The post-partum period refers to time after a woman delivers a child (or has an abortion) following a pregnancy. This period is characterized by many changes in the woman’s body including sudden changes in hormonal levels. There are also changes in the surroundings (presence of the new born baby) and resultant changes in lifestyle and behaviours (increased responsibilities and stress, reduced sleep etc). All these changes make the person vulnerable to developing mental disorders during this period.
Nearly 85% of women experience some type of mood disturbance in the post-partum period. These are commonly called the post-partum blues and it is considered more of a normal experience following childbirth rather than a psychiatric disorder. The women experience extreme swings in mood from happiness to sadness, tend to be tearful, and appear to be anxious or irritable. Such symptoms often peak by the 4th or 5th day after delivery and usually resolve by itself by the end of two weeks. No treatment is required, and the women is able to function as expected. If the symptoms are severe or persist for longer than 2 weeks, they may require evaluation for more serious issues.
Post-partum depression is a more serious condition and may occur at any time during the post-partum period or may begin towards the end of pregnancy and continue in the post-partum period. The symptoms seen are similar to those of a major depressive disorder . These include low mood, sadness, fatigue, loss of sleep and appetite, feelings of guilt and worthlessness, inability to concentrate etc. In some women, symptoms of anxiety including panic attacks and obsessive-compulsive symptoms may also be seen. The possibility of developing post-partum depression is higher in those who have had a previous mood disturbance (depression or bipolar disorder) either independently or in relation to a former pregnancy. The chances of developing post-partum depression is also higher in women who have had depression during the pregnancy, recent stressful life events, marital problems, and insufficient social and family support.
In some women, it is also seen that Obsessive-compulsive disorder (OCD) can start during the post-partum period. These symptoms sometimes may not amount to a disorder but often cause a lot of anxiety in these women and may also worsen depression.
Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is rare and occurs in one or two out of every thousand post-partum women. The symptoms are dramatic and start quite early (usually within 3 days of delivery) with restlessness, irritability, and lack of sleep. There are sudden extreme shifts in mood with erratic behaviours. They may appear confused or disoriented. False beliefs often centring around the baby as well as voices in the head instructing the mother to harm herself or the child are also seen. There is a high risk of suicide and infanticide in such situations. There is also a higher possibility of those with post-partum psychosis to develop bipolar disorder with episodes unrelated to pregnancy later in their lives.
Before making a diagnosis of post-partum depression or psychosis, your doctor will rule out other possible causes for mood disturbances in the post-partum period including thyroid insufficiency and anaemia. For this, he may do a physical examination and/or ask for laboratory investigations.
The treatment for post-partum illness depends on the severity of symptoms and availability of resources. Certain psychotherapy techniques may be useful to handle depressive and anxiety symptoms in mild cases and in those who insist on avoiding medications in view of breast feeding.
Antidepressant medications are used in more severe situations. Additional medications may be required based on severity of symptoms including sleep disturbance, and presence of false beliefs and voices in the head. Your doctor may also choose electroconvulsive therapy or electric shock treatment in severe situations as this method shows faster recovery and can allow for lesser medications to be given in view of breast feeding. Although all psychiatric medications used for post-partum illnesses are secreted in breast milk, the exposure of the infant to medication can be minimised by changes in drug dosage and timing of the feed. No major side effects have been noted in infants related to the commonly prescribed antidepressants.
Those women who have had mood disturbances previously following a delivery or as a part of bipolar disorder and are likely to develop a post-partum illness may be given medications starting towards the end of pregnancy to avoid disturbances after delivery.
Although severe forms of illness are rare, they are a cause of significant problems during the postpartum period, affecting both the mother and the child. Adequate support and medical intervention when required can improve the quality of mother’s life and the mother-infant bond significantly.