More than just baby blues
View(s):Dr. Thilini Rajapakse discusses a hidden suffering- Depression in the postpartum period
The family didn’t think anything of it, until Chaya said she was leaving home. She had been much quieter than usual for the past two months, irritable at times, and lying in bed during the day, but they attributed all this to the tiredness of looking after the new baby. But in the past week, Chaya had been tearful, restless, and said that she was leaving home. This had worried her husband. “What do you mean? What about the baby?” he had asked in confusion. His wife’s reply had been strangely flat and apathetic. “I don’t know. It’s better if I leave. Someone else will look after the child better than me.”
Postpartum depression is not rare; it affects upto 10-20% of all women who have delivered a baby. It is not a disorder that differentiates between people – all new mothers can be affected, although certain women, such as those who have experienced depression in the past, are at increased risk. Postpartum depression is different from maternal blues – which is a more common, mild and transient change of mood, which occurs within the first week of delivery and resolves in a few days.
On one hand, postpartum depression is basically depression that occurs in a woman who has recently delivered a child. But on the other hand, it is also strikingly different from depression that occurs at any other time in our lives –because it dramatically impacts not just one person – but a new mother, her baby, and family. Postpartum depression not only causes maternal suffering, it also negatively impacts how mothers care for their infants. Think of the interaction between a healthy mother and her baby; not only does she look after the baby, she constantly interacts with the child, talks to the child – and the child learns and responds. This is crucial for the baby’s cognitive development as well as for the bonding and attachment between the child and the mother.
Research shows that depressed mothers have less vocal and visual communication with their babies. Evidence states that maternal depression is associated with impaired mother-baby attachment, and increased risk of behavioural problems and impaired cognitive development, in the child. These are serious implications, with long-lasting negative impacts on the growing child.
The symptoms of postpartum depression usually have a gradual or insidious onset, often starting within a few weeks or a few months after delivery of the baby (within the first year).
When you think of the term ‘depression’, you may think that it equals ‘feeling sad’; but the illness of depression is a much broader concept. While it does include low mood, it is also characterized by other key features, such as a constant tiredness, a lack of interest in what used to be enjoyable, reduced appetite, reduced sleep, and many negative thoughts, worries, self-blame and guilt. And these features persist throughout the day, for days on end, for weeks and months.
So how would these symptoms be seen, in a mother who has a new baby? Looking at it from outside, what you would observe is a mother who seems tired, lethargic or uninterested in a child; who may lie in bed during the day, who doesn’t interact with her child much, who may neglect her child’s care and feeding. This persists and worsens over weeks or months. Some depressed mothers also get very anxious.
And if you observed these changes in the mother, what would you conclude? Often, our first response may be to criticize or blame the mother – a ‘bad’ mother, a mother who is ‘neglecting her beautiful baby’, etc. Because – viewed from outside, depression is often difficult to identify as an illness. For example, instead of becoming depressed, what if this mother fell and broke her leg- would we blame her for not walking? Obviously not. Instead we would seek treatment and support her until the fracture heals.
But the illness of depression is not so externally visible; and thus there is a high risk that the family, and even the woman herself may not identify it as an illness. The woman may be blamed. Alternatively, the change of behaviour in the depressed mother maybe identified in more traditional terms – for instance as her ‘bad time’, or as ‘evil spirits’.
Mothers who are experiencing depression in the postpartum period may articulate their experiences clearly if given the chance. One mother described it thus:
“Doctor, I know there is no problem – my husband and I wanted this child – but now I don’t feel anything. I don’t feel anything for the child, I feel flat and tired all the time, I can’t sleep, and little things make me so angry. And I feel guilty for being a bad mother. Sometimes I think I should just leave, or give the baby away. I’m such a bad mother.”
Here the woman describes her sense of anhedonia, or the absence of joy or enjoyable feelings – which is often a distressing feature of the disorder. Depressed mothers may feel very guilty and blame themselves; may contemplate suicide, or reject the child. There could be a significant risk of suicide in a severely depressed mother; and risks to the child. Recent Sri Lankan data indicates that maternal suicide is an increasingly common cause for deaths among postpartum mothers. It is very likely that these mothers were suffering from an undiagnosed psychiatric illness.
The good news is, depression starting in the postpartum period, if identified early and treated properly, often has a good prognosis. Recovery may take weeks or sometimes a few months. Therapy is likely to include medication, ‘reuniting’ the mother and her baby, helping her to interact with the child again, and support to her husband and family.
So the crucial first step is–be aware of this disorder, suspect it early, and seek specialist psychiatrist opinion. Postpartum depression can be, and should be, treated – for the well being of the mother, the child and the family.
(The writer is Senior Lecturer, Department of Psychiatry Faculty of Medicine, University of Peradeniya)
Pic courtesy Speedkingz/Shutterstock