This January 13th is the world day of action against depression, a condition that affects millions of people around the world. Postpartum depression is one important type of this disease.

What is postpartum depression?

Some estimates suggest that the incidence of postpartum depression is between 10% and 15% of all mothers, although it varies according to the population. Some studies conclude that the incidence of postpartum depression in primiparous women is around 25%, and in Latina women living in Mexico or the United States, it can reach 56% of the population. The prevalence is three times higher in developed countries.

However, mental illness can still be stigmatised in many parts of the world, making it difficult for women to seek help. In addition, the romanticisation of motherhood makes mothers feel guilty when not they don’t experience happiness or well-being after the birth of a baby, so the prevalence of postpartum depression may be underestimated. This leads to underdiagnosis and the impossibility of implementing resources, affecting a mother and establishing a bond with her baby, among other problems.

Risk factors for postpartum depression

Although postpartum depression can affect all women who have given birth, there are some factors that increase the risk of it:

• Depression during pregnancy
• Anxiety during pregnancy
• Experiencing stressful life events during pregnancy or the early postpartum period
• Traumatic birth experience
• Premature birth and/or admission of the newborn to the neonatal intensive care unit (NICU)
• Lack of sleep
• Poor social support
• History of depression
• Difficulties with breastfeeding

Signs and symptoms of postpartum depression

The most common symptoms of postpartum depression are usually:

• Persistently feeling sad, anxious or feelings of emptiness
• Irritability
• Feelings of guilt, worthlessness, hopelessness or helplessness
• Loss of interest or pleasure in hobbies and activities
• Fatigue or abnormal decrease in energy
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping (even when the baby is sleeping), waking up early in the morning or oversleeping (this factor is a risk and a symptom)
• Abnormal appetite, weight changes, or both
• Body aches or pains, headaches, cramps or digestive problems with no clear physical cause or that are not relieved even with treatment
• Constant doubts about their ability to care for the newborn
• Thoughts of death, suicide, or harming yourself or the newborn

Postnatal depression goes unnoticed easily because changes in sleep, appetite and libido can be attributed to the physiological process of postpartum. In addition to the difficulty for healthcare professionals to recognise postpartum depression, evidence suggests that up to 20% of women who have mood changes that could be related to depression do not identify it themselves.

For this reason, according to the American Association of Obstetrics and Gynecology, it is important for practitioners to ask their clients about their feelings. Consultations throughout the postpartum period for both mother and infant should always allow for its exploration.

Ideally, all professionals in contact with the woman in this crucial time should know how to screen for postpartum depression to make an appropriate referral. Careful screening is important here so that resources can be put in place.

Screening for postpartum depression

One screening tool is the Edinburgh Scale. It consists of 10 questions with four response options that mothers answer about how they felt in the past seven days. It is usually answered in less than five minutes. This is a validated scale for screening for postpartum depression six weeks after birth. A score above 11 and/or a positive response to question 10 indicates that an assessment by a perinatal psychology professional needs to be recommended.

Clinical examination is necessary to assess the need for referral to a perinatal psychologist, as well as a request by the patient.

Treatment of postpartum depression is compatible with breastfeeding, even when medication is necessary. Information on the safety of any medication in breastfeeding is available at www.e-lactancia.org.

References:

Perinatal depression. (s/f). National Institute of Mental Health (NIMH). Retrieved on 10th of January 2023 on https://www.nimh.nih.gov/health/publications/perinatal-depression

Management of women with mental health issues during pregnancy and the postnatal period (good practice no.14). (s/f). RCOG. Recuperado el Retrieved on 10th of January 2023, on https://www.rcog.org.uk/guidance/browse-all-guidance/good-practice-papers/management-of-women-with-mental-health-issues-during-pregnancy-and-the-postnatal-period-good-practice-no14/