Depression and psychosis

I think I’m depressed. What should I do?

Postpartum depression is not just sadness; it is a mental illness that can start during pregnancy or during the first year after birth. It can affect sleep, appetite, and the ability to concentrate. Individuals report feeling guilty, sad, anxious, worthless, or irritable. Mothers who notice these feeling should consider seeing their health-care providers. Treatment may include support, counselling, and medication. Postpartum psychosis, which is rare, requires immediate attention from a health-care provider. Such mothers may have thoughts of hurting themselves or their baby. 

A) Describing perinatal and postpartum depression

Perinatal depression includes major and minor episodes of depression that happen during pregnancy or in the first twelve months after delivery. It is estimated to affect one in seven mothers (ACOG 2018). Mothers with perinatal depression are not just sad; they are ill, with changes in brain function (Duan 2017).

Depression that happens after the birth of a child can be called postpartum or postnatal depression

Depression can affect either parent but is more common in mothers. 

Severe mental illness can develop during or after pregnancy. While suicide is relatively rare during this time, mothers with postpartum depression, bipolar disorder, and postpartum psychosis are at a higher risk of suicidal thoughts and suicide attempts and of neglecting and even harming their baby (Orsolini 2016).

If you have any thoughts of hurting yourself, your baby, or others, please see your health-care providers immediately.

B) Signs of postpartum depression

Mothers with postpartum depression can feel (Yim 2015):

  • Hopeless
  • Guilty
  • Anxious
  • Worthless
  • Irritable
  • Angry
  • Extremely sad
  • Exhausted
  • Rapid mood changes

Depression and postpartum depression are serious. They can have a significant negative impact on the mother and her family.

Postpartum depression can (Slomian 2019):

  • Cause mothers to withdraw from activities.
  • Decrease sleep quality.
  • Decrease appetite.
  • Decrease the ability to concentrate.
  • Increase the risk of the mother seeing the child as difficult or fussy.
  • Increase the risk of the mothers feeling indifferent towards the baby.

C) Postpartum depression and breastfeeding

The relationship between pregnancy, birth, breastfeeding, and depression is complex and not all studies reach the same conclusion. Individual psychological, physical, social, and cultural factors may affect mothers differently and also influence their mental health and their breastfeeding journey.

Studies of mothers with postpartum depression report that they are:

  • Less likely to start breastfeeding (Butler 2020).
  • Less likely to breastfeed exclusively (Butler 2020).
  • More likely to stop breastfeeding early (Buttler 2020; Slomian 2019).
  • Less likely to have confidence in their ability to breastfeed (Slomian 2019).
  • More likely to use less-healthy feeding practices including adding cereal to the baby’s bottle (Gaffney 2014; Slomian 2019).
  • More likely to start solid foods early.

Mothers who are in pain, experiencing breastfeeding problems, or whose milk comes in late are more likely to become depressed and also breastfeed for shorter periods (Annagür 2013; Slomian 2019; Watkins 2011).

D) Effect of postpartum depression on the baby

Maternal depression may affect the child. Studies have shown that it can (Dadi 2020; Aoyagi 2020):

  • Reduce the mother's levels of the love harmone (oxytocin) (Thul 2020).
  • Reduce levels of disease-preventing antibodies in breast milk (Kawano 2015).
  • Change the baby’s gut immune system (Kang 2018).
  • Result in the baby having attachment problems (Barnes 2019).
  • Result in a child being overweight or underweight.
  • Affect a child’s or teenager’s thinking and behaviour.
  • Affect a teenager's ability to cope with stress (O’Donnell 2013).

E) Preventing postpartum depression

Mothers at risk of postpartum depression can prepare themselves before delivery by:

  • Learning about depression (Akbarzadeh 2018).
  • Optimizing support from partnersfamily and friends (Liu 2020).
  • Forming relationships with knowledgeable health-care providers (Chaput 2016).
  • Starting counselling (O’Connor 2019).
  • Exploring peer support and other community-based resources (Nagano 2020).

F) Treating postpartum depression

1) See your health-care providers

Please see your health-care providers if you believe you are suffering from depression. You may be asked to complete the Edinburgh Postnatal Depression Scale (Cox 1987). This is a 10-part self-rating questionnaire often used to identify mothers with depression.

2) Breastfeeding

Some studies have shown that breastfeeding can help prevent or reduce the symptoms of depression (Figueiredo 2014; Toledo 2021).

Breastfeeding can protect your baby from some of the harmful effects of depression (Gelaye 2016; Jones 2004).  

3) Looking after yourself

Mothers can benefit from knowing that they are not alone as depression affects about one in nine women. The tools that can minimize manage sadness may also be useful for depression. Exercise, in particular, has been shown to be effective (ACOG 2020; Schuch 2016).

4) Treatment

Treatment options include support, counselling, and medication (O’Hara 2018; Molyneaux 2014; Thompson 2017).  

Most antidepressant medication is compatible (poses little or no risk to the baby) with breastfeeding, and in general mothers with depression who need such medication are encouraged to continue breastfeeding (Molenaar 2018; Sriraman 2015). If anti-depressant medication is needed, sertraline, paroxetine, and possibly nortriptyline are appropriate first choices (Sriraman 2015; Anderson 2020). 

Mothers on selective serotonin reuptake inhibitors (SSRI) medication, such as sertraline and paroxetine, need to ensure their babies are growing well as there is a small chance these medications will reduce the milk supply.   

G) Postpartum psychosis

A small number of mothers develop postpartum psychosis. One research review (Bergink 2016) reported a rate of less than one mother (0.25 to 0.6) per 1,000 births. Mothers can experience:

  • An abnormally happy mood
  • Racing thoughts
  • Loss of inhibitions
  • Paranoia
  • Confusion
  • Hallucinations
  • An obsessive fear of hurting the child
  • Delusions

Postpartum psychosis is a psychiatric emergency and requires immediate medical attention. Mothers are often admitted to hospital for this. Treatment options include antipsychotic medication and electroconvulsive therapy. The illness can put the lives of the mother and baby in danger. The decision whether to breastfeed must weigh the benefits and risks for each person.

References

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