Baby blues, depression and postpartum psychosis
In the first days after childbirth, many women experience “baby blues”: tearfulness, irritability, mood swings. It begins on days 2–5, does not interfere with caring for the child, and goes away on its own within two weeks. Postpartum depression is deeper and longer lasting and can begin immediately or several months after childbirth. Postpartum psychosis is rare, usually develops in the first weeks and requires immediate hospitalization.
- Baby blues - up to two weeks, goes away without treatment
- Postpartum depression - longer than two weeks, disrupts life
- Postpartum anxiety disorder - obsessive fears about the baby
- Postpartum psychosis - confusion, delusions, hallucinations, emergency
Causes and risk factors
After childbirth, the level of estrogen and progesterone sharply decreases, and lack of sleep, pain, changes in usual life and responsibility for the newborn create a great burden. For some women this leads to depression, for others it does not: heredity and previous experience matter. Depression can also occur in those who were really expecting a child, and after the second or third birth.
- Previous history of depression or anxiety disorder
- Depression during pregnancy
- Bipolar disorder in a woman or relatives
- Lack of support, family conflicts
- Difficult labor, illness or prematurity of the child
- Feeding difficulties, chronic lack of sleep
Symptoms
Depression is suspected if depressed mood or loss of interest and joy persist for most of the day, almost every day for two weeks or longer. Many women hide these feelings out of shame, believing that they should be happy. Loved ones should pay attention to isolation, constant fatigue and words about their own worthlessness.
- Depression, tearfulness, emptiness
- Lack of joy, including from a child
- Severe anxiety, panic attacks
- Feelings of guilt and failure as a mother
- Sleep and appetite disorders
- Difficulty concentrating, thoughts of death
Diagnostics
The diagnosis is made by a psychiatrist or psychotherapist after a conversation. To identify depression, obstetricians and pediatricians use a short questionnaire, the Edinburgh Postnatal Depression Scale, which the woman fills out herself. A high score is not a diagnosis, but serves as a reason for consulting a specialist. The doctor also evaluates the risk of suicide and signs of psychosis. To exclude causes that may masquerade as depression, thyroid function and hemoglobin are checked.
- Conversation with a psychiatrist or psychotherapist
- Edinburgh Postnatal Depression Scale
- TSH - to exclude postpartum thyroiditis
- Complete blood count to rule out anemia
- Assessing the safety of mother and child
Treatment and support
For mild to moderate depression, psychotherapy, primarily cognitive-behavioral and interpersonal, is effective. For moderate and severe forms, a psychiatrist prescribes antidepressants; many are compatible with breastfeeding, so stopping breastfeeding is not usually necessary. The effect of the medications develops gradually, over several weeks, and they cannot be canceled on their own. The help of loved ones is very important: the opportunity to sleep, share child care, and not be left alone. For postpartum psychosis and suicidal thoughts, treatment is carried out in a hospital.
- Psychotherapy
- Antidepressants prescribed by a psychiatrist
- Family help with night feedings and daily routine
- Regular sleep and nutrition
- Support groups for new mothers
- Emergency assistance by dialing 103 in case of danger to life
