1ST CITY CLINICAL HOSPITAL

Postpartum depression

26.11.2024

One of the most important and at the same time difficult periods in the life of every mother is the postnatal period, which can be accompanied by various emotional changes, including postpartum depression.

This condition is an important topic that requires attention and understanding, because it affects not only the woman, but also her child, as well as the entire family structure.

Postpartum depression is a psychological condition that can occur in women after the birth of a child. It is characterized by a long-term feeling of sadness, apathy, fatigue, and loss of interest in life, including caring for a newborn.

Transient depressive symptoms are very common during the first week after delivery. Postpartum blues usually last 2 to 3 days (up to 2 weeks) and are relatively mild; in contrast, postpartum depression lasts > 2 weeks and is disabling, interfering with daily activities.

Postpartum depression affects 7% of women during the first year after giving birth. Any woman is at risk, but women who are most at risk are:

• History of depression
• With a history of established depression diagnosis
• Family history of depression
• Significant life stressors (e.g., relationship conflict, stressful events in the past year, financial difficulties, single parenting, partner's depressive disorder)
• Lack of support from partner or family members (e.g. financial support or help with childcare)
• History of mood changes that coincide in time with the menstrual cycle or use of oral contraceptives
• Previous or current unsuccessful pregnancy outcomes (e.g. previous miscarriage, premature birth, neonatal intensive care unit admission, child with congenital anomalies)
• Previous or ongoing conflict with the current pregnancy (e.g. if it was not planned or termination was being considered)
• Problems with breastfeeding

The exact etiology of postpartum depression is unknown, but previous depression and hormonal changes during the postpartum period, poor sleep are major risks; genetic predisposition may also contribute.

Symptoms of postpartum depression can vary, but they typically affect a woman's emotional state, behavior, and physical health. What distinguishes postpartum depression is its duration and intensity of symptoms, which can seriously affect daily life and family relationships.

It is important to understand that postpartum depression is not a sign of weakness or failure in motherhood. It is a serious illness that can occur in any woman, regardless of her age, number of children or social status. The main thing is to recognize the symptoms in time and seek qualified help.

Postpartum depression affects a woman's psychological, emotional and physical state, and its symptoms can vary greatly. However, there are a number of common signs to look out for

Emotional signs

• A persistent feeling of sadness, emptiness, or hopelessness.
• Tearfulness, often for no apparent reason.
• Feeling anxious, irritable, or angry.
• Lack of interest or pleasure in normal activities, including caring for a child.
• Feelings of guilt, worthlessness, or inadequacy as a mother.

Behavioral signs

• Lack of energy and fatigue, even after rest.
• Sleep problems – insomnia or, conversely, excessive sleepiness.
• Changes in appetite - decrease or increase.
• Lack of concern for one's own health and appearance.
• Avoiding contact with friends and family, social isolation.

Physical signs

• Chronic fatigue and lack of energy.
• Pain, including headache, back pain or muscle pain.
• Digestive problems, such as nausea or changes in bowel habits.
• What is special about postpartum depression is that these symptoms can significantly affect a woman’s ability to function in everyday life and as a mother. This condition requires understanding and support from loved ones, as well as professional medical intervention.

A woman's partner may also have an increased risk of developing depression, and depression in either parent can lead to stress in the relationship.

Without treatment, postpartum depression may resolve on its own, but it can also become chronic. The risk of relapse is 1 in 3–4 cases.

Diagnosis of postpartum depression requires a comprehensive approach that includes assessment of the woman’s physical condition, psychological profile, and social context. Often, the condition goes unrecognized because many symptoms may be mistaken for normal postpartum changes. However, timely diagnosis is critical to initiate effective treatment and support.

The following methods can be used in the diagnostic process:

• Medical history and consultation: The doctor conducts detailed interviews with the woman to understand her emotional state, pregnancy and birth history, and whether there have been similar episodes in the past. Any factors that may affect the psychological state, including personal, family, and professional circumstances, are also discussed.
• Psychological assessment: Specialists can use specialized questionnaires and scales to assess the level of depression. One of the most common tools is the Edinburgh Postnatal Depression Scale, which helps determine the severity of symptoms and the need for further intervention.
• Physical examination: Although postpartum depression is a psychological condition, it is important to rule out physical causes that can cause similar symptoms, such as thyroid problems or other endocrine disorders.
• Collaboration with other professionals: In cases where a comprehensive approach is required, psychotherapists, social workers or family therapists may be involved to provide additional support and help in adapting to new life circumstances.

The article was prepared by: Head of the Obstetric Physiology Department, obstetrician-gynecologist of the highest qualification category, E.V. Dvornik.

Obstetrician-gynecologist of the second qualification category Fomenok K.B.