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Postpartum depression

2020; Informa; Volume: 99; Issue: 3 Linguagem: Português

10.1111/aogs.13784

1600-0412

Attachment and Relationship Dynamics

Acta Obstetricia et Gynecologica ScandinavicaVolume 99, Issue 3 p. 423-425 PATIENT PERSPECTIVEFree Access Postpartum depression First published: 19 February 2020 https://doi.org/10.1111/aogs.13784Citations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Being told by a very sympathetic nurse that I had postpartum depression catapulted me into a wave of emotions. Obviously, the first was relief—knowing this was not how I was supposed to feel—but I also felt very confused, like there must have been some sort of mistake. I also felt sad and guilty (these would be unwanted companions throughout it all). I felt like a disappointment to my partner and to my child. I had such a beautiful, happy, easy baby. Such a loving partner, who did everything and more to support me. I was surrounded by family and friends who supported me. Nevertheless, I felt so lonely all the time, while also feeling claustrophobic by being close to another human being 24/7. I started attending a treatment group for postpartum depression. I could not have been more excited—a feeling I had mostly forgotten. “Finally,” I thought. Finally, I was on the road to feeling better. The format was group therapy with two psychologists, me, and 5 other moms with postpartum depression. Partners were allowed, and mine of course attended every session. Again, I felt guilty. It is my fault that we are sitting here, I thought. It is my inability to handle things. The group therapy was completely wrong for me, which evoked even more guilt. The very nice psychologists kept talking about commitment and interaction with your child. This makes sense for so many people with postpartum depression who feel a lack of love or connection with their child. Just not me. See: I loved my child endlessly. From the moment I took her home from hospital, I felt so much love, like one big cliché. The psychologists kept telling me that it would make sense with time. It was a standardized program with a few videos that were screened at each session, which we then discussed. The program was tested and verified. It had been used since the 1990s (judging from the videos). However, as months passed, I felt more and more tired. I could not muster the energy to do anything. The problem was, in my head, I thought that this was what being a first-time parent was like. You are constantly tired. You are constantly exhausted. You never shower. You will never have a hot cup of coffee again. You cannot go out like you used to. I was simply living the standard, maternity leave life. Everyone I talked to in my mother group was exhausted. My parents told me anecdotes of how they had almost thrown me out of the window one night when I would not stop crying. All parents are exhausted, everybody knows that. They walk around the streets with a stroller and an empty look in their eyes. When we had a session about triggers, and what part of interacting with your child is the hardest, I broke down crying afterwards. I had not said a word. No part, and all parts, were the hardest about being with my child. I did all the clichés; I took my child swimming, to baby music classes. I marveled when she sucked on her fingers. I looked at her for hours just loving her little tiny face. I felt proud when people complimented her. Every day I could feel my heart expand with love for her. I saw the world through her eyes and was absorbed in whatever light, color, sound would interest her. There were no specific moments that were difficult for me. But every night when I laid in my bed waiting for another sleepless night, I would have preferred to cry myself to sleep from exhaustion. I would feel like I was an empty void with nothing to give, somehow getting up and caring for another being. I would feel the void inside me getting bigger and bigger, wondering how on earth I could sing lullabies or take her for a stroll. I would feel ready to break down crying at any single moment, while at the same time I could break out laughing if she sneezed in a cute way. When I told the healthcare professionals this, they comforted me and told me the feelings were completely valid feelings, that it must be so hard. But my feelings did not feel valid. And their words, after yet another session that I could not see the point in sitting through, were not comforting. Photo by Kat Jayne from Pexels. I do not know how to describe my experience with postpartum depression in a way that captures the multitude of emotions I was feeling at the same time. In writing, everything seems so dichotomous; either I was exhausted, cancelling all plans and not able to walk out the door, or I was an annoying Instagram-mother who took her 3-month-old baby to music sessions she did not in any way understand. But I was both. I was so exhausted every single minute of every single hour, longingly looking at the clock for when my partner would return, while also sitting in music classes hitting a tambourine. If this was a movie narrative of postpartum depression, I would have broken down, found myself, and somehow come out stronger on the other side. I did not break down. I did not find myself. I did not even feel like I had a moment of understanding why I felt the way I did; a moment where I suddenly realized my postpartum depression was over, and I was finally a happy mother taking a stroll with her child. My group therapy was limited to 12 sessions, and then it ended. My individual therapy was limited to 12 sessions during which I mostly talked about my childhood, and suddenly that also ended. The only thing I can say is that I no longer feel like crying when I go to bed. Life happened. My child got bigger and for me somehow easier and less exhausting to spend time with. I think I am lucky. So many people do not just kind of get over it. So many people do not feel unconditional love for their child. So many people do not have an array of concerned people around constantly trying to help. These are privileges. However, I also do not think I ever got the help I needed from the nurses, doctors, and psychologists, because they were so absorbed by this monolithic idea of what postpartum depression should look like, so invested in this system that could only deal with postpartum depression in one way, that I never met a person who understood my experiences, despite all the well-meaning questions and nods. Account by Elisabeth Bruun Gullach, Denmark POSTPARTUM DEPRESSION FACT SHEET Postpartum depression (PPD), also called postnatal depression or puerperal depression, is a type of mood disorder associated with childbirth with an onset 1 week to 1 month following childbirth. There are different types and severities of PPD. 1 SYMPTOMS Symptoms of PPD may include extreme sadness, mood lability, feeling overwhelmed, low energy, poor concentration, indecisiveness, feelings of guilt or worthlessness, anxiety, obsessional worries or preoccupation, irritability, loss of interest, reduced ability to experience pleasure, changes in sleeping or eating patterns, psychomotor disturbances, lack of bonding feeling for the baby, suicidal thoughts or thoughts of harming the child.1, 2 2 INCIDENCE In PPD, the transitory condition known as baby blues persists and worsens. PPD prevalence rates vary among countries, ranging from 6.9% to 12.9% in high-income countries to more than 20% in some low- or middle-income countries. PPD is much more common than the more serious disorder of postpartum psychosis.3 About 8% of fathers may also experience PPD with risk factors that appear to be similar to those of mothers.4 Baby bluesBetween 50% and 80% of all mothers go through a milder transitory condition, often referred to as baby or maternity blues, in connection with the beginning of lactation some days after childbirth. During the baby blues, the mother may experience mood lability, tearfulness, and some mild anxiety and depressive symptoms. Baby blues can be distinguished from PPD by the severity and persistence of the latter.4 3 CAUSES The exact cause of PPD is unclear but it is believed to be a combination of physical, emotional, and genetic factors. Following childbirth, the woman undergoes rapid hormonal changes such as withdrawal from the high pregnancy levels of estrogen, progesterone, and endorphins. She may also experience increased anxiety, stress, fatigue, irritability, and insomnia following childbirth. Her neuropsychiatric responses to the changing hormone levels and to her own individual psychosocial conditions are thought to cause PPD. 4 RISK GROUPS The strongest risk factor is a history of mood or anxiety disorder or psychiatric illness including depression, especially if active symptoms are present during pregnancy.2, 3 Premenstrual syndrome appears to increase a woman’s risk of experiencing PPD.5 Psychosocial risk factors for PPD include lack of emotional or social support, financial difficulties, stressful life event during pregnancy or shortly after giving birth, persistent infant health problems, difficult infant temperament, marital difficulties, domestic violence, prior abuse, pressure to have male offspring, and alcohol or drug abuse problems. Elevated psychological distress symptoms such as fatigue, insomnia, anxiety, and stress constitute risk factors. Postpartum psychosisPostpartum psychosis is a rare psychiatric emergency that occurs in about 1 in 1000 pregnancies, in which a woman experiences symptoms of high mood and racing thoughts (mania), depression, severe confusion, loss of inhibition, paranoia, hallucinations or delusions beginning suddenly in the first 2 weeks after childbirth, often within 72 hours. The symptoms vary and can change quickly. The most severe symptoms last from 2 to 12 weeks, and recovery often takes 6 months to a year. About half of women who experience it have no risk factors but women with a history of mental illness are at a higher risk. It is different from PPD and maternity blues.2-4 5 TREATMENT There are different types and severities of PPD with varying times of onset, which warrant the need for tailored treatments that improve outcomes for women with PPD. Some countries have started screening for PPD but a clinical evaluation is the reference standard for determining a diagnosis. There are effective treatments for PPD.2, 3, 6 Healthcare providers can assist in choosing the best treatment, which should include self-care, sleep protection, exercise, and possibly: Psychosocial interventions: peer support and counseling Psychological interventions: Cognitive behavioral therapy: helps people recognize and change their negative thoughts and behaviors Interpersonal therapy: helps people understand and work through problematic personal relationships Medication: antidepressant medication such as selective serotonin reuptake inhibitors; infant exposure through lactation must be considered. Somatic treatments: electroconvulsive therapy and focal brain stimulation therapies can be used when psychotherapy or pharmacotherapy do not induce remission. 6 PREVENTION Psychological counseling and psychosocial interventions late in pregnancy or within 6 weeks after childbirth can reduce the risk of PPD. The preventive measures are more effective when conducted with at risk populations and individually. Psychosocial intervention measures include home visits by nursing staff after childbirth, telephone support, and attending early parenting programs.7, 8 Postpartum depression is one of the most common complications of childbirth and is often underdiagnosed and undertreated. Without treatment, PPD can last for months or years: 24% of women diagnosed with PPD are still depressed 1 year after giving birth and 13% after 2 years. Like postpartum psychoses and other depressions, there is an increased risk that the new mother will harm herself or the child.2, 3 In addition to affecting the mother’s health, it can interfere with her ability to connect with and care for her baby, which in turn may cause the infant to develop sleeping, eating, or behavior problems.7 REFERENCES 1 National Institute of Mental Health, USA. Postpartum Depression Facts. https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml. Accessed September 9, 2019. 2Stewart DE, Vigod SN. Postpartum depression: pathophysiology, treatment, and emerging therapeutics. Annu Rev Med. 2019; 70: 183- 196. 3Howard LM, Molyneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet. 2014; 384: 1775- 1788. 4Cameron EE, Sedov ID, Tomfohr-Madsen LM. Prevalence of paternal depression in pregnancy and the postpartum: an updated meta-analysis. J. Affect. Disord. 2016; 206: 189- 203. 5Amiel Castro RT, Pataky EA, Ehlert U. Associations between premenstrual syndrome and postpartum depression: a systematic literature review. Biol Psychol. 2018; 147: 107612. doi: https://doi.org/10.1016/j.biopsycho.2018.10.014. [Epub ahead of print]. 6 NICE (Natl. Inst. Health Care Excell .). Antenatal and postnatal mental health: clinical management and service guidance, 2014. Updated April 2018. http://www.nice.org.uk/guidance/cg192. Accessed September 9, 2019. 7Werner E, Miller M, Osborne LM, Kuzava S, Monk C. Preventing postpartum depression: review and recommendations. Arch Womens Ment Health. 2015; 18: 41- 60. 8Curry SJ, Krist AH, Owens DK, et al. Interventions to prevent perinatal depression: US preventive services task force recommendation statement. JAMA. 2019; 321: 580- 587. Citing Literature Volume99, Issue3March 2020Pages 423-425 ReferencesRelatedInformation