Postpartum Depression

A mother has spent nine months bearing a child in her womb. Nine months of major physical changes, constant nausea, back pain, insomnia, reduced energy levels, anxiety, and a lot more. After delivering the baby, the mother would believe that this is now the end of her pregnancy journey. But, post-pregnancy can not only have many physical changes, but with it comes mental impacts, with a major one not talked about as much as it should: Postpartum Depression.

Overview

Postpartum Depression is a condition of depression that a mother goes through after childbirth, which arises from a combination of hormonal changes and psychological adjustment to motherhood. A mother can experience “baby blues,” which only last for a couple of days or a couple of weeks, and can become severe, leading to depression.

Symptoms of baby blues include mood swings, anxiety, sadness, irritability, feeling overwhelmed, crying, reduced concentration, appetite problems, sleeplessness, etc.

These symptoms are heightened and last longer in Postpartum Depression, interfering with the mother’s ability to care for the baby and handle day-to-day tasks. It usually develops within the first couple of weeks postpartum, but can begin earlier during pregnancy or later, up to a year after.

Additional symptoms:

• difficulty bonding with your baby

• withdrawing from family & friends

• insomnia

• sleeping too much

• overwhelming loss of energy

• reduced interest in previous interests & hobbies

• rage

• fear of not being a good mother

• feelings of worthlessness, shame or guilt

• hopelessness

• severe anxiety & panic attacks

• thoughts of harming yourself or the baby

• contemplation of death or suicide

  
  

Possible Causes:

• Genetics: if there is a family history of Postpartum Depression, it increases the risk, especially if it was major

• Physical changes: Hormones like estrogen, progesterone and other hormones produced by the thyroid gland significantly drop after childbirth, leading to energy loss

• Emotional issues: A mother goes through many changes after childbirth that are physical, mental, and emotional, drastically changing her lifestyle. Stillbirths and miscarriages may also be a cause.

  
  

Postpartum Depression can also be bipolar-related, and a mother may develop a rare condition of depression known as “Postpartum Psychosis,” which develops in the same time frame, but can lead to life-threatening thoughts or behaviours that require immediate treatment.

Bipolar-Related Symptoms:

• Feeling confused and lost

• Having obsessive thoughts about your baby

• Hallucinating and having delusions

• Having sleep problems

• Having too much energy and feeling upset

• Feeling paranoid

• Making attempts to harm yourself or your baby

  
  

It is also possible for the other parent to experience postpartum depression: Paternal Postpartum Depression, due to changes in usual eating or sleeping patterns, leading them to feel sad, tired or overwhelmed.

Ancient vs. Modern Lifestyles

About 13% (WHO) of women worldwide experience postpartum depressive symptoms within three months of giving birth. The number has risen, which is believed to be linked to modern lifestyles that contrast sharply with ancestral environments; similar to how diabetes and obesity are linked to cultural shifts. Many contemporary aspects have contributed to the rise of this number.

1. Diet

   Modern diets consist of highly processed grains and lack much variety in nutritional value. In contrast, ancestral diets were rich in wild meats, tubers, fruits, and vegetables. This meant their diet was far richer and offered them omega-3 fatty acids. Modern diets are not ideal to prevent the risk of postpartum depression as they lack omega-3 fatty acids, but are higher in omega-6 fats. Omega-3 fatty acids are essential for brain function and reduce inflammation. Pregnancy and breastfeeding drain maternal omega-3 stores, leading to an increased risk of postpartum depression, with diet-related inflammation possibly playing a role, while having a sufficient amount has shown some antidepressant effects.

   
   

2. Breastfeeding

   Historically, infants were breastfed for about 2-4 years; however, in the present-day U.S., infants are either not breastfed or breastfed for six months. Reduced breastfeeding may increase the risk of postpartum depression, though not fully proven due to a variety of factors that must be taken into account. Breastfeeding releases oxytocin and prolactin, which are hormones that reduce stress and may protect against depression; with these hormones not being released as much, it can influence the risk.

   
   

3. Physical activity

   Ancestral humans burned more calories through physical activity as they walked, foraged for roots and food, and collected water. In the present day, society values working and studying for long hours, burning fewer calories overall. A rich diet, combined with exercise, is known to reduce inflammation, improve mood-regulating neurotransmitters, and has been shown in randomized trials to reduce postpartum depression symptoms.

   
   

4. Sun Exposure

   With reduced sun exposure due to the contemporary indoor lifestyle, there has been a widespread Vitamin D deficiency. Deficiency during pregnancy is associated with depressive symptoms, though intervention studies in postpartum women are still limited. Being Vitamin D deficient can impact mental health as Vitamin D regulates immune function and reduces inflammation.

   
   

5. Kin Support

   One’s family and relationships are more impactful to mental health, beyond the substances that work together in the body. Historically, mothers raised children within multigenerational kin networks, providing vital support during difficult times. On the other hand, modern families are more socially isolated, reducing the social and emotional support received. Low social support is one of the strongest predictors of postpartum depression. The “Latina paradox” is cited: immigrant Latina mothers often have lower depression rates despite economic disadvantage, possibly due to stronger family support networks.

   
   

The common trend between all these factors is inflammation. Based on the “Pathogen Host Defense” model, depressive symptoms may partly be due to immune activation (the immune system detecting foreign substances). Modern behaviors during pregnancy and postpartum may increase inflammatory processes, contributing to the risk of Postpartum Depression.

While this hypothesis may seem true, it has not been thoroughly explored, with most of the evidence being correlational. However, these potential findings are crucial as they help mothers understand that Postpartum Depression does not arise from a personal failing, but rather their biological system.

Culture and Stigma

In 2014, a US survey answered by 1400 women revealed that 40% of those with symptoms of depression did not seek help. Women with intended pregnancies, Asian/Pacific Islander women, as well as women with no previous mental health contact, were all less likely to seek help for their depressive symptoms.

Postpartum Depression is highly undiagnosed due to the social stigma that surrounds it, as with many conditions: many women in the survey felt guilt, shame and fear for having a mental illness. Based on around 3.7 million annual births in the U.S., the finding that 1 in 8 women experiences PPD means over 460,000 mothers are affected each year (only accounting for live births & ones reported).

Going Forward

Parenthood is a complex experience with many ups and downs, but that should not involve isolation and extreme hardships. Further research and tests (omega-3s, vitamin D, exercise) must be done to spread the message so strong biological reasoning behind Postpartum Depression can be understood by as many individuals as possible.

References:

Carberg, J. (2016). An Overview of Postpartum Depression - PostpartumDepression.org. PostpartumDepression.org. https://www.postpartumdepression.org/postpartum-depression/

Hahn-Holbrook, J., & Haselton, M. (2014). Is Postpartum Depression a Disease of Modern Civilization? Current Directions in Psychological Science, 23(6), 395–400. https://doi.org/10.1177/0963721414547736

Manso-Córdoba, S., Pickering, S., Ortega, M. A., Asúnsolo, Á., & Romero, D. (2020). Factors Related to Seeking Help for Postpartum Depression: A Secondary Analysis of New York City PRAMS Data. International Journal of Environmental Research and Public Health, 17(24), 9328. https://doi.org/10.3390/ijerph17249328

Mayo Clinic. (2022, November 24). Postpartum depression - symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617 PostpartumDepression.org -

Helping Women with Postpartum Depression. (2016). PostpartumDepression.org. https://www.postpartumdepression.org/