Postpartum Depression: How to Manage it

Pregnancy can be one of the happiest times in a woman’s life. However, there are several changes that occur during the postpartum period. Postpartum depression is one problem that some women have to deal with.

Postpartum depression (PPD) is a type of mood disorder that can occur in women after childbirth. A combination of biological, physical, and emotional factors may lead to this problem.

The levels of estrogen and progesterone in the body fluctuate dramatically after delivery. These hormones are linked with neurotransmitters that affect a person’s mood. These chemical changes can contribute to PPD.

An estimated 13%-15% of women develop PPD in the first year after childbirth. This risk is substantially higher, up to 41%, in women who have a history of depression or other mood disorders before pregnancy.

What are the Causes of and Risk Factors for Postpartum Depression

PPD is largely brought on by certain hormonal changes that take place in women following childbirth. However, there are some women who are more likely to experience PPD than others, due to the following risk factors:

  • If they have a personal history of depression, bipolar disorder, or other mental health conditions of the like
  • If mental health issues such as depression or bipolar syndrome run in their family
  • If they lack a strong support network among family and friends
  • If they experienced depressive episodes during pregnancy
  • If they have previously struggled with a problematic pregnancy or childbirth in the past
  • If they are in a financial crunch and have money constraints
  • If they are going through an emotionally stressful phase, which can be due to personal as well as professional upheavals
  • If they are below 20 years of age
  • If they are grappling with alcoholism or illegal drug abuse
  • If their pregnancy was unplanned or unwanted
  • If they are raising a baby with special needs
  • If they have a demanding baby that is difficult to care for
  • If they have problems in breastfeeding their child

While the above-listed factors can make one increasingly susceptible to developing PPD, the condition is not limited to high-risk women alone. This form of postnatal depression can affect any new mother, including those who have had a normal delivery and have given birth to a healthy child.

As a personal history of depression can increase the risk of PPD, let your doctor know if you have struggled with depression or anxiety in the past. By taking special precautions, you may be able to reduce your risk of developing PPD.

What are the Symptoms of Postpartum Depression?

Major symptoms of PPD include:

  • Feelings of being overwhelmed
  • Intense anxiety
  • Frequent crying or weeping
  • Irritability or anger
  • Sadness
  • Fatigue
  • Feelings of worthlessness
  • Changes in sleeping or eating habits
  • Lack of concentration
  • Intense worry about the baby or lack of interest in the newborn

PPD can also cause physical symptoms such as:

The infant can be affected by the mother’s development of PPD; therefore, it is crucial to recognize the signs and symptoms of PPD. It is also important to seek treatment immediately if those signs or symptoms are present.

How is Postpartum Depression Treated?

Bringing a new life into the world is a painful yet life-changing experience, something that most women look forward to. However, this new and exciting chapter in a woman’s life can often be overshadowed by a thick, gloomy cloud of postnatal depression.

When you take on the role of a mother, the responsibilities that come with it can be quite daunting and overwhelming, especially in the initial phase. PPD can further cripple new mothers by making them feel lonely, distressed, and anxious.

It is the duty of friends and family to rally around the patient and help her through the bad times. As far as treatment is concerned, the following strategies have proven to be quite effective:

Self-Care Measures – You need to help yourself before anyone else can help you. To that end, you can try opening up to your family and friends about your feelings and what kind of help you need from them. Give yourself time to unwind by doing things that make you happy.

A healthy diet along with regular exercise is essential to keep you in the best of spirits. Try to pack in as much sleep at night as possible, and keep recharging your batteries by taking rest breaks throughout the day. Ask your partner, friends, or family to help out with the baby as much as possible. It is imperative that you don’t inundate yourself with mother duty.

Psychological Therapy – Ask your doctor to recommend a self-help course or a course of therapy such as cognitive behavioral therapy (CBT), which can help you overcome the postpartum blues.

Medication for Severe Cases – If all other methods fail to improve your condition, the last resort is taking a doctor-prescribed antidepressant that is safe to consume while nursing.

How Do You Deal with Postpartum Depression?

Here are 10 ways to fight and prevent PPD.

1. Up Your Vitamin D Intake

Vitamin D is an essential nutrient that is important for mental health.

This vitamin aids in the production of serotonin, the brain hormone associated with mood elevation and happiness. An adequate level of serotonin helps prevent and treat PPD.

During pregnancy, with the demands placed on the body by the fetus, there is an increased risk for vitamin D deficiency.

Numerous studies in the last 5 years support that low vitamin D during pregnancy is a risk factor for developing PPD.

However, there was one study done in 2013 in which the findings did not support a link between low vitamin D during pregnancy and PPD. Instead, this study revealed the opposite, that there was an increased risk for PPD among women with the highest vitamin D levels.

Vitamin D is acquired from exposure to sunlight, diet, and vitamin D supplements. Foods that contain vitamin D include some kinds of fish, egg yolks, and fortified dairy and grain products.

As there are relatively few dietary sources of vitamin D, most of the body’s vitamin D comes from direct exposure to sunlight. Vitamin D supplements are another common source of vitamin D.

2. Eat Foods Rich in Omega-3 Fatty Acids

Omega-3 fatty acids are vital nutrients for a number of cell functions.

These fatty acids are key components in cell membranes, which aid the proper functioning of serotonin. Serotonin is important for carrying messages to the brain cells to maintain a positive mood.

Omega-3 fatty acids also play a key role in the development and functioning of the central nervous system, and they have been proven effective in the treatment of perinatal depression, which includes depression both during and after pregnancy.

A review of literature in 2018 revealed strong evidence to support that dietary supplementation with omega-3 fatty acids during or following pregnancy can reduce the symptoms associated with depression. Furthermore, there is evidence that supplementation in healthy pregnant women reduces the risk of PPD.

To ensure an adequate intake of omega-3 fatty acids, eat more flaxseeds, fatty fish such as salmon, walnuts, and omega-3-fortified eggs. You can also take an omega-3 fatty acid supplement, after consulting your doctor.

3. Breastfeed Your Baby

New moms diagnosed with PPD need a secure emotional attachment with their newborns. The infants also need this secure attachment with their mothers. This nonverbal emotional bond aids in releasing endorphins that make mothers feel happy and confident as a mom.

To build this strong emotional bond, breastfeeding is the best option. However, mothers with PPD may be less likely to breastfeed.

This is supported by a 2012 study that revealed that there seems to be a reciprocal relationship between PPD and breastfeeding; women who breastfeed are less likely to develop PPD, while women with PPD are less likely to continue breastfeeding.

So, it becomes important for the partner or other family members to help new moms understand the importance of breastfeeding.

A study in 2018 showed statistically significant evidence that women who breastfeed their infant are less likely to develop PPD. Further, this study suggested that even women who intended and planned to breastfeed but ultimately did not may be at a lower risk for PPD.

4. Consider Talk Therapy

In talk therapy, a mental health professional (a counselor, therapist, psychologist, psychiatrist, or social worker) talks with the woman suffering from PPD on a one-to-one basis.

This allows the new mom to share all her fears and emotions in confidence with someone outside her circle of family and friends. Through the therapy, the new mother becomes ready to accept the new responsibility of motherhood in a much better way.

Two types of counseling are found to be very effective in treating PPD. These are cognitive behavioral therapy (CBT) and interpersonal therapy (IPT).

CBT helps people recognize and change negative thoughts and behaviors. This talk therapy is based on the premise that both perceptions and behaviors are intimately linked to mood. Evidence suggests that antenatal CBT is an effective method for the prevention and treatment of PPD.

IPT helps people understand and work through problematic personal relationships. This time-limited therapy focuses mainly on addressing the person’s interpersonal connections.

A 2007 study suggested that IPT can be beneficial in treating PPD because it helps address interpersonal stressors that occur during the postpartum period.

In both these therapies, treatment usually lasts 3 to 4 months.

5. Relieve Your Stress with a Massage

A soothing, warm massage is one of the best ways to pamper a depressed body.

Massage not only rejuvenates a depressed body but also fills it with renewed energy, which is important as, being a mother, you have a new responsibility of taking care of your newborn baby.

It even helps get rid of all the negative feelings and thoughts, as well as plays a key role in managing physical pain and the impacts of stress.

Postpartum massage has other benefits too, including hormone regulation, reduced swelling, better sleep, and improved breastfeeding.

Along with that, doing a baby massage under the supervision of your partner or an expert can also help fight PPD. Massaging the baby helps depressed mothers bond with their newborns.

There is evidence to suggest that massage during pregnancy benefits not only the mother, including reduced incidence of depression and lower cortisol levels during the postpartum period, but benefits the infant as well.

A study found that infants born to mothers who had massage therapy during pregnancy were less likely to be born prematurely and had a lower incidence of low birthweight. Those infants also had lower cortisol levels, like their mothers, and they performed better on orientation and motor scales.

A study published in the Journal of Affective Disorders indicates that attending baby massage classes improved maternal depression and mother-infant interactions during the first year.

It is important to find a massage therapist who is certified in post-delivery massage therapy.

6. Try Acupuncture Therapy

Another significant way to deal with depression post-delivery is age-old acupuncture therapy. In this therapy, thin needles are inserted at specific vital pressure points in the body.

It helps maintain the equilibrium of the various hormones in the body. Acupuncture is also beneficial during pregnancy.

Acupuncture is an effective treatment that can help to reduce depression symptoms during pregnancy. It can even give the mother a boost of energy to replenish the energy depleted during childbirth.

When it comes to acupressure, it is important to get it done by an expert only.

7. Go for Bright Light Therapy

The use of bright light therapy as a treatment for depression has become popular in recent times.

Bright light therapy has fewer side effects and is less expensive than antidepressant medications. The antidepressant effects of bright light therapy are well established, and it is a relatively safe treatment for depressive disorders.

In this therapy, the patient’s eyes are exposed to intense but safe amounts of light for a specific and regular length of time. The light corrects a problem with the inner biological clock, called the circadian rhythm.

Also, it affects neurotransmitters in the brain, including serotonin, noradrenalin, and dopamine, which are important in treating depression. Studies have shown that bright light therapy can improve the regulation of the serotonergic system in women with perinatal depression.

Two cases highlighted in a letter to the editor of the American Journal of Psychiatry in 2000 showed a good clinical response to bright light therapy along with subjective reports of improvement in mood. The therapy was well tolerated in both cases with no adverse effects during the treatment course.

8. Practice Mindfulness Meditation

Mindfulness is defined as “the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us”.

It is a concept of Buddhist philosophy and is practiced to achieve enduring happiness and gain the appreciation of the true nature of existence.

The practice of mindfulness meditation has been proven to effectively reduce stress, anxiety, and negative mood during pregnancy, thus lowering the risk of developing PPD.

Mindfulness training has also been shown to be effective during childbirth and is used by some women as an alternative to systemic opioid pain medication.

In fact, mindfulness meditation can make you feel calm and energized. These factors are needed for the new role of parenthood.

The practice of mindfulness-based childbirth and parenting (MBCP) results in a lower incidence of anxiety, depression, and negative affect during pregnancy, childbirth, and the early parenting period.

Initially, make it a daily habit of spending at least 5 minutes intentionally practicing deep relaxation. Then, gradually increase the time.

9. Take Proper Sleep and Rest

Altered sleep patterns and sleep disturbance are common during the postpartum period. These are related to newborn sleep and feeding patterns.

The Wisconsin Maternity Leave and Health Project indicated that sleep is highly essential for a new mom. A full 8 hours may seem impossible when you’re dealing with a newborn, but poor sleep makes depression worse.

Poor sleep leads to significant alterations in brain neurotransmitter functioning, which is one of the reasons behind depression.

A study done in 2001 revealed that difficulty falling asleep in the first month postpartum was one of the four predictors of depression at 4 months postpartum. The other predictors included maternal age, depression during pregnancy, and thoughts of death and dying at 1 month postpartum.

During pregnancy and the postpartum period, it is important to catch up on lost sleep with naps. If possible, a new mother should take the baby out for a walk every morning to improve the maternal and child circadian rhythms. You can also ask your partner to help with the nighttime work.

10. Engage in Mild Exercises

Exercise is just as effective as medication when it comes to treating depression. Hence, after delivery, the sooner you get back up and moving, the better. Numerous studies have shown that exercise is associated with decreased symptoms of anxiety and depression.

There is no need to indulge in intense workout programs. Just a 30-minute walk each day will work wonders. You can also take your baby along in a stroller. Stretching yoga exercises are also helpful in getting you back in shape.

A 2007 review of the literature found evidence that supports exercise as a useful treatment for PPD. It is further suggested that taking a walk while pushing the baby in a stroller may be beneficial in the treatment and prevention of PPD.

A 2018 study revealed that aquatic exercise can reduce the risk of developing PPD. It was also suggested that obesity and a sedentary lifestyle during pregnancy are associated with positive screening for PPD.

Another 2012 study published in BMC Pregnancy and Childbirth also highlights the effectiveness of a 6-month exercise program as an effective treatment for PPD. Exercise should be considered as part of a comprehensive treatment program for mothers who are at risk for or who have been diagnosed with PPD.

What is Postpartum Psychosis?

In rare instances, PPD can acquire a rather extreme and possibly dangerous form, which is known as postpartum psychosis. This is a serious disorder that is characterized by a sudden onset, usually within a week or two after delivery and sometimes as early as the first two days.

A woman suffering from this extreme degree of psychosis is unable to differentiate between what is real and what’s not. Due to this kind of delirium, the patient can easily jeopardize her own health as well as that of the baby.

The risk of suicide and infanticide is imminent, and therefore hospitalization is usually required to keep the mother and the baby out of harm’s way.

A woman with postpartum psychosis usually exhibits the following symptoms:

  • Hallucinations, which include seeing things that aren’t real or hearing imaginary voices
  • Delusions characterized by feelings of paranoia as well as unfounded beliefs that defy logic
  • Extreme agitation
  • Severe anxiety
  • Confusion and disorientation
  • Sudden changes in the mood
  • Bizarre behavioral antics
  • Inability or refusal to eat or sleep
  • Thoughts of harming or killing her baby
  • Suicidal thoughts or attempts

How Can Postpartum Depression Affect Your Baby?

Being in the throes of PPD can make it difficult for a woman to care for herself and her baby as well. A perpetual case of PPD can cause the following:

  • The mother may find it difficult to care for herself and the baby as she may be skipping her routine visits to the doctor.
  • The relationship between the mother and her baby may be strained, which may affect the baby’s feeding schedules. Breastmilk is the primary source of food for a baby.
  • The baby may not be getting the medical attention and care required for his/her healthy development such as timely immunization and routine checkups.
  • The baby’s cognitive health and developmental milestones may also be affected.

Trust your healthcare provider to show you the way through this difficult phase. Early treatment will help safeguard not just your own health but your baby’s well-being as well.

Additional Tips

  • Learn to bond with your baby. The more emotional connection you have with your baby, the lesser will be the chance of getting depressed.
  • Motherhood is not an easy job. Do not hesitate to lean on others for help and support.
  • Make your relationships a priority. During difficult times, strong relationships will help you get through the situation.
  • Don’t keep your feelings to yourself. Share what you’re experiencing – the good, the bad, and the ugly – with your partner or anyone else with whom you feel comfortable.
  • Make yourself and your baby the priority and do not worry much about household chores.
  • To avoid PPD, make time to take care of yourself. The more you care for your mental and physical well-being, the better you’ll feel.
  • Make meals a priority and be sure to follow a well-balanced diet.
  • Make time for your relationship with your partner.
  • Keep the lines of communication open, especially with your life partner.
  • Listen to a variety of music.
  • Keep a journal to express your thoughts and feelings by writing them out.
  • In severe cases of PPD, antidepressants may be an option. However, medication should be taken only under the guidance of a physician.

Resources:

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Patrick Moser, FNP-BC, RN

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