Postpartum Depression
Postpartum depression (PPD) affects a large percentage of women after childbearing. It is a mental disorder that may be disabling and has is complications, but it is treatable. The American Psychiatric Association has included Postpartum depression in their list of mental disorders manual popularly known as the DSM-5. It is categorized as a major episode if the symptoms happen during pregnancy or between the first four weeks after giving birth.
Nevertheless, if the depression occurs four weeks after giving birth, it is not categorized as a major depression though it may still be harmful and should be treated.
Diagnostic criteria
According to Stewart & Vigod (2016), there is still a significant controversy on the ideal method of detecting or screening for postpartum depression. However, undertaking a sensitive inquiry on mood swings and stability during postpartum clinical visits is helpful in identifying the postpartum depression issue. The American College of Obstetricians and gynecologists, together with the American Academy of Pediatrics, recommend using 10- item Edinburgh postnatal scale (EPDS) (Stewart & Vigod, 2016). Having these series of questions geared at determining if a parent is suffering from anxiety or depressions is an excellent step, as indicated by Diamond, H. (2018). However, Diamond advises that this is a responsibility that should not be left to the mothers because it would diminish the chance of ever addressing mental health. It would put more doubt on mothers’ health as they would not be sure if what they are experiencing is a depression or needed to be mentioned in a clinical setting.
According to Diamond (2018), 80 out of a hundred new mothers suffer from the baby blues, which is characterized by depression and anxiety symptoms that are more or less transient. 15 percent of new mothers suffer from severe postpartum issues. Therefore, judging from this statistical evidence, mothers must be taken through the Edinburgh scale through the clinical inquiry. The clinical officer will know if the mother is in transient anxiety by undertaking a face-to-face inquiry or there is a need for an intervention. The U.S agency for health care research and quality states that there should be serial testing, which should start with a two-question kit or screening a mother’s feelings. Such scrutiny will help establish if the mother has feelings of happiness or anxiety, lack of pleasure, or interest in activities. After that question, a follow-up question should be used but this time focusing on a specific instrument depending on how the first question was answered. In undertaking such a strategy, the process aims to reduce false positive or false negatives.
The course of postpartum disorder
Highlighting the course of postpartum, including its symptoms and trajectories experienced by women, is significant because the clinical prevalence of depression is hitting 21.9 percent within the first year (Fisher et al. 2019).
The records show that over 800 000 women are affected by mental disorders every year. A cross-section of data pooled from 19 data sources across seven different countries showed that women suffering from postpartum depression portrayed distinct phenotypes depending on the severity, timing, comorbidity, and suicidality (Fisher et al. 2019). A different report by other investigators indicates that a section of women has a long-lasting course depending on the timing of the postpartum onset.
Other determinants of the course include biological or the genetic contribution of the mother’s psychosocial past as well as the personal characteristics. Mothers who show symptoms of elevated depression when they are pregnant and suffer postpartum at the first year tend to have less education, are younger, have poor health, have less social support, and use alcohol in their prenatal stage (Fisher et al. 2019). Therefore, having a predictive model that can be used to determine the course would be necessary for providing information on the treatment selection as well as the intensity to be applied.
Perinatal depression, when combined with other life disorder, it becomes comorbid. With such a condition, it exacerbates the postpartum depression course and makes it more severe Fisher et al. 2019). The course outline forming perinatal depression symptoms from the third to sixth trimester is closely associated; hence women showing elevated depression levels also suffer from high anxiety levels. The contemporary presentation of both anxiety and postpartum depression symptoms contribute a lot in shaping maternal psychology course, including high risks of relapse, reaction to treatment, and committing suicide.
Prevalence rates of postpartum
Postpartum depression prevalence is estimated at 12.9 percent and above for the people in the middle and lower incomes (Stewart & Vigod, 2016). Different studies have presented higher numbers of depression in new fathers, while others do not report. Most of the people suffering from postpartum depression depict symptoms like sleep disturbance, irritability, obsession with the baby, being overwhelmed, and anxiety (Stewart & Vigod, 2016). There have been suicidal ideations as well as worries of harming the baby being reported. The worst risk associated with postpartum depression is having a past history of untreated depression or anxiety within the pregnancy period. One of the contributing factors to depression development in vulnerable women is having a rapid reproductive hormone decline (Stewart & Vigod, 2016). However, the disorder’s precise pathogenesis is not well known.
A study carried by Anokye et al. (2018) involving 257 mothers established that postpartum depression affected 7 percent of the population, while 93 percent did not have any signs of postpartum. The trend was also established in other African countries when a comparison with other studies was made. The low prevalence rate recorded in the study was associated with the instrument used in the study. Nevertheless, there have been some challenges in identifying the prevalence rates because of many factors, including the lack of accurate and modern instruments for assessing the prevalence. It was also established that the prevalence rates of postpartum depression were more amongst mothers within twelve months after giving birth (Anokye et al.,2018). A larger population of the participants had minimal depression. Others had mild, severe, and too severe depression. Amongst the predisposing factors noted in the study were stress in life, m prenatal anxiety, and having a history of past postpartum depressions (Anokye et al.,2018).
Other contributors to postpartum depression, as indicated by Stewart & Vigod (2016), include genetic factors and social factors such as violence in marriage and other adverse life activities. Therefore, the natural course for the disorder is sometimes variable.
Though it may sometimes resolve quickly in few weeks after starting, about 20 percent of women continue to suffer from the disorder beyond the first year after they have delivered, 13 percent within the next two years, and 40 percent will experience relapses the subsequent pregnancies. Suffering postpartum depression leads to other issues like maternal suffering and diminished functioning, which are associated with children’s developmental problems. The disorder leads to pared infants and caregiver connection as well as a lack of emotional attachment and cognitive development.
Differential Diagnostic
There has been a debate over the years as to whether any depression that occurs after birth is different from the major depressive disorder to warrant it to be considered a different disorder. During the 1800s, case studies conducted gave a description of a distinctive puerperal mental disorder that was different from the nonpuerperal disease (Batt et al. 2020). In the 1960s, another study described a different form of “nonclassical depression,” characterizing the common depressions that occurred after birth (Batt et al. 2020). As time passed, the DSM-iv added the postpartum specifier as a major depressive disorder. The specifier introduced the distinction in timing for the major depressive episode within the period of postpartum. Major depression during the onset of postpartum represented a depressive episode happening within four weeks after delivery. Although this specification still exists in DSM-5, it now comprises the episodes that start during pregnancy and within the peripartum onset.
However, whether a woman experiencing major depression during the postpartum period (postpartum depression) is distinctive from other major depression occurring at different times (major depressive disorder) to warrant a different diagnosis is a subject of debate (Batt et al. 2020). The distinction of evidence available is mostly based on epidemiology, the cause, and the treatment. Overall, the available evidence differentiating PPD from other major depressive episodes is primarily dependent on the definition of the postpartum period. According to Batt et al. (2020), depression manifesting in the early days of PPD periods, such as within the first eight weeks, with severe symptoms combined with epigenetic data indicates that it may differ. The difference comes out compared to the one happening in the later stages of the PPD period, which is similar to the major depression disorder experienced outside the perinatal duration.
Recommended Treatment
According to Tartakovsky (2020), postpartum depression rarely subsides unless it is treated. It needs treatment for the patient to feel better, and luckily there are available treatment options. A different patient receives different treatment plans depending on the severity and the symptoms showing. For instance, the Canadian Network for Mood and Anxiety Treatment (CANMAT) guidelines released in 2016 advice that the first option for treating mild and moderate postpartum depression should be psychotherapy (Tartakovsky (2020). The specific psychotherapy that a physician should adopt may include cognitive-behavioral (CBT)or interpersonal therapy (IPT). Another option that is recommended is the use of medication, such as selective serotonin reuptake inhibitors (SSRI’S) (Tartakovsky (2020; Stewart & Vigod, 2016). For treating severe PPD, the first option should be medication, but combining both medication and physiotherapy always works best.
The treatment using therapy can effectively deal with PPD, but they are limited as they can only be effective in 12 to 20 weeks (Tartakovsky, 2020). CBT is anchored on the knowledge there is a link between human thinking, behavior, and mood. Therefore, CBT looks to help moms examine their negative thoughts and try to modify them into a better and healthy one. It is also a method that helps moms to develop beneficial coping strategies and problem-solving tactics.
The traditional setting for offering the CBT is in a group or as an individual. However, preliminary research studies say that conducting a CBT over the phone can be useful but only for those with mild and moderate symptoms. Other studies suggest that a therapist can offer internet-based admiration of CBT to reduce effects such as anxiety and stress and increase the patient’s quality of life (Tartakovsky, 2020). On the other hand, IPT pays attention to improving one’s relationships and the circumstances that may be directly connected to depression. The patient and their therapist select an interpersonal problem to develop. The interpersonal areas are four in number, including grief, role transition, disputes, and personal deficits. IPT is mainly tailored to help mom build a better relationship with their babies, partner, and even in the workplace.