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An understanding of postpartum psychiatric illnesses!

The birth of a child can stimulate all types of emotions mostly being nervousness, excitement, proud and joyfulness. Following childbirth is the stage known as the postpartum period, usually lasting around 6 weeks from the beginning of childbirth. It is at this period when a mother is most vulnerable to certain postpartum disorders.  The most common being the ‘baby blues’, which can be expressed as mood swings due to the abnormally high fluctuations that normally occur immediately after childbirth.

The ‘baby blues’ are experienced by 85% of women by which the symptoms are known to be short-lived and mild. However, in other cases, around 10 to 15 % of women may experience more severe symptoms such as depression or anxiety, or in rarer cases, women may experience postpartum psychosis. As shown in the image below these illnesses are on a continuum expressed from common or less severe too severe.

Should postpartum blues or ‘baby blues’ be something to worry about?

The answer to the question is no, the baby blues are so common it is described to be more of the norm than a psychiatric illness.

The baby blues are very common among new mothers. Characterised by mood swings, the baby blues onset usually occurs around 3 to 5 days after initial childbirth, this is due to the hormones readapting to configure normal hormone levels for the body.

Symptoms are explained not to be of sadness, but of mood lability, tearfulness, anxiety or irritability. These symptoms last for up to a few weeks after childbirth. However, if these mood swings do prolong further than 2 weeks along with symptoms of depression, then the problem may be more severe than postpartum blues, and the mother may need to seek more help. Women who have a history of depression are at higher risk of developing a more severe postpartum psychiatric illness.

So what exactly is postpartum depression?

Postpartum depression is significantly more severe than the baby blues but is shown to be less common, affecting around 10 to 15 in every 100 women after childbirth. As announced in depression, the symptoms are the same in postpartum depression, which the onset initiates after childbirth, and can last up to a year. The symptoms of postpartum depression include:
  • Depressed or sad mood
  • Tearfulness
  • Loss of interest in usual activities
  • Feelings of guilt
  • Feelings of worthlessness or incompetence
  • Fatigue
  • Sleep disturbance
  • Change in appetite
  • Poor concentration
  • Suicidal thoughts

The causes of postpartum depression are still unclear, but there are thought to be many factors that contribute to the onset of postpartum depression. Firstly, due to the massive changes in hormonal levels may have a negative effect on certain mood hormones such as serotonin. Other factors may include situation risks, whereby the childbirth itself may have caused a great deal of stress and as a result lead to the onset of depression. Lastly, certain life stresses that may be ongoing being carried on through childbirth may be enough to stimulate postpartum depression. For example, stress with work, money worries or the relationship with the father, these stresses along with childbirth may trigger postpartum depression.

Postpartum psychosis

As shown on the image above, postpartum psychosis, also known as puerperal psychosis, is the most severe out of all of the postpartum psychiatric illnesses. Also, being the rarest, postpartum psychosis affects around 1 to 2 per 1000 women after childbirth. In some cases postpartum psychosis can be expressed within 48 to 72 hours, however, in most cases, the onset of postpartum psychosis is expressed within the first two weeks of childbirth.

Common signs are usually expressed as restlessness, irritability and insomnia. In most cases, postpartum psychosis is found to closely resemble the manic stage of bipolar or the depressive stage. Symptoms can change very quickly from hour to hour and from one day to the next. Other symptoms may be expressed as delusions (false beliefs) and hallucinations (false perceptions) and shown as general psychotic reactions. Women suffering from postpartum psychosis are generally admitted to the hospital until she is in a stable condition.

There may be no warning signs, and you may also be unaware that you are ill or suffering from postpartum psychosis. Women who are already susceptible to a previous diagnosis of bipolar disorder or schizoaffective disorder are generally at a higher risk of postpartum psychosis. Moreover, if your mother or sister who was diagnosed with postpartum psychosis, or you have been previously diagnosed with postpartum psychosis your risk is higher than normal, increasing your risk to 25 to 50%.

The understanding of postpartum psychiatric disorders is important, not only for the new mother but for the new father and other family members around you. This will help to differentiate between each postpartum psychiatric illness, and allow others to offer the support and understanding the new mother requires.