Becoming a parent is one of the most wonderful feelings in the world. Even the mere thought is associated with a lot of intense emotions and feelings. The birth of a baby is expected to bring unmatched contentment and joy. But, sometimes, it may result in an unfortunate condition - Postpartum Depression.
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It is also known as Postnatal Depression. This condition is the onset of a depressed mood and its associated symptoms within the first year of the birth of the child. It is observed that most mothers experience baby blues, and some mothers develop persistent severe symptoms that do not resolve on their own.
Postpartum Blues and Postpartum Depression are two different sides of the same coin, but Postpartum Depression is more severe and is a long-term condition that should not be overlooked. Postpartum Blues, also known as Baby Blues, are temporary changes in mental and emotional state that occur in the mother within 2 to 3 days after childbirth and last for approximately 2 weeks.
They usually resolve on their own without medical intervention. However, suppose the symptoms of Baby Blues elevate and persist for more than a few weeks. In that case, it can be identified as Postpartum Depression (PPD), which is a more serious condition and requires proper support and health care.
Jessica, a 37-year-old mother of a four-year-old, recalls feeling irritable, sleepless, stressed, and angry after giving birth. She did not receive a formal diagnosis and prefers to refer to her symptoms as "Baby Blues" rather than "Postpartum Depression" considering the severity of her condition.
Postpartum Depression Causes
Every year, there are 140 million births worldwide, while the incidence of postpartum depression is estimated to be around 10–20 percent of new mothers. The obvious question to ask is why some mothers get postpartum depression while others do not. Here are a few causes:
Genetics
Studies indicate that sometimes family history of the condition is one of the main causes of postpartum depression in mothers. More people have this prevalent subtype of major depressive disorder than any other psychiatric disorder due to genetics.
The largest meta-analysis of genome-wide association studies carried out by an international team of researchers investigated the genetic makeup of postpartum depression. According to the study, common genetic factors may account for approximately 14% of the variations seen in cases of postpartum depression.
Chronic Fatigue
Evidence suggests that chronic fatigue may raise a woman's risk of postpartum depression. Lack of sleep lowers sleep quality, making it harder for a mother to regain her physical stamina and agility. The symptoms of anxiety and depression may worsen as a result of inadequate sleep.
A single sleep session is insufficient to address the chronic fatigue that emerges from an imbalance between rest and activity. It impacts over 60% of new mothers and may result from many conditions, including thyroid dysfunction, anemia, inflammation, and infection. The changes in the mother’s hormones may also result in postpartum fatigue.
Jessica had to deal with sleep disturbances in the postpartum period. She also recalls having insomnia and struggling to sleep for the recommended number of hours. Implementing sleep hygiene in small but significant steps would have helped her deal with this situation more effectively.
Loss of Aspiration
Stressors related to psychology may arise as a result of becoming a mother. The drastic changes in a woman’s body, overwhelming responsibilities, and perception of society can all trigger and contribute to low self-esteem. A person may easily experience a loss of motivation and aspiration as a result of such abrupt changes in their life, which can exacerbate the symptoms of postpartum depression.
Women are more likely to feel difficult feelings like frustration, confusion, anxiety, guilt, and sadness during the postpartum period, in addition to overwhelming emotions like excitement, anticipation, fulfillment, and happiness.
Jessica recalls feeling a lack of ambition and fear about the future after having her baby. She almost forgot to have some fulfilling "me time" because she was so preoccupied with the responsibilities of her child.
Relationship Discord
When a child is born, the parent's relationship undergoes a dramatic transformation. Despite this milestone being a source of great joy, it can also lead to emotional distress due to parental frustration shortly afterward. These intense emotions may result in postpartum depression symptoms in both parents. It can disrupt the mother-child bond and, in some cases, affect the child’s emotional and cognitive development. Paternal discord can lead to later disorders in children and have an impact on their behavioral development.
Individuals' depressive states worsen during this phase when couples stop doing things they used to enjoy together, such as traveling, going to the gym, enjoying moments together, seeing friends, and spending evenings out. This disconnection can sometimes become so severe that couples lose recognition for each other as the people they once loved.While adjusting to the arrival of a newborn, the mother may struggle to maintain her bond with her elder children. Elder children may struggle to cope with the arrival of a new sibling because it divides the mother's attention and makes them feel less loved.
Jessica's relationship conflict with her husband was the most difficult aspect of her pregnancy and postpartum experience. She struggled to cope without her partner during her difficult divorce.
But she was really fortunate to have the support of her friends and family, which helped her avoid severe mental health symptoms. She still believes that the presence of both parents would have been beneficial to her daughter's behavioral development.
Sheehan’s Syndrome
Sheehan's syndrome, first described in 1937, is postpartum hypopituitarism caused by shock or hypotension as a result of massive hemorrhage or blood loss during or after childbirth. This syndrome can manifest itself during or after the postpartum period as lactation failure, generalized weakness and debility, cessation of menstrual periods, premature wrinkling of the face and forehead, body hair loss, and dry, coarse skin.Sheehan's syndrome is estimated to affect one out of every 1,00,000 births worldwide. Women in developing and underdeveloped countries have limited access to sophisticated medical care, skilled healthcare professionals, and medical resources, which contributes to higher rates of postpartum hemorrhage and raises the figure to five out of every 1,000 births. It is considered 'rare' in industrialized nations, but the numbers are increasing due to the influx of immigrants from developing countries.
Sheehan's syndrome is frequently diagnosed late due to its chronic nature. Because it presents as a case of multiple hormone deficiencies, it may be misdiagnosed as hypothyroidism, pituitary tumor, or postpartum depression.
Some patients struggle with achieving the correct diagnosis and are often treated as cases of postpartum depression or major depressive disorder. An incorrect diagnosis leads to the wrong treatment and worsens symptoms, making the patient prone to intensified mental health conditions, including depression.
History of Depression
A history of depression and anxiety has been identified as a significant psychological risk factor for postpartum depression. According to a study that observed approximately 70,000 births in Sweden between 1997 and 2008, women with a history of depression are twenty times more likely to develop postpartum depression than those without a prior depression diagnosis.
Women who have contracted depression earlier are more susceptible to hormonal changes and can better identify their symptoms. Referring to the research foundations laid by O’Hara MW, it is clear that 23.9% of women who were diagnosed with postpartum depression had experienced depression before. In contrast, only 2.6% of women with no history of psychiatric illness were diagnosed with PPD symptoms.
In line with previous research, this study reveals significant rates of recurring postpartum depression (PPD) among women who have previously experienced PPD. The risk of developing PPD after the birth of a second child was found to be 46.4 times higher (95% CI 31.5–68.4) for women who had been hospitalized for PPD following the birth of their first child. Similarly, women who were treated with antidepressants for PPD after their first child had a 26.9-fold increased risk of experiencing PPD after their second child (95% CI 21.9–33.2).
Anemia
Anemia is a condition in which the body lacks red blood cells, or hemoglobin, which transports oxygen to the tissues. During pregnancy, a woman is more likely to develop four types of anemia: iron deficiency anemia, pregnancy anemia, folate deficiency, and vitamin B-12 deficiencies. This condition may cause the baby's unfulfilled growth, resulting in an underweight or premature birth.
Iron deficiency anemia is the most common type of anemia among pregnant women, accounting for approximately 80% of cases. Anemia has been identified as a significant contributor to postpartum depression. It is therefore critical to pay attention to the nutritional status of women during this time. The prevalence of anemia in pregnant women may be influenced by lifestyle, diet, and geographical location.
Anemia can lead to negative pregnancy outcomes such as preeclampsia, low birth weight, small head circumference, premature birth in the baby, and postpartum depression. According to research, the prevalence of PPD in anemic women is significantly higher than in non-anemic women, and there is a link between anemia and postpartum depression.
High Work Load
A study published on PubMed suggests that higher psychological work demands, lower perceived control over work and family, and lower schedule autonomy intensify the symptoms of postpartum depression. Low job flexibility and a higher workload are other contributors to this condition.
Working women may find it difficult to balance multiple work commitments while also dealing with the unnecessary guilt of not being good mothers. Some solutions to postpartum depression symptoms caused by poor work-life balance include mental and social support from peers and colleagues, partners assisting with household chores, reduced workload at work, maternity leave, motivation and encouragement for the mother, and equal distribution of responsibilities among partners.
Jessica believes that her decision to take time off from work after becoming a mother allowed her to rest and recharge. After returning to work, she embraced the support of her coworkers, which made it easier for her to integrate work-life balance and successfully restart her career.
Loss of Identity
New mothers frequently experience a loss of identity. After having a baby, some parents may believe that being a parent is their sole identity. Postpartum depression symptoms may worsen if thoughts of exhaustion, worry, and unhappiness persist for an extended period, making it difficult to get through each day.
Loss of identity causes feelings such as disrupted professional identity, inability to earn money, a low-quality social life, less time for leisure activities, and a lack of self-confidence. All of these characteristics may cause parenting issues and a lack of bonding with the baby.
In most cases, mothers discontinue activities they once enjoyed, such as seeing friends, taking long showers, spending quality time with their partners, and engaging in hobbies.
Difficult Pregnancy
Pregnancy complications can arise due to concerns about the mother's health, the fetus's health, or both. Even healthy women may experience difficulties during their pregnancies. Complications include high blood pressure, gestational diabetes, infections, preterm labor, stillbirth, and preeclampsia. Mothers who do not receive adequate and timely prenatal care are more likely to develop such pregnancy complications, which may contribute significantly to the onset of postpartum depression.
High-risk pregnancies can occur due to pre-existing medical conditions or complications that arise during pregnancy. Some factors are mentioned below that may contribute to difficult pregnancies:

• Age (less than 20 or more than 35)
• Lifestyle choices, such as consuming alcohol, cigarettes, or drugs
• Chronic health conditions such as high blood pressure, diabetes, obesity, thyroid, or infections
• Pregnancy complications such as the unusual location of the placenta, low fetal growth, and Rh sensitization
• Pregnancy with multiple babies
• Problematic pregnancy history, such as miscarriage or stillbirth

Hormonal Imbalance
There has been much speculation about the causes of PPD, with some claiming that the rapid changes in reproductive hormones such as estradiol and progesterone before and after childbirth may play a part. While several studies, both in humans and in animals, have found a link between changes in hormone levels and PPD, others have discovered no link between hormone concentrations and symptoms.
For example, studies on the differences in ovarian hormone levels and depressive symptoms during the postpartum period have not found a direct link between absolute estrogen and progesterone concentrations and PPD.
However, studies that used estradiol treatment successfully alleviated depressive symptoms, and animal studies have shown that withdrawing estradiol and progesterone can cause depression-like behavior.
Reproductive hormones play important roles in a variety of functions, including basic emotion processing, arousal, cognition, and motivation. As a result, they may indirectly contribute to postpartum depression by influencing psychological, social, and economic risk factors. Interestingly, these hormones also regulate the biological systems involved in major depression, implying a direct link to a woman's risk for PPD.
Thyroid hormones have been proposed as a potential biomarker for PPD due to the suspected link between thyroid dysfunction and major depression. Thyroid dysfunction is associated with pregnancy and may contribute to PPD in some women.
Nutritional Deficiency
Malnutrition, or a lack of specific nutrients such as B and D vitamins, n-3 polyunsaturated fatty acids (PUFA), folate, trace minerals, iron, antioxidants, and so on, can increase the risk of developing postpartum depression. Lactation and pregnancy place additional demands on a new mother's body, making nutritional deficiencies more common during this time and paving the way for depression symptoms.
Investigations are currently underway to determine whether low vitamin D levels may increase the risk of postpartum depression. This is because vitamin D functions as a neuroactive hormone, playing an important role in the nervous system rather than the endocrine system. Its primary function is to link sensory stimuli to the release of hormones, resulting in a hormonal response.
Vitamin D helps to regulate neurotransmitters like adrenaline, norepinephrine, dopamine, and serotonin. Any abnormalities in these neurotransmitters and hormones have been linked to the onset of depressive symptoms.Omega-3 fatty acids have also been linked to PPD. Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are two types of omega-3 fatty acids that are well-known for their cardiovascular benefits, but they also play an important role in brain development and neurotransmitter regulation.
Increased DHA and EPA levels are associated with improved serotonin receptor sensitivity, which is achieved by increasing the fluidity of the receptor cell membrane. Furthermore, omega-3 fatty acids are thought to reduce neuroinflammatory processes associated with the onset of depression.
Many people in the United States are deficient in omega-3 fatty acids due to a lack of these nutrients in their diets, according to reports. The typical American diet consists primarily of fast food, which is deficient in nutrients and does not meet recommended nutritional guidelines.
Pregnant women are especially vulnerable to the harmful effects of low omega-3 fatty acids. This is because the increased blood supply required for fetal oxygen causes a natural decrease in DHA and EPA levels. In addition, the body prioritizes the fetus's growth and development by redirecting blood and nutrients, putting pregnant women at greater risk of developing nutritional deficiencies and, as a result, postpartum depression.
Dealing with postpartum depression (PPD) can be difficult for both the mother and her child. It jeopardizes both the mother's health and the child's development. Women with PPD frequently struggle to maintain consistent breastfeeding due to depressive symptoms.
PPD complicates the mother-child relationship, resulting in poor cognitive functioning, aggressive behavior, excessive crying, emotional instability, and sleep issues in infants and adolescents. PPD is linked to negative thoughts, substance abuse, postpartum psychosis, hallucinations, confusion, mood swings, paranoia, impaired judgment, loss of appetite, and insomnia in mothers.
It impairs a woman's ability to interact and socialize with her own family, making her feel inadequate as a mother and preventing her from participating in activities and hobbies. Women with PPD are also more likely to commit infanticide and suicide, as well as develop serious mental illnesses such as bipolar disorder.
"In a world where women are constantly invalidated, they must seek help for postpartum depression," says Jessica. She believes that women should understand that PPD is normal and, in some cases, inevitable.
It is effective to see an Online Psychiatrist for postpartum depression, as it is economical, involves less hassle, and is more accessible.
Gaba Telepsychiatry's psychiatrists aim to deliver a comprehensive approach to psychiatric care while adhering to evidence-based medicine. Our online psychiatrists consider a range of factors, including genetics, development, trauma, nutrition, hormones, career and relationship difficulties, coping skills, concurrent medical illnesses, head injuries, medication side effects, and more.
Visit https://gabapsychiatrist.com/postpartum-depression-treatment/… to know more and seek help for depression.

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