1) What is postpartum depression?

A diagnosis of Postpartum depression (PPD) is made when the female experiences a major depressive episode during the period following childbirth, usually 4 weeks to 6 months. 

The main symptoms of postpartum depression, besides the usual depressive symptoms of low mood, lack of interest, fatigue, worthlessness feelings are - difficulty bonding with the baby, feeling incapable of childcare, heightened feelings of helplessness and thoughts of harming oneself or the baby. 

2) Causes and symptoms of postpartum depression 

Combination of factors contributes to PPD.

• New mothers often feel overwhelmed by the demands of caring for a newborn. Lack of sleep and limited social support worsen the feelings.

  
  

• Preexisting biological vulnerability for mental health problems and hormonal fluctuations in oestrogen and progesterone during the postpartum period, add to the risk of developing depression.

  
  

• Life stresses such as difficult delivery, complications with baby's health, financial constraints, interpersonal conflicts with family members etc, can make coping with the challenges of new motherhood even more difficult.

  
  

3) Statistical data on postpartum depression in India - What makes Indian women more vulnerable to developing postpartum depression?

The national prevalence of PPD is around 22% which is higher than the global average of 17%.

Social stigma around mental health can prevent women from seeking help for PPD fearing judgement or shame. Lack of awareness about postpartum depression as a medical condition results in undiagnosed cases and delayed access to mental healthcare. 

Traditional practices such as going to parental home at 7 months of pregnancy and being there for three months post-delivery ensures adequate support for childcare. However, nuclear families and migration to far of places of work, results in women not getting the support as they used to earlier.

4) Crucial factors that make a woman more susceptible to postpartum depression

All pregnant women have some level of risk for developing PPD. But not everyone will experience it. Adequate social support from partner, family and friends, is a strong protective factor against developing PPD. Women who have healthy coping mechanisms to manage stress and adequate self-care are at lower risk for PPD.  

5)  Diagnosis of PPD in India

The treating gynaecologist refers to a mental health specialist such as psychiatrist or clinical psychologist on detecting depression or anxiety in the new mother. The mental health professional does a detailed history-taking and to rules out other potential causes for the symptoms. Short screening questionnaires are often administered to assess the severity of the postnatal depression. 

6)  Challenges that healthcare professionals face while treating postpartum depression

 Two main challenges Healthcare professionals in India face are:

1) due to social stigma, the women with PPD and the family may dropout from the treatment of that health professional when a mental health problem is diagnosed and referred to a mental health professional. So often health care professionals do not talk of mental health problems explicitly even if they are able to diagnose it.

2) scarcity of qualified mental health professionals reduces accessibility of mental health care. Travelling far during postpartum period or coming to the hospital another day just for the sake of consulting mental health professional may not be viable options.

7) Is postpartum depression related to any underlying mental health conditions?

No, PPD is not related to any underlying mental health condition. However, women with biological and psychological mental health vulnerabilities are at higher risk for PPD. Pre-existing mental health conditions can worsen during the postpartum period.

8) Various phases of postpartum depression 

Different stages within the postpartum period can influence the experience of depression differently. 

• Baby Blues (1-2 weeks after childbirth):
  Affects 80% of new mothers, with symptoms such as mild mood swings, tearfulness, anxiety, fatigue, and difficulty sleeping, and resolves on its own in 1-2 weeks 

  
  

• Onset of Postpartum Depression (4 weeks- 6 months after childbirth):
  More severe symptoms of depression and anxiety causing considerable emotional challenges. 

  
  

• Long-Term Postpartum Depression:
  A chronic condition if left untreated, can significantly impact a woman's well-being and her ability to function in daily life. 
  
  

9)  Various treatment options available in India - When to know that it’s time to see a doctor? 

Non-pharmacological treatments include psychotherapy, help mobilizing additional support and facilitating lifestyle changes such as getting enough sleep, eating a healthy diet, and exercising regularly.

Antidepressants that regulate brain chemicals like serotonin and norepinephrine that help mood regulation are the most often used pharmacological treatments or medications. Options that are compatible with breastfeeding are followed during PPD.

Some signs that seeing a doctor might be advisable are:

• Symptoms persisting beyond a few weeks

  
  

• Severe symptoms that disrupt sleep and appetite

  
  

• Self harm thoughts

  
  

• Difficulty in daily life functioning

  
  

10) Other important things to know

Some things that are not often spoken about regarding PPD but can be important are: 

• Anger and irritability are common symptoms are often not recognized symptoms of PPD and cause costly interpersonal misunderstanding and distancing among family members. 

  
  

• Partners can also experience PPD due to factors like sleep deprivation, adjusting to new responsibilities, and witnessing their partner struggle. However, conversation around PPD often centres on mothers, while postpartum experiences of men are often overlooked  

  
  

• PPD can recur with future pregnancies

  
  

• Recovery is possible