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Term Postpartum Depression (PPD)

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Postpartum depression affects about 10% of women who have simply given birth, but not all instances are reported and can be as high as 35% in a given demographic crew. This term postpartum depression (PPD) describes the temper disorders which engulf the mother quickly after childbirth. Some cases of postpartum depression go unreported due to some circumstance such as lack of time and problems relating to screening. However many of the undisclosed cases are as a end result of social stigma, mothers fearing to be seen as sad and the public image they portray. Stewart et al. (2003) observe that many of these who undergo screening accept that they are depressed however refuse to agree that their depression is as a result of their babies. In these cases, it is the postpartum depression that brings about embarrassment, shame, guilt, and fear. Furthermore, the societal expectations about motherhood add more burden to the already affected mother. Thurgood, Avery, & Williamson (2009) reiterate that most women try not to show their distress and struggle alone so as not to be seen a bad or unfit mothers and even fear that their babies might be taken away. They may downplay the gravity of the conditions and assume that what they are feeling is a result of the increased tasks due to the newborn baby or lack enough sleep. If not treated the probability of PPD recurring is over 50%. Most of these mothers continue to suffer in silence wondering about that pathology of their state, not knowing that it can be treated (Stewart et al., 2003).
Causes
The most common postpartum illnesses are the blues, postpartum depression, and postpartum psychosis. All three differ in the degree of prevalence, prognosis, and management. Baby blues are mood disturbances for mothers having childbirth and affect 50% to 80% of new mothers. The symptoms begin soon after birth and peaking after five days and diminishing in about 10 to 14 days. Some signs of this baby blues include frequent crying, insomnia, fatigue, unexplained anger, sadness, emotional instability and irritability (Thurgood, Avery, & Williamson, 2009). The situation is considered normal and should the symptoms exceed 14 days it could indicate the development of PPD. The main feature that distinguishes the blues form PPD is that the blues do not affect the normal functioning of the mother and it regulates itself thereby does not require treatment (O'hara, & McCabe, 2013).
Brummelte & Galea (2016) purported that Postpartum depression is characterized by more than four of the following symptoms which should persist for more than 14 days: excessive insomnia, very low self-esteem, guilt, unpredictable appetite, fatigue, psychomotor retardation, suicidal ideation, and low level of concentration. There is a loss of interest in normal daily tasks and a depressed mood which manifest within a month of childbirth. Moline et al. (2001) reiterate that whereas about 50% of a mother who experiences PPD show symptoms within three months after delivery others experience the signs for over 12 months. Therefore, medical practitioners peg the range of those at risk of PPD at three months to two years.
Who is at risk?
The exact cause of PPD is not known. However, results from meta-analyses of 15000 women showed that the following were same critical factors that could predict. Encountering a stressful event during pregnancy, depression, and anxiety during pregnancy, lack of enough support from a family member, and having experienced depression over the years. Other factors, though to a lesser level include low self-esteem, obstetric complications, poor quality with partner, and negatives cognitive characteristics. Gender of the child, educational levels, ethnicity and age of the mother were found to not affect PPD (PPD (Stewart et al., 2003). If the mother has low income, and especially if she is relatively young, it is likely that she has limited access to financial support. This stress combined with other factors would bring about a substantial amount of stress which is a risk factor for PPD (O'hara & McCabe, 2013).
Will Untreated Postpartum Depression Affect The Baby?
Postpartum depression affects children above one year and the mental health of the partner. Studies indicate that the mother’s depression may negatively affect the cognitive, behavioral, social development of the kids including babies and toddlers (Thurgood, Avery & Williamson, 2009). Some effects can affect the child permanently. The babies of affected mothers may have a higher chance of child abuse and highly probable to portray insecure attachment tendencies. These attachments are essential since they can affect the later life of the child (Stewart et al., 2003). At school age, those kids whose mothers were depressed after birth show heightened emotional instability. Clinicians should put into consideration the level of mother’s emotional support thereby get the family members involved and emphasize her social support network and inform the mother to have a close connection to those who have her interest at heart (Thurgood, Avery & Williamson, 2009).
How is Postpartum Depression treated?
Most PPD cases can be treated at outpatient, but if suicidal ideation is diagnosed or the safety of the baby is not guaranteed, then the patient is hospitalized. Outpatient treatment takes two essential forms: psychotherapy and pharmacotherapy. Psychotherapy is more efficient for mild to severe cases of PPD whereas pharmacotherapy works better for moderate to severe PPD. In most cases, the first line treatment includes a combination of pharmacotherapy and psychotherapy (Brummelte & Galea, 2016). Those who are recommended undertaking pharmacotherapy get concerned about breastfeeding and how the medications prescribed would affect their babies. Whereas studies have indicated a negligible immediate effect on breastfeeding babies’ developing brains, long-term effects are yet to be established (Thurgood, Avery & Williamson, 2009).
Although PPD is the most common depression disorder for new mothers, it is critical to rule it out and consider diagnosing other forms of depressions and treat them. Such treatments are those that are least harmful to the infant but which could be beneficial. If the clinicians determine that antidepressants are investable, close monitoring should be done to ensure that there are minimal side effects to the baby. Some side effects to the baby are sleeping pattern change, problems in feeding and gaining weight (Brummelte & Galea, 2016. Since depressants are secreted into the mother’s milk, it is necessary for the physicians to start to the smallest effective quantity and what the behavior of the baby for any side effects. It is recommended that antidepressants be taken soon after breastfeeding and just before the baby sleeps to allow drug concentrations to drop. The PPD cases that are sensitive to these medications should start with a half the dose for a few days and increase the quantity gradually. In most cases, PPD cases being treated by depressants are considered to have achieved acute response when symptoms have lowered by half. The dose should be maintained for more than six months to avoid recurrence (Stewart et al., 2003). Since treating a lactating mother affects the babies, involving a pediatrician is recommended. It is also critical for physicians to involve the partners of the women. PPD treatment should, therefore, be holistic and family-centered. It should point out knowledge about the disorder, cultivation of habits that improve and support mental health and the treatment options. Particularly, each case should be treated individually putting into consideration the circumstances surrounding it (Thurgood, Avery & Williamson, 2009).
Preventing Postpartum Depression
The previous history of depression heightens the risk that a mother would develop PPD. The threat is highest for a woman who had been diagnosed with PPD in her previous pregnancy. If the history of depression is reported, clinicians should consider appropriate options to avoid a recurrence of the same. If this is the first childbirth, and the mother has shown good health all through, experts suggest not giving new treatment but monitoring the mother carefully. Treatment should only be given if symptoms show up (Moline, 2003). However, Moline further points out that if the mother had had PPD previously, it is recommended starting preventive treatment whereby antidepressants are given together psychosocial interventions soon after childbirth. If the mother has greater risk interventions should be provided during the third trimester.
Conclusion
Postpartum depression affects about 10% of women who have just given birth, but not all cases are reported and can be as high as 35% in a given demographic group. The exact cause of PPD is not known. Postpartum depression is characterized by more than four of the following symptoms which should persist for more than 14 days: excessive insomnia, very low self-esteem, guilt, unpredictable appetite, fatigue psychomotor retardation suicidal ideation and low level of concentration. Encountering a stressful event during pregnancy, depression, and anxiety during pregnancy, lack of enough support from a family member, and having experienced depression over the year are the risk factors for PPD. Outpatient treatment takes two essential forms psychotherapy and pharmacotherapy.

References
Brummelte, S., & Galea, L. A. (2016). Postpartum depression: etiology, treatment and
consequences for maternal care. Hormones and behavior, 77, 153-166.
Chaudron, L. H. (2003). Postpartum Depression. Pediatrics in review, 24(5), 155.
Moline, M. L., Kahn, D. A., Ross, R. W., Altshuler, L. L., & Cohen, L. S. (2001). Postpartum
depression: a guide for patients and families. Postgraduate medicine, (Spec No), 112.
O'hara, M. W., & McCabe, J. E. (2013). Postpartum depression: current status and future
directions. Annual review of clinical psychology, 9, 379-407.
Stewart, D. E., Robertson, E., Dennis, C. L., Grace, S. L., & Wallington, T. (2003). Postpartum
depression: Literature review of risk factors and interventions. Toronto: University Health Network Women’s Health Program for Toronto Public Health.
Thurgood, S., Avery, D. M., & Williamson, L. (2009). Postpartum depression (PPD). American
Journal of Clinical Medicine, 6(2), 17-22.

July 24, 2021
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