Are you just having baby blues, or postpartum depression?

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“You don’t want to be with your child; you’re worried you might hurt your child; you’re worried you weren’t doing a good job.” That’s how pop singer Adele revealed she felt when she was struck with postpartum depression some four years ago when she gave birth to her son, in a recent magazine interview.

According to KK Women’s and Children’s Hospital, as many as 15 per cent of women suffer from postpartum depression – a major depressive illness that develops after childbirth.

This is different from “baby blues”, which affects up to 80 per cent of women. Women with postnatal blues may experience mood swings, irritability and occasional tearfulness in the first two weeks of giving birth. Most mothers recover quickly from this without the need for treatment.

Unlike the baby blues, postpartum depression has more severe implications on mother and baby. It causes the mother to have intensely negative thoughts about herself and her baby. In very serious cases, she may even commit suicide or kill her own child.

We talked to Dr Lim Boon Leng, a psychiatrist at Gleneagles Hospital, to find out more about the condition and what you can do if you experience such negative emotions after giving birth.

 

Know your risk of postpartum depression  

Doctors have yet to pin down the exact causes of postpartum depression, but Dr Lim says it’s likely that genetic influences play a role. Your risk of getting postpartum depression is increased if you or any of your family members have a history of depression.

Another risk factor is how prepared you feel having a child. Older women and single mothers tend to have greater anxiety about the birth and this can lead to postpartum depression. Similarly, first-time mothers are more susceptible as they tend to feel unsure of their abilities to care for the newborn. Ambivalence towards your pregnancy and a lack of social support from family and friends also increase your risk.

 

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“It is also postulated that postpartum depression is related to hormonal changes,” says Dr Lim. “During pregnancy, your oestrogen and progesterone levels rise to 20 to 30 times more than normal. After you give birth, these hormone levels as well as your thyroid level drop sharply. This can affect your mood and consequently lead to depression.”

 

Signs to watch out for

Women who have postpartum depression tend to exhibit the following symptoms for more than two weeks, usually within six weeks of giving birth but occasionally as much as three months after:

  • Pervasive low mood,
  • Loss of interest in your usual activities,
  • Disturbances of appetite,
  • Fluctuations in weight,
  • Poor concentration and indecisiveness,
  • Feelings of guilt, loss of confidence, low self-esteem and suicidal thoughts

 

More significantly, they might experience delusions or entertain ideas about harming their babies, such as smothering the newborn or tossing it out of the window. At this stage, they require urgent professional help.

 

Treatment

Antidepressants like sertraline are usually prescribed to patients whose negative moods persist for longer than two weeks after childbirth.  

If you’re breastfeeding, doctors may recommend that you pump and dump, meaning you throw away the milk produced after you take the medication and nurse your baby three to four hours after.

Dr Lim explains: “There have not been any medical trials conducted on nursing mothers, so while they may be deemed safe for use, it is best to minimise your baby’s possible exposure to medication in the breast milk.”  

 

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Another viable treatment is psychotherapy conducted by either a psychiatrist or psychologist, says Dr Lim. During therapy, the therapist talks to the patient in order to make an assessment of her condition. They then discuss the negative thinking processes that may be causing the depressive mood and work on more positive thinking. A whole course of therapy is usually about 12 weekly to biweekly sessions.

While a patient is undergoing treatment, it is ideal that her child be admitted into the psychiatric unit with the mother, provided that intensive psychiatric nursing and support is available. “This is not always available in Singapore,” laments Dr Lim. Because of limited resources, women are screened and undergo psychiatric evaluation before doctors deem if this is necessary. “But we will always try our best to maximize the mother’s interaction and bonding with the child.”

 

Minimise your risk

Feeling moody, stressed or overwhelmed after giving birth is nothing to feel guilty or ashamed about. In fact, it is healthy to express your emotions and talk about them with your family and friends. This provides them with the opportunity to offer you help, understand your needs and help you cope with those feelings.

Without the support and care of your close relatives and friends, temporary baby blues can develop into postpartum depression. Dr Lim says the most important thing to prevent postpartum depression is to rally your loved ones around you.

If you know an expectant mother who might be at risk, monitor her mood so that if necessary, she can seek treatment as early as possible. Intensive nursing care at home has been shown in some countries to help prevent postpartum depression in those at risk.

Women with postpartum depression also have a higher risk of depression in the future so it’s important to continue to monitor their emotional wellbeing, says Dr Lim.