Prologue
Post-Partum Depression is one of the most common complications following Pregnancy. It is amongst the most treatable of all psychiatric disorders but also one of the least talked about, it is a known fact that more than 50% of women develop some kind of emotional disturbances following childbirth yet only 15% get any kind of professional help. I will attempt to explain the psychiatric disorders postpartum in the form of a case story, I am naming the protagonist of this story as Super Woman, as all women who go through labour should be called.
The Back Story
It had been 3 years since she was married to the man she loved, her life on the face of it had everything she could ever ask for , she had a satisfying Job and was excelling in it, she was blessed with a 5-week-old baby boy, she had been wanting a child since some time now and her dreams had just come true. One would expect her to be happy, ecstatic even, yet that was not the case.
The Suffering
She woke up with a sinking feeling in her heart, she was supposed to take a small nap and then get up and give her baby a bath, she heard her husband finishing the task and getting the baby dressed. Normally she would never have overslept, but now she just could not help her self, moreover, she did not feel like doing it. How could she feel like that, how irresponsible of her, she hated her self. Her heart started pounding and her breath became shallow while streams of tears rolled down her cheeks. It first started a few days after childbirth, she found her self being moodier than usual, more irritable. Her sleep pattern got disturbed and she started to feel tired all the time. The last week although had been exceptionally bad, she felt low all throughout the day, as if there was a dark cloud hanging all over her. She was worried if she would ever feel better again and if having a child was the right decision. She knew that a mother’s love and affection are extremely important for a child specialist in the initial stages yet she could not get her self to take care of her baby. Perhaps she just was not capable of being a mother, perhaps her baby and her husband were better off without her and she was only a burden to them. Perhaps she was the cause of all their suffering and should just end things. She felt overwhelmed, she felt hopeless. An invisible enemy had defeated her, her powers had vanished, for the first time in her life, she did not feel super.
The Villain (Diagnosis)
She was desperate for help, she was willing to try anything. She went to the doctors and pleaded with them to stop her pain. The doctors revealed to her that she was not alone and that everything she has been feeling is a part of her mental and behavioural disorder during childbirth. He described three separate mental and behavioural disorders with varied presentations that have been known to be associated with childbirth.
Post-partum Blues: The symptoms begin within a few days of delivery, usually on day 3 or 4, and persist for hours up to several days. The symptoms include mood lability, irritability, tearfulness, generalized anxiety, and sleep and appetite disturbance. Postnatal blues are by definition time-limited and mild and do not require treatment other than reassurance, the symptoms remit within days.
Post-Partum Depression: It usually begins within the first six weeks postpartum and most cases require treatment by a health professional.
The signs and symptoms of postpartum depression are generally the same as those associated with major depression occurring at other times, including depressed mood, anhedonia and low energy. Reports of suicidal ideation are also common.
Post-Partum Psychosis: Postpartum psychosis is the most severe and uncommon form of postnatal affective illness, with rates of 1 – 2 episodes per 1000 deliveries. The clinical onset is rapid, with symptoms presenting as early as the first 48 to 72 hours postpartum, and the majority of episodes developing within the first 2 weeks after delivery. The presenting symptoms are typically depressed or elated mood (which can fluctuate rapidly), disorganized behaviour, mood lability, and delusions and hallucinations
The Explanation
On hearing her diagnosis she felt validated and relieved in a way, she understood that it was not her fault for feeling this way, yet there were more questions than answers, she had no predisposition to mental illness, no childhood or genetic emotional vulnerability, she had faced and dealt with many stressful situations in her life and she really wanted the baby, yet why on earth would she get depressed? she read through scientific articles for answers, among the factors implicated in post-partum disorders Hormonal theory seemed to be the most widely studied
The hormonal and biochemical theory of Postpartum depression: During pregnancy, the levels of hormones like progesterone, estrogen, cortisol and thyroid raise to more than double their pre-pregnancy levels, this raise happened gradually. As soon as a woman gives birth to her child the levels of these hormones fall all of a sudden very abruptly. This abrupt drop in the hormones causes haywire in the brain leading to the levels of cAMP, serotonin and tryptophan to fluctuate in the midbrain and the prefrontal cortex. Since these areas play a role in regulating our emotions and thoughts, psychiatric conditions are precipitated.
The Battle (Treatment)
She was told that the first step in defeating her nemesis was to stop feeling guilty, she understood that even though she could manage everything on her own previously it was ok to not be able to do everything herself in her current state. She understood that it was absolutely ok to ask for, to need and to accept help. Her husband and her parents were made to understand her disorder and her symptoms and were told to support her the best they could. She made a list of all the things which normally would make her happy tried pursuing them one at a time. The trick was not to do fun things after she felt good but to do fun things to make her self feel good. She made a time table where she noted down all the work that she had to accomplish. Initially, only a small amount of time was devoted to work but gradually as the days went by she increased her work schedule. This gave her a sense of accomplishment which increased her confidence which gradually improved her mood. She kept a tight schedule of her sleep and food patterns was determined to follow a routine no matter what she felt. Her doctor had prescribed her an antidepressant with the name of Tablet escitalopram, he had given her a choice of which antidepressant she felt comfortable taking. He had mentioned that other tablets like Sertraline, Fluoxetine, Desvenlafexine could also be given. He had assured her that she could safely breastfeed her baby while on the medication.
The Epilogue
She was planning a party, she wanted it to be the best party she had ever planned, after all, it was her child’s first birthday. She had taken the day off work and was waiting for her husband to come home before she could heat up the dinner, things were going as planned, she had not felt hopeless for 6 months and even discontinued her medications. She looked at her baby playing with his toys and smiled. she felt healed, she felt happy.
