Postpartum depression is triggered by major hormonal changes and other factors such as strong mental tension, child’s responsibility, and postpart physical discomfort. Inheritance also has a big influence. Postpartum depression is associated with a multiple decrease in the levels of female sex hormones, especially estrogen. How a woman will experience the postpartum period in psychological terms depends on her personality type, on the child its own, the child care experience, and the quality of partner and family support. Much of the psychological instability is due to the high demands on both herself and her partner, the pursuit of perfection, and the restless and still crying child. The psyche of a woman in a puerperium also affects physical problems like exhaustion after heavy labor, anemia, thyroid malfunction or infectious disease.
How does postpartum depression arise? Communication between nerve cells in the brain (on the nerve synapses) provides chemical substances called neurotransmitters. In depression, functional deficiency of norepinephrine and serotonin is a function of nerve synapses. In the woman’s body, the synergism of serotonin and the female sex hormone of estrogen, occurs. In addition, synergism results in a situation where the final effect of the co-acting components is greater than the sum of the effects of the components. That is why women are more prone to depression than men, and postpartum when there is a multiple decrease in estrogen levels will make depression to occur much easier.
Postpartum depression suffers 10-15% of mothers, especially single mothers without family background. It may occur suddenly or gradually at any time during the first six months after birth of a child. The first risk period is after the arrival from the hospital when a woman has to take care of the child but also the household. Generally, however, it occurs 3 to 4 weeks after birth of a child. At that time, intensive of support from their family members declines. It may also begin when the woman stops breastfeeding or the first menstrual period occurs.
Depressed mothers are tired, crying and irritated, or have strong mood swings, when the excellent mood quickly changes depression. They are unable to take care of their child, suffer from anorexia, intestinal and biliary problems, and sleep disorders (insomnia or dreadful dreams). Some women are overly concerned, they are afraid of the health of their child. Other depressing mothers feel guilty about being bad and incompetent mothers. In deeper postpartum depression, a mother refuses to take care of her child, nursing her/him, the child is indifferent to her or, on the other side, is aggressive to him/her and may endanger his/her life. Also if mother suffers from more serious psychological disorder, postpartum or lactation psychosis may occur. Its occurrence is rare, affecting 0.1 – 0.2% of women. These are severe changes in mother’s behavior accompanied by hallucinations. Women are not only depressed but also restless and disoriented (completely out of reality). Lactation psychosis usually breaks out from 3rd to 14th day after birth. Lastly, some mothers have suicidal thoughts.
Postpartum depression can lead to disruption of the relationship between mother and child. Untreated disorder damages and slows the child’s psychological, emotional and intellectual development. It has been shown that children of depressed mothers have reduced cognitive functions in their fourth year of life, such as memory deficits, attention deficit disorder, unable to adequately process new information, etc. Mother depression can lead to an increased risk of depressive and anxiety in a later life.
Postpartum depression is not diagnosed in half of the affected mothers. Therefore, the gynecologist should evaluate the mother’s psychic attrition at the first puerperium check. To find out what the mother’s diagnose is the routine depression test is not recommended because women in the puerperium usually have depressive mood. A screening method is used to screen the Edinburgh scale of postpartum depression. This is a series of ten questions in which the mother assesses her behavior, moods and feelings with a four-point scale (0 to 3 points). If a woman reaches 12 or more points, she is probably suffering from postpartum depression. The treatment of lighter depression can be guided by a gynecologist himself. Women suffering from a heavier form of postpartum depression should be in the care of a mental health expert, a psychiatrist. If the mother or child is at risk, immediate hospitalization at the psychiatric clinic is required.
Postpartum depression requires therapy. Depending on the intensity of depression, medication, psychotherapy and hormonal treatment are combined. Mild and moderate forms of depression are treated with psychotherapy. For more serious conditions, a combination of antidepressants and intensive psychotherapy is appropriate. Hormonal therapy can strengthen the effect of both psychotherapy and medication in postpartum depression.
The specific drugs in the treatment of postpartum depression are antidepressants. In postpartum depression, SSRI antidepressants are selected to prevent serotonin reuptake. Individual antidepressants are excreted to the breast milk in different degrees. The most suitable antidepressants are Ascentra, Zoloft, Sertralin, Parolex and Fevarin, because their levels in breast-fed infant’s blood are very low or almost undetectable. The lowest level of antidepressants in infant’s blood is when given Sertraline (in Asentra, Zoloft, Sertralin). It is recommended to take the medicine immediately after breast-feeding. Antidepressants do not work immediately, the improvement of mood occurs after 2-3 weeks of continuous treatment, full effect after 4 weeks.
From psychotherapeutic methods, interpersonal and cognitive-behavioral psychotherapy is the most successful treatment. It is believed that psychotherapy makes changes in neural cell communication, including the influence of neurotransmitter function. In cognitive-behavioral psychotherapy, the psychotherapist helps a woman to change her thoughts, opinions, and attitudes to induce a change in her behavior. It is assumed that the change of attitude will change the woman’s view on the world. Interpersonal psychotherapy is based on psychoanalysis. During treatment, an ill woman tries to understand the relationship between current difficulties and past experience and their effect on mental health.
Because postpartum depression is associated with decrease of estrogen levels in women’s blood, hormone therapy can be used in the treatment. Trans dermally applied estradiol in preparations Dermestril, Estraderm, Estrahexal, Estrapatch or Systen can enhance the effect of antidepressants and psychotherapy.
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