Postpartum depression is a mood disorder that affects mothers anytime in the first year after childbirth. About 1 in 7 women report feeling symptoms of postpartum depression, but experts believe that up to 50% of cases go unreported due to stigma and patients’ reluctance to disclose symptoms.
Biochemistry of postpartum depression
During pregnancy and the postpartum period, women experience extreme changes in hormone and neurotransmitter levels. According to the Journal of Biochemical Tech, progesterone levels during the third trimester of pregnancy can be 50 to 100 times greater than they are during menstruation. In addition, serotonin levels are significantly lower during pregnancy, while testosterone and cortisol are elevated.
In the postpartum period, estrogen, progesterone, dopamine, and serotonin drop precipitously. This can lead to insomnia, feelings of hopelessness, anxiety, and anhedonia.
Related CE course for nurses: Postpartum Depression
Risk factors of postpartum depression
Women with a history of depressive episodes are at a significantly higher risk of experiencing postpartum depression. Women who experience prenatal depression have a 400% higher chance of experiencing postpartum depression than those who do not experience mental health problems during pregnancy.
Family history
Women with a family history of postpartum depression are at a much higher risk of experiencing it themselves. Having a first-degree relative with postpartum depression makes it 2.5 times more likely that a woman will experience it herself.
Life stressors
The Maternal and Child Health Journal explains that life stressors have an especially strong link to postpartum depression. Financial stress, relational stress, and trauma all contribute to postpartum depression. Understandably, women who experience a miscarriage are also at an increased risk of developing PPD.
According to research, women with high relational stress had the highest risk of developing postpartum depression when compared to women with high financial stress or high traumatic stress. A challenging relationship with the infant’s father and low family support are some of the most difficult problems for new mothers to navigate.
Catching PPD and “Baby Blues”
Women may have a hard time explaining their symptoms and often avoid seeking help. Many new mothers feel pressure to enjoy motherhood and are embarrassed to admit that having a new baby is anything but a blessing.
Healthcare providers need to encourage new mothers to be honest about their feelings and seek out help when they need it. New mothers can be assessed using the Edinburgh Postnatal Depression Scale and Postpartum Depression Screening Scale. It’s a simple, ten-question screening tool that helps identify at-risk mothers.
Questions on the scale ask mothers to score themselves (1-3) on whether they are experiencing the following:
- An inability to laugh and see the funny side of things
- Ability to look forward to or enjoy things
- Blaming themselves unnecessarily when things go wrong
- Feeling anxious or worried for no good reason
- Having difficulty sleeping
- Feeling sad or miserable
- Frequent episodes of crying
- Thoughts of self-harm
- Difficulty with normal life tasks
A score of greater than 10 points indicates a positive result of postpartum depression
Healthcare providers can also encourage family members and friends to be aware of symptoms to watch for, as mothers may be too overwhelmed to notice them in themselves. Symptoms to watch for include:
- Frequent crying disproportionate to the situation
- Changes in social habits
- Difficulty sleeping unrelated to infant sleep/wake patterns
- Expression of severe anxiety
- Inability to enjoy activities
Outcomes related to PPD
Unrecognized and untreated postpartum depression can have long-term consequences on the mother, child, and family unit. In fact, some research shows that children of mothers experiencing untreated postpartum depression experience more illness than children of mothers without symptoms of PPD.
Women suffering from postpartum depression are at higher risk of familial conflict, poor self-esteem, and poor mother-infant bonding. These mothers often struggle to care for themselves, maintain a healthy weight, socialize, and manage their responsibilities. In the most severe cases, mothers may have suicidal or even homicidal ideation.
Treatment and prevention strategies
While postpartum depression is, unfortunately, quite common, there are many effective treatment strategies available to new mothers. Often, identifying PPD is the most challenging step. Mothers who can be identified and start treatment almost always find relief for their symptoms.
Pharmacology
Zurzuvae was approved in 2023 for the treatment of PPD. It is a neuroactive steroid that’s taken once daily for just 14 days, with efficacy maintained through at least day 42 after discontinuing the medication. Patients should be aware that this medication can cause drowsiness for up to 12 hours after each dose. In addition, breastfeeding mothers must “pump and dump” or discontinue breastfeeding while on this medication.
Other common medications include SSRIs such as Seroquel and Lexapro, and SNRIs such as Venlafaxine and Duloxetine. These medications often take 4-6 weeks for noticeable effect, but are some of the safest medications with the fewest reported side effects. SSRIs can be taken while breastfeeding.
Sleep
Sleep, while hard to come by for any new parent, is essential for good mental health and is a great protector from PPD. Poor sleep quality can lead to worsening depressive symptoms and anxiety, which can, in turn, cause even worse sleep. This can become a vicious cycle for new parents.
Exercise
Like sleep, finding time to exercise can be a challenge for parents juggling a newborn, household responsibilities, work, and possibly other children. However, even 20 minutes of exercise each day can reduce PDD symptoms by half. Exercising in the sunshine is even better.
Support
A good support system is the number one protective factor against postpartum depression. For mothers with a family or personal history of depression, it is essential to form a good network before delivery. Having a person to help new mothers get sleep, find time for exercise, and recognize symptoms of PPD can be life-saving.
Healthcare providers who identify mothers lacking good support can make referrals to social services and support groups such as Postpartum Support International.
