1ST CITY CLINICAL HOSPITAL

04/11/2024

Postpartum depression occurs in a much larger number of women than is commonly thought; 15–30% of women are affected to varying degrees. This is important for all mothers to know. After all, the sooner they diagnose the signs of the disorder and begin treatment, the more effective it will be.

Symptoms of postpartum depression

Women who were already depressed before pregnancy are more susceptible to postpartum depression. Mothers who have less social support, those who experience difficult life circumstances alongside parenthood, and those whose children were born with serious health problems are also prone to depression.

To effectively treat depression, the main thing is to diagnose it early. Symptoms of postpartum depression may include:

• constant tears for no reason (after the first emotional outburst has passed on the 3-5th day after birth);
• constant feeling of dissatisfaction and low self-esteem;
• difficulties in establishing an emotional connection with the child;
• self-neglect, dissatisfaction with appearance;
• insomnia and fatigue during the day;
• loss of sense of time;
• loss of sense of humor, inability to see the funny side of a situation;
• increased anxiety for the child;
• indifference to the child;
• (sometimes) negative thoughts towards the child: not the desire to harm, but the awareness that the mother could do it.

If you have any doubts, don't leave things to chance. Today there is a wide choice of means of struggle: from psychological help to hormonal drugs and antidepressants.

The main causes of postpartum depression are currently considered to be a ban on the expression of negative feelings, primarily aggression towards the child. Psychotherapist Irina Gibermann writes about this in her book “I Live as I Want”:

The mother is prohibited from showing any negative feelings towards the baby. Anger, envy, jealousy, desire to push away, need for silence. Aggressive impulses are suppressed.

Unlived emotions are a catalyst. I direct aggression towards myself, strengthening with anger the awareness that I can’t do this. You can’t be angry at a child - I’m angry at myself. The spiral twists in such a way that it is no longer possible to adequately exit it.

The roles of “loving mother” and “smiling baby” are played out to the outside world. Inside, breakdowns occur, there is a desire to cover your ears, leave, leave the baby, hit yourself, the wall, the child. Yell when he yells, not calm him down. Pushing him away when he cries rather than comforting him. Get some sleep. Catch my breath. At least for a moment. But immediately a feeling of guilt comes over you: you are a bad mother, you are a nonentity, everyone can do it, but you can’t. Guilt triggers the desire to destroy oneself so as not to harm the child. Exit? Recognize aggression and its scale.

In addition, the child themselves can make the situation worse: if they sleep little and poorly, the mother is more likely to develop depression, and this will almost certainly be related to their own lack of sleep.

How is postpartum depression diagnosed?

For diagnosis, the Edinburgh Postnatal Depression Scale is most often used (although there are other versions of questionnaires). We took it from the book “Everything is fine!”, which talks about how to survive the first years after the birth of a child.

It’s easy to calculate your result: each answer from the first column is worth three points, from the second – two points, from the third – one point and from the fourth – zero points. Answers to questions 1, 2 and 4 are scored in reverse: the answer from the first column is zero points, from the fourth - three points. Then the results are summed up. As a rule, doctors take 10–12 points as a threshold value. This means moderate depression. Twenty or more points indicate that there is severe depression.

Treatment of postpartum depression

Treatment of postpartum depression consists of several stages. In cases of mild depression, the doctor will first try to avoid prescribing medications. There is evidence that exercise and massage help with mild depression. And, perhaps, the main medicine is sleep.

Getting better sleep

Lack of sleep can play a huge role in the development of depression, especially if this is your first child. No wonder. Try sleeping less than usual for a few nights, and even without a screaming baby in your arms, you will feel depressed. Now imagine sleeping in fits and starts for many weeks and even months - of course, this will significantly worsen your emotional state.

Obviously, the problem of lack of sleep is difficult to solve when you are responsible for a newborn baby.

Even if you do not teach your child a certain daily routine and do not plan to do so, or if your baby is still too young, there are still ways to improve the situation:

• ask your friend, sister or mother to replace you for a night or two;
• if funds allow, hire a night nanny;
• Share the night watch with your spouse so that each of you gets enough sleep without emergency awakenings.

And remember that taking action against depression is not a selfish whim. You are doing this for your own child.

Psychotherapy

In addition to quality sleep, the doctor will first recommend cognitive behavioral psychotherapy or some other type of conversational psychotherapy. They will help you work through negative thoughts and focus on constructive actions.

Antidepressants

In the case of more serious depressive disorders (twenty points or more), doctors tend to prescribe antidepressants that are compatible with breastfeeding. Although the active substances of these drugs pass into breast milk, there is no data on their negative effects on the child's body.

Anxiety disorder and postpartum psychosis

Many books and articles are devoted to postpartum depression. However, not all postpartum mental disorders take the form of depression. Another common problem is postpartum anxiety disorder . Many of its symptoms coincide with those of depression. But women with anxiety disorders are more likely to have obsessive thoughts about terrible things that could happen to their child. This leads to insomnia, even when all conditions are created for quality sleep, and the woman herself endlessly repeats obsessive-compulsive actions in order to protect the child from everything in the world. This disorder is also treated with psychotherapy and, in more serious cases, with medications.

There is a rarer, but more dangerous form of mental disorder - postpartum psychosis . It occurs in one to two women out of a thousand (compare with the prevalence of depression: one case in ten women). A major risk factor is a maternal history of bipolar affective disorder. Postpartum psychosis is characterized by hallucinations, delusions and manic episodes. In most cases, hospitalization is required as the consequences of this condition can be extremely serious.

All mental postpartum disorders are caused, on the one hand, by a surge of hormones, and on the other, by placing the main responsibility for the child on the woman.

The sooner you notice the problem and take steps to deal with it, the sooner you can enjoy parenthood and the happier your family will be.

Women who were observed for pregnancy at the 4th antenatal clinic can always seek help from a psychologist at the 4th antenatal clinic by first making an appointment by calling +375(17)3797353