What is postnatal depression?

Postnatal depression is a known medical condition where a woman who has had a childbirth feels sad, "down" or depressed. About one out of every eight women has postpartum depression after delivery or about 10% of women. About one woman in 500 develops severe mental illness in the first month after delivery.

Postpartum depression can begin at any time within the first three months after delivery. It can seriously threaten both the woman and her baby as the mother is unable to breastfeed or bond with her baby.

This condition should not be confused with postpartum blues or baby blues which is a more common (up to 50% of women) and less serious condition. While women with this condition are happy most of the time, she:

• Is more irritable
• Tearful and sensitive
• Feels sad
• Feels confused

The postpartum blues peak three to five days after delivery and usually end by the tenth day after the baby's birth. Compared to women with post-partum depression, women with postpartum blues can function normally. These mood swings are thought to be due related to changes in hormone levels after delivery. They are not linked to depression at a later stage of life.

How does it happen?

Doctors believe that changes in the woman's hormones after delivery cause postpartum depression. Women who have ever been depressed are at greater risk for postpartum depression than other women.

If labour is complicated and the delivery unexpectedly performed as an emergency procedure it could potentially be stressful to the mother. In such scenarios there may be an association between emergency operative delivery and postnatal depression. Several studies have investigated this association, though the current evidence is conflicting, with some studies reporting an association and others not. However, studies have also shown that elective caesarean section does not reduce the risk of postnatal depression.

What are the tell-tale signs?

She may have some of the following symptoms which persist for at least two weeks:

• Unable to sleep
• Lack of interest
• Feelings of guilt
• Lethargy
• Difficulty to concentrate
• Poor appetite
• Restlessness or slowed movement
• Suicidal ideas
• Wanting to harm the baby

The symptoms of depression are less clear cut because of broken sleep and fatigue of new parents, but screening questionnaires such as the Edinburgh postnatal depression score can be used to have a more objective assessment.

Women should try to do the following to prevent postnatal depression:

• Talk to your husband or a good friend about how you feel
• Get plenty of rest
• Do not hesitate to ask your husband, friends and family for help
• Make time for yourself
• Try to leave the house at least once a day, even if it is just for a short while to pursue other matters, such as visiting the shopping mall or saloon
• Join a new mother's group and share your feelings with the women you meet there

What can we do to curb post natal depression?

It is usually best for a team of health care professionals to work with a woman who has postpartum depression. Support groups may help. Some women go to therapy or counselling with a mental health professional.

Anti depressant drugs can prevent the depression from becoming chronic. The most commonly used antidepressants for postpartum depression come from a group of drugs called selective serotonin reuptake inhibitors (SSRIs) such as setraline or fluoxetine.