What is postpartum depression?

It is normal to feel some amount of sadness, stress, exhaustion, or anxiety during childbearing and after childbirth as a woman’s body and her life undergo big changes, but if these feelings intensify and last longer than 2-3 weeks, it may be postpartum depression, says clinical psychologist Dr. Poojashivam Jaitly.

She says if the feelings of guilt, irritability, emptiness, sadness, or worthlessness persist for a longer time and a new mother finds it hard to bond with her baby, she should seek professional help.

According to the World Health Organisation (WHO), postpartum psychiatric disorders fall into three categories: postpartum blues, postpartum psychosis, and postpartum depression.

The organisation says that postpartum blues or ‘baby blues’ happen to about 300‒750 per 1000 mothers, globally. However, these resolve within a few days to a week. Postpartum psychosis occurs in about 0.89 to 2.6 per 1000 births. It is a severe disorder which may need hospitalisation. Postpartum depression happens in an estimated 100‒150 per 1000 births.

In India, as many as 22% women suffer from postpartum depression post child birth, according to a study. It says some of the risk factors seen in India were: financial difficulties, birth of a girl, lack of family support, marital conflict, history of mental health issues, pregnancy complications and low maternal education.

We spoke to clinical psychologist Dr. Poojashivam Jaitly about what postpartum depression is, and how it is different from ‘baby blues’. Edited excerpts:

• What is postpartum or postnatal depression?
• How is postpartum depression different from baby blues or anxiety or exhaustion?
• What is prenatal or antenatal depression?
• Talk to me about the types of postpartum depression.
• Tell us about the incidence of postpartum depression.

What is postpartum or postnatal depression?

When a woman gives birth to a child, several changes occur in her body and in her life. Even if she’s well prepared, she may still experience moments of stress and anxiety. Women also go through sudden hormonal changes and these could lead to a state of anxiety and sadness or what we commonly know as ‘baby blues’.

‘Baby blues’ are quite common but when these become intense and happen for a longer period of time, leading to a neglect of self and an inability to take care of the baby, then it is something more than just ‘baby blues’. Postpartum depression is a long-lasting feeling of sadness and an inability to carry on, in general. It’s very important that we understand postpartum depression as a significant mental health concern in women and address it. Women with postpartum depression experience symptoms like hopelessness, feelings of guilt, worthlessness, irritability, lack of energy, loss of interest in doing things, and a lack of sleep and appetite. It can last from a few weeks to a month, and requires professional intervention.

How is postpartum depression different from ‘baby blues’, anxiety, or exhaustion?

Childbirth is very stressful; physiologically, it takes a huge toll on a woman’s body. There are also hormonal changes which affect the mood and other things. Women may experience loss of sleep, mood swings, irritability, and moments of anxiety about the baby doing fine. There are also doubts about being a “good mother”. All of these contribute to ‘baby blues’.

It is very important to understand that these are some of the feelings that most women go through, but when these symptoms intensify, they are long-lasting, if there is excessive crying, there is difficulty bonding with the baby, there is withdrawal from family and friends, there is sadness, a depressed mood, intense mood swings, loss of appetite and energy, these are not just ‘baby blues’. ‘Baby blues’ only last a couple of days, maybe a week or two, and are less intense in nature compared to postpartum depression.

But when these symptoms intensify, they are long-lasting, if there is excessive crying, there is difficulty bonding with the baby, there is withdrawal from family and friends, there is sadness, a depressed mood, intense mood swings, loss of appetite and energy, these are not just ‘baby blues’.

If women find it difficult to carry on with their responsibilities as a mother and have trouble bonding with the baby, and experience an inability to enjoy their time with the baby, it could be postpartum depression. They may also experience feelings of helplessness, hopelessness, worthlessness, difficulty falling asleep, and some of the other symptoms we discussed earlier.

We also have to understand that a lot depends on factors like — the support network, the kind of situation women are in, or the circumstances that she has gone through to bear a child or to give birth to a child, all these contribute to postpartum depression. 

What is prenatal or antenatal depression?

It occurs during pregnancy. It is important to understand that a lot of times women experience a certain mood state while they are pregnant, and which will continue even after childbirth. It starts from before childbirth and goes on for a few hours after, it is called perinatal depression. This is something that is often ignored by most doctors, and most people don’t even know about it. The symptoms are feeling weak, low energy, difficulty falling asleep, heightened anxiety, unusual amount of worry about giving birth and parenthood.

Talk to us about the types of postpartum depression.

We can differentiate them in terms of the intensity. There is also postpartum psychosis, which we have often seen in our clinical cases, where women experience a completely psychotic state, and may have hallucinations, delusions, and a detachment from reality.

Tell us about the incidence of postpartum depression.

It’s quite high. It could be anywhere between 200 to 250 per 1000. It can be very high in certain areas. I must say that as psychologists, we see quite a large number of patients with postpartum depression in our clinics. The data is very variable because it is often not reported. The reasons for that vary; maybe the healthcare worker was not aware, maybe  the family is not ready to talk about it, or the patients themselves don’t talk about it. Patients often suffer silently, and they may not be reported or receive help because of the stigma attached to it.

Patients often suffer silently, and they may not be reported or receive help because of the stigma attached to it.

There are also cases wherein a woman hasn’t experienced it in her first pregnancy but goes through it in the second pregnancy. 

To a very large extent, it also depends on the preparedness of the mother or the kind of support system, the kind of circumstances that she’s in, the family environment, the kind of demands on her before she gives birth to the child, all of it can contribute to postpartum depression. All of these factors also define the severity of the symptoms in many cases. I do think that the kind of support the woman has can be a preventive factor in some cases.

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