During pregnancy, women's bodies will circulate more estrogen and progesterone hormones. These hormones can play a protective function against depression during pregnancy. Many women recall the pregnancy to be a happy time in their life. The cause of Post-Partum Depression is unknown; however, it is thought that the drop in the levels of hormones post-delivery may cause depressive symptoms.
For a woman to receive a diagnosis of postpartum depression, the symptoms must start after delivering the baby and last at least two weeks. All of the following signs and symptoms must be present for a diagnosis: depressed mood decreased interest in activities known as anhedonia, decrease in energy, changes in sleep such as insomnia or oversleeping known as hypersomnia, weight gain or weight loss, reduced concentration, disturbed self-esteem or self-concept such as feeling guilty or worthless, and feeling either agitated or slowed (psychomotor agitation or retardation). Finally, a woman must also feel either actively or passively suicidal or have thoughts about not wanting to live. In most cases, the physician will also order the bloodwork as some new moms experience low thyroid post-pregnancy, which can cause depression. If this is the case, the physician will likely prescribe a thyroid replacement medication. Once the thyroid levels are stabilized, the depression will also likely subside.
Now, it's essential to not confuse Baby Blues with Post-Partum Depression. Baby Blues is a natural reaction to the postpartum adjustment. It will not be a significant problem for the new mom. The baby blues is not considered the past postpartum depression. So how do we differentiate Baby Blues from Post-Partum Depression? Baby Blues will last less than two weeks and typically start 2 to 3 days after giving birth, affecting 80% of women who deliver the baby.
On the other hand, Postpartum depression is more severe. It typically starts within a month after having a baby and sometimes may begin within one year after delivery. It affects 5 to 7% of women and is moderate to severe in intensity. This kind of depression will last longer than two weeks, and suicidality will be more pronounced. Women who experience harmless baby blues are not experiencing suicidal ideation.
Once a woman is diagnosed with postpartum depression, she will require some treatment. Depending on the severity of depression, psychotherapy will be offered, and consideration may also be around prescribing antidepressants. However, one concern is if a woman is breastfeeding her newborn, which can be pretty nerve-wracking for a new mom. However, the physician will typically prescribe an antidepressant appropriate for breastfeeding moms. The psychotherapy that is effective for postpartum depression is interpersonal and cognitive behavioral therapy, on either individual or group basis. Both interpersonal therapy and CBT have significant evidence behind them. Interpersonal therapy will focus on the role transition aspect. The therapist will work with a new mom to help her transition into her unique and more demanding role. CBT will likely focus on recognizing the symptoms of depression, identifying cognitive biases and distortions, designing a behavioral activation plan, and engaging in the cognitive restructuring of cognitive distortions. Psychoeducation is an integral part of both therapies. It involves educating a new mom on her symptoms, prognosis, and treatment options. These types of psychotherapy are expected to be very helpful for mild to moderate postpartum depression. In these cases, medication will likely not be prescribed.
On the other hand, a severe case of Post-Partum Depression will likely require both psychotherapy and antidepressant. In addition, the severity of depression can be assessed by a qualified practitioner using psychometric testing such as Edinburgh postnatal depression scale. In very severe cases involving thoughts of suicide, a woman may be hospitalized in a
facility. In the hospital-like facility, she will remain for the period of treatment and stabilization, after which she will likely be discharged home with support.
Some women will want to try natural treatment modalities for their Post-Partum Depression. Unfortunately, there is not enough research backing these treatment methods. For example, some women may find a yoga class, exercise and acupuncture session helpful. Some women will try kinesiotherapy, physiotherapy, and music therapy. However, research shows that light therapy is not appropriate for Post-Partum Depression.
At Crocus Care Solutions Inc, we provide interpersonal and Cognitive Behavioural Therapy to women experiencing Post-Partum Depression. The treatment is done using work insurance or private payment. We also offer psychotherapy for new moms who are refugees with a valid Interim Federal Health Plan (IFHP). This includes the claimants who have not received their permanent residency yet, and are not covered under OHIP. In addition, we provide direct billing for refugee claimants.
In some instances, direct billing may be done. In these cases, the client will only cover the applicable co-pay portion. However, there are many resources available to women in Ontario. For example, the local public health departments have programs that support women with Post-Partum Depression.
Sources: Ibrahim Ismayilov, Registered Psychotherapist, wrote this blog post. He used his knowledge and clinical experience as well as the article by ATHRYN P. HIRST, MD, AND CHRISTINE Y. MOUTIER, MD, called "Post-Partum Major Depression" published in 2010.