Postpartum depression is not a myth. It really exists and has a solid scope - according to various sources, up to 70% of puerperas are subject to it to varying degrees. Severe forms of neuropsychic disorder are, of course, less common. But even a mild depressive state can significantly harm the woman herself, her nursing baby, family relationships and social ties of the young mother. In this material, we will try to understand the causes and mechanism of the development of a depressive state after childbirth and show you how to get rid of it.
What it is?
Postpartum depression is not a fiction or a contrived problem, but a real mental disorder. Depression refers to mood disorders, that is, mood disorders. The term comes from the Latin word deprimo, which means "to crush", "to suppress". It is a depressed state, lack of interest in anything that characterizes this pathological condition.
Postpartum depression, according to the WHO, occurs in 10-18% of normal births. However, the corresponding diagnosis is made, according to statistics, only 3% of women. These are usually women with severe depressive disorder. Mild to moderate depression is more common and can affect up to 70-80% of new mothers.
Such a small percentage of diagnosed disorders does not mean that the problem is exaggerated by psychologists and society. Rather, the fact is that women and primary care doctors simply do not know how to distinguish between the first "alarm bells" and habitually write off the deterioration of their condition and perception of the world as a temporary natural reaction to childbirth, which is undoubtedly stressful.
What is dangerous postnatal depression, too, not everyone knows. And it can have a very negative effect on the life of the whole family:
- relations between spouses deteriorate, sometimes irreversibly;
- a woman loses social contacts and connections with family and friends;
- the child has an increased risk of developing a mental disorder in early childhood;
- the child is at risk - not always the mother can adequately give him the amount of love, care, care necessary for harmonious development and physical safety.
In a state of postpartum depression, a woman practically loses the ability to get pleasure from something, interest in what is happening disappears, and a reduced melancholy mood prevails, which can be replaced by bouts of irritation. Women's self-esteem falls, a young mother is constantly tormented by a not always justified feeling of guilt, she does not see bright prospects and becomes a pessimist, it is difficult for her to concentrate on anything. Sleep and appetite disorders are common. In difficult cases, suicidal impulses develop.
The reasons for such a dramatic change in a person can be different. Depression is of different types - there are major and minor forms, atypical depression and dysthymia. Postnatal depression has been identified as a separate species. It develops in direct relationship with childbirth, but it can develop in women who have given birth, and in men who have recently become young fathers. Women are prone to violation of the affective spectrum much more often.
Postnatal depression most often develops in women who have undergone a difficult childbirth, in women who have given birth to an unwanted child, who live in families where violence (physical and psychological) is common, in women who have difficulties with financial support for a child, in mothers loners.
If a woman had cases of depression before childbirth and even before pregnancy, then in the postpartum period the likelihood of developing the disorder increases by 50%.
Dangerous timing - start and duration
Postnatal depression is generally very similar to classic clinical depression, but it has its own nuances. First of all, they consist in the timing of the onset and duration of the disorder.
Most often, depression begins between 1 and 4 months after the birth of a baby. The baseline risk of developing the disorder during this period is quite high - the symptoms of depressive disorder during this period start in about two out of ten women. The risks increase by almost 50% if a woman has had depression before. If a depressive state at least once appeared directly during pregnancy, then the risk that postnatal disorder will begin in the first four months after childbirth is 75%.
The exact timing of the onset of depression is difficult to determine. Usually, experts point to a wide range of terms, starting from the second day after birth and ending with six months after the birth of the baby. Slightly less often, depression develops in the period from six months to a year.
The insidiousness of depression lies in the fact that in half of cases, in the absence of adequate therapy, it does not go away at all, but is cleverly disguised and becomes a chronic mental disorder. In every fifth woman, signs of various degrees of postpartum disorders of the neuropsychic type are recorded even after the child turns one year old. In 2-3% of women, depression becomes protracted and gradually, over the years, transforms into other types of depressive disorders, some of which may not be cured at all.
The sooner a woman asks for help, the more chances that the pathological mood will be able to win faster. Therefore, the timing of the end, in fact, depends on the mother herself. The reality, alas, is unsightly: a woman notices signs of disorder, but does not seek help, because she is embarrassed or does not want to look in the eyes of others as a defective mother, unable to take care of the child. It does not cure depression, but suppresses its manifestations in itself. In this case, the state does not end, but passes into some new forms of mental deviations.
The good news is that postpartum depression responds well to therapy. And it can be avoided altogether if the woman and her doctor pay sufficient attention to prevention issues even while carrying a child.
Why does it start?
The psyche of a woman is in direct relationship with hormonal factors, which is why women who suffer from a depressive state during the premenstrual period develop postpartum depression more often than others. And the female cycle, and pregnancy, and childbirth always proceed with the most active change in the balance of active hormonal substances, and therefore depression can be conventionally considered a "side effect" of endocrine changes in the female body. But it is impossible to blame all the blame only on hormones, and this assumption has been confirmed by the latest developments of scientists.
The mechanism of development of depression is complex - it involves not only hormonal factors, but also social, psychological, biological, economic and household factors. At the same time, it is not only the presence of certain negative factors that matters, but also the attitude of the woman herself to them, how important they are for her.
What is more likely to lead to depression in women in labor? There are a great many answers to this question, we will give the most common situations.
Mismatching reality with expectations
Most often primiparas "sin" with this. During pregnancy, rainbow pictures of touching communication with the baby were presented, an idyll in a relationship with her husband after the birth of a baby. In reality, everything goes wrong - for five minutes of touching communication, there are several sleepless nights at the crib of a crying baby, the chest hurts, and the stitches imposed on the crotch do not imply sexual contact with the spouse.
Even if there are no seams, the effort and time to establish an intimate life may not remain if the child is restless. All this does not contribute to the establishment of trusting relationships. The woman is disappointed. The reality turned out to be more brutal.
Poor health, postpartum complications
We have already spoken about the effect of hormones, and it can be safely put in the first place in this group of reasons. But they are not the only ones that can cause depressive disorder. A woman's metabolic processes proceed at a different rate, she cannot lose the extra pounds gained during the period of bearing a child. Often anemia develops, weakness and poor health after childbirth worries, especially if they were difficult or a cesarean section was performed.
Lactation problems - mastitis, low milk supply, cracked nipples that cause pain when feeding and expressing, lack of sleep are all physiological factors that contribute to the development of depression.
Predisposition to depressive disorders
There are women at high risk. It includes young mothers who have not yet turned 19 years old, as well as women over the age of 38 years. Motherhood and caring for babies takes too much of their energy. At risk of women and girls who are characterized by pronounced premenstrual syndrome with all its behavioral "quirks", women who abuse alcohol, have relatives with mental illness.
A difficult first birth and a difficult postpartum period very often make a woman at risk of depression after a second birth - negative experiences are influenced. Also, the doctor should pay attention to the category of expectant mothers who, during pregnancy, were distinguished by increased tearfulness, tearfulness, often panicked, complained of intolerable fatigue, hopelessness and melancholy.
Social and household "disorder"
This group of reasons is very diverse. Most often, depression after childbirth occurs in women who cannot find a common language with their spouse, face misunderstanding on his part, lack of help in caring for a baby, and financial difficulties. Women who have devoted a lot of effort and time to their careers and education, after the birth of a child, understand that career growth will temporarily stop. Sometimes a woman in such circumstances regrets that she has given birth to a child.
Depression can be caused by poor living conditions, in which it was somehow possible to live without a child, but it became very difficult with a baby. A woman with a baby usually does not have the opportunity to visit, visit friends, does not have as much free time as before.
Even the rudeness of a pediatrician in a children's clinic or the hostile attitude of doctors in a maternity hospital can provoke a drop in self-esteem in a woman.
Inconsistency with the ideal
There are many stereotypes in society. Movies, books, social media support certain stereotypes of the ideal mom. A woman really wants to correspond to them, but it does not always work out. It is not always the strength to get up and go to the nursery at the first cry of the child in the middle of the night, there is not always a desire to give the child a massage, sometimes you don't want to go for a walk, but stay at home and sleep a little or read a book. In all these situations, an internal conflict develops between "how the mother should act" and how she actually acts. With this, sometimes very severe and protracted depressive disorders begin.
Individual psychological qualities
If living conditions, if you try, can be changed, then a woman cannot change her psychotype. She received it at birth and lived with him all these years. The most prone to the development of postnatal depression are women who are infantile, dependent, have low stress resistance, suspicious, with low self-esteem, indecisive and timid.
Also, the risk group includes mothers who are accustomed to always blaming themselves for everything, looking for their shortcomings, easily suggested.
Signs
It would be a mistake to consider depression any change in the mood of a new mother in a negative direction. Bad mood is a temporary disorder, and depression is a serious mental disorder, the symptoms and signs of which, if left untreated, will recur with enviable frequency.
To find out the exact answer to the question of whether there is depression, you should consult a doctor, preferably a psychiatrist or psychotherapist. But a woman can suspect certain signs in herself on her own, because with this neuropsychiatric disorder self-criticism does not suffer, a woman is capable of assessing her condition.
The most striking symptoms of postnatal depression appear in the morning and in the morning. Symptoms usually subside by evening. Therefore, a woman needs to pay attention to her thoughts and mood in the morning.
All signs that may indicate the presence of a depressive disorder can be conditionally divided into two groups - main and additional. The diagnosis of "postnatal depression" can be established only when a woman has at least two main signs and four additional ones. Let's take a closer look at them.
General
Psychiatrists call the classic symptoms of depression a triad. A depressive disorder is characterized by:
- depressed mood;
- decreased interest and inability to enjoy something;
- slowness in all its manifestations.
Reduced mood should be considered the predominance of negative thoughts throughout most of the day, if this condition has been going on for more than two weeks. The woman looks sad, dreary, laconic, her speech is slightly slowed down.
Decreased interests and loss of pleasure are manifested by unwillingness to engage in certain activities that you previously liked. The woman does not show feelings of joy, even if negative circumstances begin to change to positive ones.
A decrease in vitality is manifested by rapid fatigue, a desire to lie down even after a slight physical exertion, slowness in actions, slow thinking, absent-mindedness, the inability to concentrate on something. A woman does not want to do anything; in severe cases, she falls into a stupor.
Additional
The list of additional signs, of which at least four must be counted for a diagnosis, is more extensive and varied. Psychiatrists distinguish the following:
- a woman morally destroys herself, refuses to recognize her dignity and achievements, her self-esteem falls;
- a young mother suffers from a strong sense of guilt in the absence of objective justification for this;
- a woman becomes indecisive, cannot even make a simple household decision on her own;
- the events that are taking place are comprehended by the newly-made mother with difficulty, the thought processes take up a lot of strength and energy, proceed slowly and hard;
- a woman has dark thoughts, it seems to her that everything will end badly, that she can never be lucky, there are no prospects and happiness in the future;
- sleep is disturbed, insomnia or excessive pathological drowsiness develops, appetite suffers (in one direction or another - either you want to eat constantly, or you do not want to eat at all);
- thoughts about a possible suicide appear as an acceptable way out of a difficult situation in an extreme case.
Nine out of ten women with postnatal depression experience increased anxiety.
Depression cannot exist for a long time only on the mental level, it crosses the psychosomatic line in a matter of days, which means that complaints appear completely specific, not ephemeral. Young mothers most often begin to complain about:
- incomprehensible weight gain or, conversely, incomprehensible weight loss;
- regular intestinal disorders (diarrhea, loose stools, or alternation of these two unpleasant symptoms);
- a decrease in sexual desires up to their complete absence, a decrease in the severity of sensations during sex, if it occurs at the initiative of a partner;
- constant pain, which can be located absolutely in any part of the body - in the heart, stomach, bladder, kidneys, lower back, headaches, etc.; they appear spontaneously, last a long time, a woman cannot indicate their precise localization, they are exclusively psychosomatic;
- instability of blood pressure, frequent heartbeat;
- increased dry skin, hair loss, brittle nails.
At the household level, relatives should also pay attention to the strange behavior of a woman. First of all, depression after childbirth is manifested by negligence - a woman ceases to responsibly fulfill her household duties, ceases to monitor her appearance, and sometimes neglects basic hygiene requirements. Communication with her "does not add up" because of her alienation, unwillingness to talk heart to heart not only with her husband, but also with other relatives.
If the family already has children, a woman may lose love for them, become almost emotionless, indifferent. The need to feed the baby can cause irritation, obvious dissatisfaction. At the peak of this symptom, some mothers of babies make a dire decision to commit suicide or murder of a child - the daily news chronicle is filled with such cases. If the media report that the alleged cause of death was “financial difficulties, family relationships,” we can safely say that it’s a matter of depression, since a normal, mentally adequate mother, under any difficulties and quarrels with her husband, will not be able to step over her own instinct, the strongest in nature - the instinct to protect offspring.
Another very striking sign on which a woman's relatives, friends and relatives must pay the most serious attention is the unfounded fears of a young mother for the child's health. It happens that in the complete absence of reasons for concern, the mother re-reads encyclopedias, the Internet, calls doctors and demands to appoint the child for examinations, since she suspects something that she cannot formulate. Sometimes this phobic syndrome manifests itself as a fear of conspiracies - “the child could have been replaced in the hospital,” “the doctor did not specifically prescribe antibiotics for us so that the child would die,” etc.
Severe postnatal depression has the character of psychosis, with it simultaneously develops both a depressive component and a manic component, which we described in the paragraph above. Psychoses can be different:
- toxicoinfectious - usually develops 2-12 days after childbirth and is associated with inflammatory postpartum complications occurring against a background of high temperature;
- endogenous - arising after childbirth on any day if the woman has a history of mental illness or has a genetic predisposition to them.
Severe cases of postpartum depression with the development of psychosis can manifest as aggression, confusion, delirium. A woman may begin to deny obvious truths, such as "white is white" or "Earth is a planet."
Obsessions, obsessive movements may develop. Severe depression can be attributed (completely, by the way, unexpectedly!) The complete absence of severe mental somatics. That is, a woman behaves usually, does not express anything negative, does not throw herself at household members with a knife, does not threaten to kill herself or the child, she leads an ordinary life. But at the same time he does not eat, gives food to animals, neighbors, children, does not trust relatives (in the absence of reason).
Such quiet and latent depressed mothers, as a rule, express extreme distrust of doctors in general and their doctor in particular, scold the government and social security, do not trust neighbors and friends. Ultimately, they become isolated and then the signs of depression begin to gain momentum and become more obvious.
Diagnostics
If a woman herself feels “something was wrong,” besides, the strangeness in her behavior is noticed by others, it is not worth trying to cope with the problem on her own, to fight to “suppress depression”. It is imperative to establish the exact type, resistance of the state. This is what psychiatrists and psychotherapists do.
There are special tests and questionnaires that make it possible to determine with great accuracy the presence and combination of the main and additional symptoms characteristic of postnatal depression. For self-assessment, the Beck scale or the Zang scale can be used. There is also the Edinburgh Postpartum Depressive Disorders Scale. It was developed in Edinburgh in 1987. This is a questionnaire. By honestly answering his questions, you can identify signs of depression with an accuracy of 86%.
A woman can pass the test on her own, but if the results are unsatisfactory, she must visit a specialist, since the diagnostic tasks lie not only in detecting the very fact of depression, but also in differentiating it from other conditions.
Often, depression is confused with the so-called "sadness syndrome in women in labor", which in Western medical literature is called even poetically - "postpartum blues". A woman with him feels sad, but she is "bright", which is a normal psychological reaction. Most often, sadness reaches its peak on the fifth day after childbirth. With it, sleep is also disturbed, fatigue increases, a woman can cry for no apparent reason. But as the hormonal background normalizes, the "postpartum blues" goes away on its own. It is difficult to say exactly how long the condition lasts, but usually no more than 2-3 weeks.
Also, depression after childbirth should be distinguished from the "grief" syndrome if a woman has recently suffered severe stress - divorce, death of a loved one. This condition is also temporary and can be easily corrected with the support of family and friends.
How to get rid of?
Treatment of postnatal depression is carried out in two directions - psychotherapeutic methods and medications.
Psychotherapy effectively helps the postpartum woman to get out of the state of depression, if the depression itself is not severe. A woman can deal with a psychotherapist, psychosomat or psychologist. She is taught relaxation, autogenous programming of positive attitudes for the future. Also, the specialist conducts classes not only individual, but also family, marriage, since relatives and loved ones help a woman to survive depression to a greater extent.
For moderate, moderate, and severe forms of depressive disorder, these methods alone are indispensable. It is for this reason that it is so important to overcome yourself and consult a doctor who will tell you whether a young mother needs to use special drugs - antidepressants.
Medication is prescribed for any form of depression. With mild - only when psychotherapeutic treatment for 2.5-3 months has not brought the desired result. Antidepressants are first line drugs. They help most women. In severe forms, tranquilizers and antipsychotics can be used at the discretion of the doctor.
Antidepressants in their action correspond to the name - they raise the mood, stimulate the brain, eliminate muscle tension, and have a slight mild hypnotic effect. Taking antidepressants is not very compatible with breastfeeding; in each case, the decision is made individually.
When prescribing tranquilizers or antipsychotics, a woman is advised to transfer the child to artificial feeding. Simultaneously with taking medications, psychotherapeutic sessions are recommended.
It is sometimes possible to treat mild or moderate depression with over-the-counter drugs that contain St. John's wort extract - an excellent natural antidepressant. Good reviews were left about "Negrustin", "Deprim Fort".
Usually, within two weeks, a woman manages to overcome the main symptoms of the disorder. It is possible to cure a young mother completely with non-severe forms with adequate therapy in 1-2 months. Prolonged depression takes longer to heal - up to a year.
The most sensitive question that worries both patients and their relatives is whether a woman will be admitted to a psychiatric hospital if she seeks help from a specialist? You don't have to worry about this. Depression is best treated if the woman is in her usual environment - at home. Hospitalization to a psychiatric clinic may be necessary only in the following situations:
- attempted suicide;
- the woman categorically refuses food;
- psychosis began;
- there are manias.
In other cases, you can help a young mother find peace of mind at home, with the active support of relatives, husband, children, friends. Changes of places are useful - travel, as well as joint family affairs, for example, changing wallpaper in the kitchen or caring for a summer cottage or garden.
Prevention
Postpartum depression is not the most pleasant condition, which is easier to avoid than to treat for a long time. Specialists in maternity hospitals are advised to deal with the prevention of depressive disorders in women in labor both before and during, and after them. Doctors of antenatal clinics have the same recommendations, but in practice obstetricians-gynecologists do not always pay enough attention to this issue. A large number of patients, an appointment, a queue - all this makes the appointment at the consultation more formal, during which they are limited to weighing and the routine question of well-being in general. Meanwhile, the Ministry of Health prescribes a careful study of the anamnesis, finding out possible family ties with mental patients, monitoring the behavior and reactions of the pregnant woman throughout the entire period of bearing the baby.
Targeted preparation for childbirth is considered an effective prevention of depression. If a woman takes courses for expectant mothers, if she is well aware of how childbirth proceeds, how to manage her feelings and emotions, how to behave at certain stages of labor, the likelihood of postnatal depression is significantly reduced. It is good if a woman is motivated to communicate - she is happy to keep in touch with other expectant mothers, doctors, her friends and neighbors. This should be encouraged in every possible way to the family and friends of the woman. Moderate physical activity is also considered psychologically useful - gymnastics, swimming, Pilates, yoga even during pregnancy.
A woman should, on time - before and after childbirth, get advice from a psychologist on how to react and what to do if depression appears. There is, perhaps, no woman in the world who has never regretted becoming a mother. Difficult moments are in any motherhood. But a good mother is not one who does not allow negative thoughts, but one who knows how to act in spite of them - constructively and positively.
The opinion of Dr. Komarovsky
Dr. Komarovsky himself rarely spoke out in his books and programs about postpartum depression, mostly mentioning it in passing. But his colleague Dr. Olekseev, whose excellently written article Yevgeny Komarovsky cites on his website in the "Library" section, describes in great detail the whole danger of underestimated pathology, which is not always taken seriously in society.
The author of the article (and Komarovsky completely agrees with him, since he published the material on his resource) argues that you should not be afraid of treatment with antidepressants, because they do not cause drug dependence, are not drugs. For more than 50 years, the whole world has been successfully using these funds to help women in labor, and the results are impressive.
With the participation of fathers, friends and other people close to the young mother, the treatment, according to the doctor, is completely fun and fast. The main thing that relatives must learn well is that a woman does not pretend, does not attract attention to herself, she is really sick and she needs their sincere participation.
If a woman is breastfeeding, you should not refuse treatment. Pharmacology does not stand still. There is a list of antidepressants that are not detected in the baby's blood at all, if the nursing mother uses them, that is, they do not harm the baby. These are the drugs Parokestin, Fluvoxamine, Sertraline, Duloxetine, Bupropion.
Reviews
According to women, in the first time after the onset of depressive symptoms, it is important not to sit around, try to always keep yourself occupied and distract. This often helps to cope with the condition. The most difficult, according to reviews on thematic forums, is the task of overcoming the reluctance to breastfeed. Women do not like to admit this, but there is a problem.
Often, unfortunately, the problem has only one way out - the woman refuses breastfeeding and transfers the baby to adapted milk formulas. For this, she experiences shame and depression is aggravated.
What are the causes of postpartum depression and how to avoid it? The answer to this question awaits you in the next video.
