Dr Yemi Atibioke, a clinical psychologist and public health expert, in this interview, speaks on a condition some parents suffer from after having a baby, the many wrong beliefs about postnatal depression, also called postpartum depression, and the need for people to pay attention to their mental health as well as ways to manage the condition, among others.
What is Post Natal Depression?
Post Natal Depression, also known as perinatal depression, is a mood disorder that affects individuals during pregnancy or within one year after childbirth.
It is a potentially severe mood disorder that affects approximately one in seven women during pregnancy or within the first year after childbirth.
Perinatal depression stems from a combination of hormonal changes, genetic predisposition, and environmental factors, yet up to 50% of cases remain undiagnosed due to the stigma surrounding the condition and patients’ reluctance to disclose symptoms.
Unlike the transient “postpartum blues,” perinatal depression is more severe, often manifesting as persistent sadness, low self-esteem, sleep disturbances, anxiety, and difficulties bonding with the baby.
Effective recognition and management of perinatal depression are essential for optimizing the health outcomes of the parent and infant.
Men can experience postpartum depression (PPD), also known as paternal postpartum depression. It can affect men just as much as women, and can have negative effects on relationships and child development.
Postpartum depression affects 1 in 9 mothers and about 1 in 10 fathers after the birth of a baby. It happens at a vulnerable time filled with changes to one’s life as they learn to care for a newborn.
Factors associated with a high risk of developing perinatal depression or postpartum blues include:
Psychological: A personal history of depression and anxiety, premenstrual syndrome, a negative attitude towards the baby, the reluctance of the baby’s sex, and a history of sexual abuse could trigger it.
Obstetric risk factors: A high-risk pregnancy, hospitalization during pregnancy, and traumatic events during childbirth that include emergency cesarean section, in-utero meconium passage, umbilical cord prolapse, preterm or low birth weight infant, and low haemoglobin could serve as triggers.
Social factors: Lack of social support, domestic violence in the form of spousal abuse such as sexual, physical, or verbal; smoking, and young maternal age during pregnancy could accelerate vulnerability.
Unfortunately, single mothers who are on the increase are more vulnerable due to a lack of adequate support.
Lifestyle: Poor eating habits, decreased physical activity and exercise, vitamin B6 deficiency (via its conversion to tryptophan and, later on, serotonin, which, in turn, affects mood), and lack of sleep; exercise decreases low self-esteem caused by depression and increases endogenous endorphins and opioids, which brings positive effects on mental health and improves self-confidence and problem-solving capacity.
Family history of psychiatric disorders: various studies have shown that a family history of psychiatric disorders is a risk factor for developing perinatal depression. This increased risk is likely due to genetic and environmental factors during childhood and later in life, which may be associated with a lack of social support, another risk for perinatal depression
What are the symptoms?
Perinatal depression is diagnosed when at least five depressive symptoms are present for at least two weeks.
Most experts include the onset of symptoms that occur during pregnancy and up to 12 months postpartum.
The following nine symptoms in affected people may be present almost daily and represent a change from the previous routine; however, a perinatal depression diagnosis should always include either depression or anhedonia:
Depressed mood (subjective or observed) is present most of the day.
Loss of interest or pleasure (anhedonia), most of the day.
Sleep disturbances (insomnia or hypersomnia)
Psychomotor retardation or agitation.
Worthlessness or guilt.
Loss of energy or fatigue.
Suicidal ideation or attempt and recurrent thoughts of death.
Impaired concentration or indecisiveness
Change in weight or appetite such as weight change of 5% over 1 month.
Other symptoms are: feeling overwhelmed intense anxiety, weeping or crying all the time
irritability or anger, feeling sad all the time, extremely tiredness and lack of energy, wanting to sleep or eat more or less than you usually do, being unable to concentrate or forgetful, intense worry about your baby, being uninterested in your newborn or doing things you used to enjoy and experiencing headaches
What are the wrong beliefs or myths about it in Nigeria?
The belief that it is just the “baby blues.” Emotional mood swings are normal for a few weeks after a baby is born. But if you feel extremely sad, anxious, or indifferent several weeks or months after having a baby, it could be postpartum depression.
It starts right after birth. Most of the time, postpartum depression begins in the first few months after childbirth. But it can start as early as during pregnancy and as late as a year afterwards.
Another one is the belief that it goes away on its own. You won’t just get over it or snap out of it. Postpartum depression is a treatable medical condition. If your symptoms get worse or it’s hard to take care of your baby, talk with your doctor about your feelings and emotions.
Another wrong belief is that ‘it can be prevented’. You can’t do anything to make sure you don’t get postpartum depression. If you have a history of depression or you’ve had postpartum depression after the birth of a child in the past, your doctor may screen you for depression before the baby is born or recommend additional check-ups afterwards to watch for signs.
There is also the belief in hearing voices or having hallucinations. Symptoms don’t include hearing voices, having hallucinations, or feeling manic or paranoid. Those are symptoms of a rare but extremely serious condition called postpartum psychosis.
Of the wrong beliefs or myths about postpartum depression is that it is as a result of evil spirits. No, it is not as a result of an evil attack. Postpartum depression is a mental health condition that anyone is vulnerable to. It can be treated.
How is it diagnosed?
Five or more of the following nine symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure.
– Depressed mood most of the day, nearly every day, as indicated by either subjective report such as feeling sad, empty, hopeless or observations made by others e.g., appearing tearful.
– Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day as indicated by either subjective account or observation.
– Significant weight loss when not dieting or weight gain such as a change of more than five per cent of body weight in a month, or decrease or increase in appetite nearly every day.
– Insomnia or hypersomnia nearly every day – Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
– Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt which might be delusional, nearly every day. That is not merely self-reproach or guilt about being sick.
– Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by their subjective account or as observed by others)
– Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
– The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
– The episode is not attributable to the direct physiological effects of a substance or to another medical condition.
What is the treatment?
Psychotherapy, particularly cognitive behavioural therapy (CBT). CBT is a treatment approach that helps you recognise negative and unhelpful thought and behaviour patterns.
CBT aims to help clients identify and explore the ways their emotions and thoughts can affect their actions.
Once they notice these patterns, they can begin learning how to change their behaviours and develop new coping strategies.
CBT addresses the present and focuses less on the past. However, therapy is not a one-size-fits-all. Understanding how CBT can help each individual cope with stressors would be the primary responsibility of the therapist for their clients.
Interpersonal therapy (IPT): Depression affects relationships and can create problems with interpersonal connections. In turn, problems with interpersonal connections can contribute to depression. The goals of interpersonal therapy (IPT) are to help those with PPD communicate better with others and address problems that contribute to their mental health status.
The medication for postpartum depression includes antidepressant medication, often selective serotonin reuptake inhibitors (SSRIs).
It is ideal for all individuals to pay attention to their mental health conditions, especially the need to understand their triggers and prevent them to the best of their ability.
It is necessary to provide effective social support for every individual. People survive mental health conditions and function effectively with adequate social support.
Self-care is also key. Everyone should pay attention to things that give them emotional stability and optimize them.