brain during this period may attain dynamic structural and functional changes that take place that accompany fundamental behavioral adaptations. This stimulates the female to progress as an individual with self-directed needs to being responsible for the care of another life.

Postpartum depression, also known as postnatal depression, is a mood disorder that occurs after childbirth. It can affect both mothers and fathers.

Postpartum Depression symptoms

Postpartum depression is a mood disorder that affects some new mothers after giving birth.It can lead to a range of emotional, behavioral, and cognitive changes. Postpartum Depression symptoms may include

Depressed mood or severe mood swings

Excessive crying

Difficulty in bonding with the baby

Withdrawal from family and friends

Loss of appetite or overeating

Sleep disturbances (insomnia or excessive sleep)

Additionally, the mom who experiences postpartum depression may feel guilty, worthless,

hopeless and helpless.It is essential to seek professional help if you are experiencing these symptoms. Resources are available to support you during this challenging time. Remember please take help from a professional, they can guide you in a proper way.