POSTPARTUM DEPRESSION IS REAL!

The links between childbirth and mental disorders have been described for hundreds of years. Mental illness after childbirth isn't merely of historical interest.

In India itself, the prevalence of postpartum depression was around 22% in 2017. If a person develops psychotic de- pression or if the depression is severe, there is a high risk of dying by suicide.

Postpartum depression is a significant form of depression that can begin after childbirth, with symptoms that vary from person to person, and has important differences from 'baby blue....

This period can last anywhere between four to six weeks following delivery, but sometimes even up to a year.

Women can be affected by a range of mental health problems in pregnancy and the postpartum period, including depression, anxiety, bipolar disorder, psychosis, and personality and eating disorders. Despite this, perinatal psychiatric disorders have not received the attention that they deserve.

Postpartum depression is a real medical illness that can affect any mother regardless of age income , or cultural and/or educational background. Women are not to be faulted for having postpartum depression.

A prior history of mood or anxiety dis- orders, stressful life events, poor social support, and domestic violence are established risk factors for depression in the postpartum period. Additional risk factors include poor social support, adverse life events, domestic violence, a history of prior psychiatric illness, unplanned or unwanted pregnancy, and present/past pregnancy complications.

Clinical presentation The clinical presentation doesn't vary much between depression in the postpartum period and depression that occurs at other times. The core symptoms of depression include low mood, loss of pleasure in activities, and easy fatigability.

However, fatigue, loss of libido, appetite, weight change, and sleep disturbances are more common in the postpartum period. Thoughts of self-harm are also common in postpartum depression.

Women who present with psychiatric symptoms in the postpartum period are at higher risk of being diagnosed with a severe mental illness called bipolar disorder.

Around 14% of women with first-time psychiatric symptoms within a month of childbirth were later diagnosed with bipolar disorder in a follow-up time frame of 15 years.

The affliction responds to the same treatments as depression at other times. Psychological interventionsareea effective for mild postpartum depression in clinical trials. Given that many people don't wish to take medicines while breastfeeding, peer support counselingg, cognitive behavioral therapy (CBT), and interpersonal therapy become important interventions.

CBT is a talking therapy that helps people by changing the way they think and be- have. It is based on the premise that thoughts, feelings, physical sensations, and actions are interconnected, and that negative thoughts and feelings can trap us in a vicious cycle. CBT attempts to restructure faulty patterns of thinking into more positive and logical ones.

Interventions are also directed at the mother-baby dyad, especially if there has been no response to treatment. Among those with moderate to severe depression, medication will be required. The use of safe, effective, evidenced-based medications for depression in pregnancy has in- creased considerably in recent decades, with rates varying from 3% to 13%.

Innovative and novel drug treatments are increasingly available for women with postpartum depression. One such involves a 60-hour hormonal infusion (brexanolone), which has shown promise in an early-stage trial. Before it can be adopted more widely the results will need to be re-decisions regarding medication for breastfeeding women must be made only after a risk-benefit analysis. Interventions such as special diets, exercise, yoga, and the use of estrogens and progestins have pregnancy and postpartum phases. GETTY IMAGES

limited evidence vis-à-vis postpartum depression as of today.

In severe depression characterized by suicidal ideas or when the person has thoughts of self-harm or of harming the baby, doctors perform electroconvulsive therapy. Here, a small electrical charge is applied to the person's temples while the person is under short anesthesia. This results in a controlled seizure that helps to offset brain changes caused by depression.

It is one of the most effective interventions in the history of clinical medicine.

A range of safe, effective, and evidence-based treatment options exist for psychiatric disorders with onset in the postpartum period. Postpartum depression is a common but serious disorder that is amenable to bio-psycho-social interventions. The right treatment at the right time leads to rapid recovery and a better quality of life. Stigma, lack of awareness, and misconceptions shouldn't hinder a person from seeking help, particularly in this sensitive time.

Screening and solutions It is vital to sensitize obstetricians to screen women for postpartum depression. Awareness about this entity is abysmally low, contributing to its morbidity, loss of productivity, and in some cases loss of life.