Non-affected people may stumble at first – postnatal depression or postpartum depression, a depression in young mothers? Is there such a thing at all and did the mother not look forward to her child? But it is not quite that simple.
What is postpartum depression?
Postpartum depression (in the jargon: postnatal depression) affects an estimated 10 to 20 percent of mothers. Far more women, about 70 percent, suffer from a milder form. This form is colloquially known as “baby blues” and has no medical significance. The real postpartum depression, on the other hand, manifests itself in a lack of energy, feelings of guilt, irritability, a sense of hopelessness, and sleep and concentration problems. Sexual desire is restricted. Obsessive thoughts occur in half of all sufferers. Killing thoughts can also play a role in postpartum depression. Nevertheless, only 1 to 2 out of 100,000 mothers suffering from postpartum depression actually kill their own child. Postpartum depression can occur within the first two years after birth.
Causes
There are several factors that can promote the development of postpartum depression. First and foremost, these include stressful life circumstances, such as a bad partnership, financial worries or traumatic experiences. Mental illnesses that were already present before the birth can also promote the development of postpartum depression. Social isolation is also a major risk factor. Working women who suddenly have to stay home with the newborn are more likely to fall into postpartum depression. Perfectionism, fear of failure and a false maternal image (“the always happy mother”) are also suspected of triggering postpartum depression. Since thyroid disorders can also be causative, women should have their thyroid gland examined after giving birth. Hormone fluctuations after birth favor postpartum depression.
Symptoms, complaints, and signs
Symptoms of postpartum depression may develop immediately after birth, but they may also first appear weeks after delivery. Many mothers suffer an emotional low around the third day after giving birth. They are tearful, feel stressed and overwhelmed. This can be explained by the hormonal changes around the introduction of breast milk and the drop in other hormones due to the end of pregnancy. As a rule, however, this low is overcome after a very few days. Longer-lasting postpartum depression is mainly manifested by the fact that affected women seem constantly depressed, unhappy and dissatisfied. Some also express this clearly and speak of being overwhelmed, a feeling of alienation and, in individual cases, even the feeling of not being able to love the child. However, many new mothers cannot or do not want to express their feelings so clearly. They are afraid of being ridiculed and misunderstood by those around them and tend to suffer in silence. This in turn can intensify the symptoms of postpartum depression. Those affected are also often conspicuous in that they believe they are unable to cope with everyday life with the child or actually no longer manage a regular daily rhythm. The care of the child can be neglected, as can one’s own personal hygiene. In extreme cases, suicidal thoughts are described.
Diagnosis and course
In the case of postpartum depression, a physician makes the correct diagnosis. The first contact person when postpartum depression is suspected should be the gynecologist. He or she will discuss the course of action and may refer the patient to a psychologist or outpatient clinic. There is a specialized questionnaire to confirm the diagnosis. Once the diagnosis of postpartum depression is established, the further course depends on the right therapy. Postpartum depression can last for several months. This leads mothers to feel hopeless. It also happens that postpartum depression is not diagnosed. The later postpartum depression is treated, the worse the course is. In the worst case, thoughts of killing develop. Furthermore, the woman suffering from postpartum depression may develop a disturbed relationship with the child.
Complications
If a depressive illness of the mother in the puerperium is not recognized early, this has fatal consequences for the relationship with the newborn, or even with the father of the child.Even if the anticipation was great, the mother may now reject her child and therefore provide insufficient care. For example, the newborn is no longer breastfed and loses weight. It also does not benefit from the antibodies contained in breast milk, which protect it from all environmental influences. The mother sometimes suffers from a painful milk congestion, which has a further negative effect on her mood. The emotional bond between mother and child is also disturbed and often leads to the baby not being paid any attention even when crying heavily. As a result, it develops anxiety, which becomes deeply rooted and affects relationship behavior in adulthood. If the depression is not treated in time, violence may be used, for example when the mother shakes the newborn out of desperation or touches it too tightly. In addition to the mother-child relationship, postpartum depression also affects the relationship with the child’s father. If the sick mother is hospitalized, for example, this means either that he is deprived of contact with the wife and child or that responsibility is completely handed over to him.
When should you go to the doctor?
The state of emotional overload often occurs in young mothers. In many cases, no doctor is needed, as the condition regulates and harmonizes itself. Immediately after childbirth, there is a hormonal change in the organism. This can lead to strong mood swings, tearful behavior and diffuse anxiety. With a stable social environment and sufficient understanding, an alleviation of the complaints can already be noticed after a few days or weeks. Often, a healing occurs completely on its own. However, if the existing irregularities increase in intensity, consultation with the attending physician or midwife should be sought. If the young mother has the feeling that she cannot adequately care for her offspring, consultation with a medical professional is advisable. If there is a feeling of deep dissatisfaction, uselessness as well as apathy, medical help should be sought. If symptoms such as loss of appetite, neglect or a never-ending sadness appear, a visit to the doctor should be made. If there is hypersensitivity, severe mood swings, and an inability to cope with everyday life, consultation with a physician is indicated. If suicidal thoughts develop or the affected person reports plans to end her life, immediate action must be taken. Relatives or close confidants have an obligation to seek help.
Treatment and therapy
The treatment options for postpartum depression are very good. In all cases, it heals without problems. But self-help is not enough in most cases. If the symptoms last longer than two weeks, the mother must seek help. If the postpartum depression is severe, professional help must be sought immediately. Sometimes a stay of several weeks in a special clinic is necessary to stabilize the mother again. In some clinics, the baby may be taken along so as not to disturb the relationship. Depending on the severity and cause, several methods of treatment are used: psychotherapy, hormone therapy, systemic family therapy or music therapy. Supportive psychotropic drugs are given in many cases. Naturopathic methods can also alleviate postpartum depression. Acupuncture should be mentioned here in particular. Over-the-counter medications should be used with caution. They can pass into breast milk and harm the child. In milder forms, it is possible that even a conversation circle with other sufferers can relieve postpartum depression.
Prevention
To prevent postpartum depression from occurring, the mother can take some precautions before the birth. She can provide a social network and help after the birth. For example, the partner should take leave to start the first time with the baby together. If there are siblings in the house, the mother should also get support. For example, grandma or a friend can play with the older child while the mother breastfeeds the baby. So it’s a matter of taking the pressure off so that the feeling doesn’t arise: I can’t manage all this!
Aftercare
The clinical picture of postpartum depression as well as its course can manifest itself quite differently in the affected women.Therefore, it is not possible to make general statements about any follow-up measures. In most cases, it is advisable after postnatal depression to continue to see at least the family doctor on a regular basis. This is especially necessary if the affected person is being treated with medication. In addition, patients who have already suffered from depression or postpartum depression in the past should continue to receive intensive medical care even after recovery, as they are at particularly high risk of relapse. Stopping psychotropic drugs on your own or reducing the dose is strongly discouraged. This should always be decided by a medical professional. It is also advisable to continue to seek psychotherapeutic or psychiatric treatment. Whether this is necessary, however, should be clarified in consultation with the attending physician. Such treatment is particularly advisable for patients who were already suffering from mental illnesses from the postpartum depression. In a few cases, medical care is not necessary for follow-up after postpartum depression. Affected women should still avoid psychological stress and be sure to consult their primary care physician or a psychiatrist if a relapse occurs.
Here’s what you can do yourself
In case of postpartum depression, support from the partner, family members and friends is important for many women. In some cities, those affected organize themselves into support groups to meet regularly and talk about postnatal depression. Participants provide each other with emotional support and help each other find solutions to specific problems. This form of social support from other sufferers can have benefits, but it is not an equivalent substitute for proper treatment. In rural areas, support groups for postpartum depression are usually lacking, so corresponding online groups are a possible alternative. For some women with postnatal depression, it helps to treat themselves to soothing moments, such as taking a warm bath or listening to relaxing music. Small time-outs in everyday life can help to reduce the overall psychological stress. Some patients benefit from setting small goals that they can realistically achieve – for example, taking a walk or completing a specific household task. Such behavioral activation can lead to a sense of achievement in everyday life, which is motivating. Long to-do lists, on the other hand, are often counterproductive because they can lead to frustration. Some experts recommend a healthy diet, exercise and sufficient sleep to counteract further deterioration of mood. Various studies show that exercise can reduce depressive symptoms.
