Understanding postpartum psychiatric problems

Spring is about to arrive, with it new beginnings. A time of birth and rebirth. A time associated with joy, but also a time to be attentive to other forces.

Women have the unique quality of carrying and giving birth to the new hopes and dreams of the human species. This is a time that holds great expectations of hope and abundant joy for all. These expectations, however, can be altered or only experienced briefly. The postpartum period can be influenced by various psychiatric problems. These include: “Baby Blues”, postpartum depression, and postpartum psychosis.

During the postpartum period, up to 85% of women experience some type of mood disorder. 10-15% of these women experience a more disabling and persistent form of mood disorder called postpartum depression or even psychosis.

The mildest form of postpartum dysfunction is called “Baby Blues.” These usually consist of a one-week period of mood lability with increased irritability, anxiety, and tearfulness. Symptoms tend to peak around day 4 or 5 postpartum and gradually subside. This does not usually interfere with child care, maternal bonding, or harm to the newborn.

Of a more serious nature is postpartum depression. This occurs in 10-15% of the general population.

The main phenomenological symptoms of this include: a depressed mood manifested by: hopelessness, lack of interest or joy, especially in areas related to daily childcare activities; feelings of emptiness, increased anxiety, which may include obsessive concerns about the health and well-being of the baby.

A prior history of depression, a genetic predisposition to depression, previous postpartum problems, or those who experience depression during pregnancy are most at risk.

The risk of greatest concern is the mother’s loss of interest in the daily activities of caring for the child, which may progress to having negative feelings towards the newborn. If this continues, she may progress to negative or intrusive thoughts and fears of harming herself, her child, or both. These tend to be more obsessive than the actual urges to do actual damage.

Other negative and qualitative changes may occur, for example, increased or decreased sleep and energy, worthlessness and guilt for no good reason, appetite swings up or down, significant decreases in concentration, and restlessness.

The other main area of ​​postpartum concern is much less common, but far more serious: postpartum psychosis. Although some research shows that this can occur up to a year after delivery, most cases occur within 2 weeks and up to 3 months after delivery. This illness presents with the potential for many psychotic symptoms, i.e., hallucinations of any sensory organ, delusional misbeliefs or illogical thoughts, sleep and appetite disturbances, agitation or anxiety at very high levels, episodic mania or delusions, thoughts or suicidal or homicidal actions.

Women most at risk are those who have a history of schizophrenia, bipolar disorder, other psychotic disorders, or a history of a previous episode of the illness with another child.

Occasionally, women with postpartum psychosis, like other forms of psychotic illness, are not always the first to notice or may be unable or unwilling to communicate their experiences or fears. The need for help may need to be communicated by a support ie a family member, friend or professional. This help must be through a trained professional.

What to do?

Q. What causes postpartum depression?

IN. Like other forms of depression, there is no single cause, but rather a combination of factors. These include genetic family history, structural and chemical changes in brain function leading to endocrine (hormonal) and immunological disturbances. Significant increases in estrogen and progesterone during pregnancy are precipitously followed by significant decreases in approximately 24 hours. postpartum A clear depressive factor. Thyroid hormones also follow this pattern. Life events experienced as stressors combine to cause symptoms and illness.

Q. What about the demands of motherhood itself?

IN. These clearly can contribute. For example: postpartum physical fatigue due to childbirth itself, as well as interruption of sleep or deprivation of care for the newborn; stressors about being a “good mom,” losing who or what she used to do or think of herself, feeling less attractive, lack of free time, and just being overwhelmed with all the challenges of a new baby or babies. Women who are depressed during pregnancy have a much higher risk of depression after giving birth.

Q. Can you just wait and let it happen?

IN. Definitely not. Postpartum depression and certainly psychosis are very serious psychiatric disorders that require psychiatric treatment as soon as possible. Some women feel embarrassed or embarrassed to feel these things at a time when they are supposed to feel happy. How will they be perceived as unfit parents perhaps? Denial can happen.

Q. What can happen if women do not seek treatment?

IN. Nothing good for either mother or child i.e. low birth weight or prematurity, restlessness for both, lack of sleep for both, missed prenatal and postnatal care, substance abuse, poor mother-infant bond, and just plain not being able to meet the needs. of your child In psychosis, risks of suicide/homicide may occur.

Treatment for these problems is available from competent and experienced doctors. Medication is generally useful and necessary. If these are necessary during pregnancy, the main risks and benefits are evaluated and weighed. Various modalities of psychotherapy and support groups are also very helpful. In rare cases, hospitalization may be necessary. These interventions can save the life of both mother and child.

All children should have the benefit of a healthy and loving mother. All mothers deserve the opportunity to have rewarding pregnancies, births, and maternal experiences. These diseases can insidiously deprive both mother and child and cause serious harm. If there are concerns, symptoms, or careful observations of the disorder, seek skilled psychiatric care immediately. Don’t fight only with fear, shame or silence.