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Understanding Postpartum Depression (PPD)

According to NIH, Up to 15% of moms experience postpartum depression (PPD). A number of psychosocial and biological risk factors for PPD have been found recently through research. It is well known that both the short- and long-term impacts on child development are detrimental. PPD is not adequately understood or treated. Pediatricians and obstetricians can play crucial roles in identifying and treating PPD. Psychotherapy and antidepressant drugs are available as treatments. Access to psychotherapists and breastfeeding moms’ worries about exposing their newborn to antidepressants are barriers to following treatment recommendations. To thoroughly assess the short- and long-term effects of drug exposure through breast milk on newborn and child development, more study is required. Although depression in women during the postpartum period may start during pregnancy or may have onset beyond the first postpartum month, PPD is strictly defined in the psychiatric nomenclature as a major depressive disorder (MDD) with an identifier of postpartum onset within 1 month after childbirth. To meet the criteria for MDD, depressed mood or loss of interest or pleasure in activities must be present for at least 2 weeks. The diagnosis of PPD is difficult because changes in sleep patterns, changes in appetite, and excessive fatigue are common for women after delivery. In addition, symptoms of sleep disruptions, appetite disturbance, loss of energy, self-doubt or guilt, diminished concentration, and thoughts of suicide may also be present. 

Differential vulnerability to hormonal fluctuations may be linked to PPD. Contrary to healthy control subjects, euthymic women with prior PPD experienced dysphoria followed by the addition and withdrawal of supraphysiologic dose levels of estradiol and progesterone. Biological theories have also included changes in other gonadal hormones, levels of neuroactive steroids upon delivery, altered cytokines and HPA axis hormones, and changes in fatty acid, oxytocin, and arginine vasopressin. According to observations of altered platelet serotonin transporter binding and reduced postsynaptic serotonin-1A binding properties in the anterior cingulate and mesiotemporal cortices, the serotonin system may be involved. Recent research using the neuropsychologic activation paradigm of functional magnetic resonance imaging (fMRI) indicated abnormal brain processing in PPD patients. Untreated maternal depression has been linked in numerous studies to poor child development. A higher prevalence of excessive newborn crying or colic, sleep issues, and temperamental issues are among the infant and child outcomes linked to PPD. However, mothers with PPD may also report these issues more frequently. Infant crying and sleeping issues may significantly increase the risk for new-onset PPD. Negative mother-infant interactions, such as maternal withdrawal, disengagement, intrusion, and aggression, are linked to PPD. Breastfeeding may be more difficult for women with PPD to start or continue; depression symptoms frequently come before an early end to breastfeeding.

How can you show support to women having PPD? 

If you are a husband, partner, sibling, parent, family member, friend or someone living in one roof with a woman who just gave birth, keep in mind the following reminders:

  1. As much as possible, do not leave the patient alone.
  2. Engage in a conversation frequently and avoid topics that are too sensitive for them to talk about.
  3. Engage in some fun activities which can divert their attention like watching movies, playing board games/video games, cooking favorite meals, etc.
  4. Listen to them if they are opening up topics to you. Sometimes, you being empathetic is all they need.
  5. Ask how they are doing. Some patients do not openly discuss their feelings so asking them might help alleviate the anxiety

These simple steps can help them recover faster and avoid a more serious problem. Being more patient and understanding would also help patients with PPD feel at ease so do your best to support them as much as you can.

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