Postpartum Depression

Postpartum depression is depression that may occur in women in the postpartum period. In the terminology, the terms postpartum or postnatal depression are also used.

Baby blues or postpartum depression?

If you are in a depressive mood only a few days after birth, it is also called howling days or baby blues. This is normal and may be temporary due to the hormonal changes. On the other hand, postnatal depression or postpartum depression persists for several weeks and may become chronic in severe cases. In very severe cases, even a postnatal psychosis or a puerperal psychosis can occur. Post-traumatic stress disorder is referred to as having experienced childbirth as traumatic. After a premature birth or the birth of a sick or handicapped child, depressive reactions may occur as well.

About fifty to seventy percent of all women experience the baby blues after delivery in childbirth. Ten to fifteen percent of all women develop postpartum depression in the postnatal period. Puerperal psychoses, however, are very rare with 0.1 to 0.2 percent. About three-quarters of all post-natal depression and psychosis affect women who have a child for the first time. Post-traumatic stress disorder occurs after about one to two percent of all deliveries. Depressive reactions occur in about twenty to fourty percent of all premature births or births of sick or disabled children.

What are the causes of postpartum depression?

The causes of baby blues and mild postpartum depression are above all the changed living situation, the hormonal change as well as the overstimulation, the lack of sleep and the lack of rest. More severe postpartum depression occurs when additional social support is lacking, problems exist in the partnership or one’s own expectations regarding the role of mother are too high and then can’t be met. Physical causes and diseases can also contribute to the development of postnatal depression:

  • thyroid disorders
  • iron deficiency
  • birth complications
  • toxoplasmosis
  • medicines like anticonvulsants, antirheumics or heart medications (beta-blockers)
  • birth trauma

Depression that has already occurred during pregnancy is also considered the cause of postpartum depression. In addition, previous mental disorders or mental illnesses in the family can promote the development of puerperal depression and, in severe cases, lead to puerperal psychosis.

Post-traumatic stress disorder can occur if the delivery was perceived as traumatic. For example, a strong sense of helplessness and being mistreated by a lack of care during childbirth can be a significant psychological burden. In addition, there is often a lack of sufficient processing of the birth experience. Even earlier traumatic experiences can play a role.

Depressive reactions are usually the result of loss events. Often the grief is not sufficiently processed or even not approved. In preterm or sick and disabled children, concern for health and related, necessary measures can lead to depressive reactions.

Signs of postnatal depression

The baby blues and postpartum depression are expressed by:

  • general increased sensitivity
  • mood swings
  • increased irritability
  • depression
  • the feeling of guilt and failure
  • concentration and sleep disorders
  • anorexia
  • limpness

The baby blues reach their peak about three to five days after delivery and close until about the tenth day. Serious postnatal depression, on the other hand, occurs rather creeping within the first few weeks after birth. If these symptoms still appear after weeks or after birth, everything points to postnatal depression.

In a postnatal psychosis behavioral changes, unfounded fears and thought disorders are added. In part, perceptual disorders such as delusions, hallucinations or the hearing of voices occur. Postnatal psychosis usually begins during the first two weeks after delivery.

Post-traumatic stress disorders are characterized by nightmares and flashbacks, in which experiences of childbirth recur. Sleep disorders, sadness, a sense of inner deafness, irritability, social withdrawal and other depressive symptoms are the result. Post-traumatic stress disorder occurs in most cases immediately after a traumatically perceived childbirth. But you can also express yourself after several weeks or months.

Depressive reactions focus on shock and a feeling of inner deafness. Often follow more depressive symptoms and a prolonged depression. Depressive reactions usually begin within the first few days to weeks after birth.

How are postnatal depression diagnosed?

For the diagnosis of postpartum depression, there is a specialized questionnaire. The Edinburgh Postpartum Depression Scale helps assess the presence of depression. The questionnaire includes ten questions about mental health during the post-partum period. Also in the assessment of depression, which already occur during pregnancy, the test can help.

What treatment options are available for childbed depressions?

In the case of baby blues, psychotherapy is usually unnecessary. For the most part, a supportive consultation by the midwife, the woman doctor or the family doctor is sufficient. In more severe cases, professional help from a psychotherapist should be sought. If inpatient treatment becomes necessary, special mother-and-child treatments offered by some clinics may be helpful. In the case of a drug treatment, it must be taken into account that the active substances may possibly harm the infant since they also enter the breast milk. Support from relatives and support groups can also play an important role in overcoming postpartum depression, postnatal psychosis or other mental postnatal disorders.

What is the course of childbed depression?

The course of childbed depressions depends on when they are detected. The diagnosis is sometimes difficult, as the symptoms often can’t be clearly differentiated from normal mood or behavioral changes after delivery. Therefore, postpartum depression is often detected too late or not at all, which can lead to a disturbed relationship between mother and child. In some cases, the psychological distress due to the lack of therapy can become so great that the affected women suicidal thoughts or attempts.

Can one prevent postpartum depression?

To prevent postpartum depression, it is important to have good social support. Increased support from the partner and the family can help reduce the risk of postpartum depression. However, too much care may increase the feeling of failure in those affected. In such cases, professional help is recommended.

In order to avoid depressive reactions, one’s own expectations of the mother role should not be set too high and the image of the “happy and carefree mother”, as it is sometimes conveyed in public, should not be overstated.

If depression has already occurred during pregnancy or is a prelude to past mental health problems in one’s own or family history, it is best to start dealing with the issues as early as possible and, if necessary, quickly seek professional help.

Baby blues or postnatal depression in the father

Almost one in ten fathers, according to Australian researchers, is stressed, worried, and often does not see the end of the tunnel after the birth of a child. The symptoms are quite similar to those of the postpartum depression of young mothers.

“We were surprised that fathers’ problems are more common than with mothers,” said research director at the Parenting Research Center in Melbourne, Australia, Jan Nicholson. 9.7 percent of the fathers mentioned several stress symptoms in the first twelve months of their offspring. For women it was 9.4 percent.

“Mental problems can be persistent and inexorable with fathers,” says the study, published in the journal Social Psychiatry and Psychiatric Epidemiology. The researchers interviewed 5,000 young mothers and 3,471 new fathers. According to Nicholson, fathers described:

  • anxiety
  • a lot of worries
  • feeling unable to do it and seeing no improvement

“Among young fathers, the rate of those who describe such problems is 40 percent higher than among men in general,” Nicholson said.

“It is often assumed that postnatal depression in mothers has biological causes, and that they have to do with the fact that in the beginning mothers are especially concerned about the children – but as far as the fathers are concerned, we have not been right so far watched”. She said. As for women, there must be help for men at this stage, she demanded.