Watch out for post-childbirth depression

Severe depression, mania and delusion experienced by women after childbirth call for immediate attention. Clinical estimates state that 40 per cent of women get depressed after childbirth.

One in 1,000 new mothers displays severe disturbance of behaviour, moods, perception and thought, which is an emergency psychiatric situation called postpartum psychosis. It is a mental illness and occurs due to hormonal imbalance, family history and also violent abuse in close relationships.

What is post-partum psychosis Postpartum psychosis is when there is a dramatic shift in the mood post-childbirth. The mother can get very excited, be very happy or go into severe depression or mania within a span of a few hours. Its onset is in the first 48 or 72 hours after childbirth. The mother has delusionary beliefs about the infant and harming the child is a major risk in these cases.

Disturbance in relationship Hormonal imbalance during pregnancy and childbirth are some of the reasons for this psychosis but it is not completely proven. Family history of the patient where the mother or aunt has suffered from a condition like this is found to be one of the reasons.

Dr A. Bhavani, chief gynaecologist at Sunshine Hospital, said, “Social factors are also found to play a major role apart from family history and hormonal imbalance. Relationship disturbances with partner and family are reasons for the women to suffer from an episode of psychosis. Complicated pregnancies and delivery, incomplete pregnancy episodes and past history of poor parenting can also cause these problems.” The common symptoms to watch out for are frequent crying, rapid changes in mood, not able to carry out regular tasks, hallucinations, delusions and a constant anxiety that someone or something is going to harm the mother and the baby.

Dr Bhavani added, “In some cases we have found that the woman displays anxiety and delusion at night and is very normal in the morning. It is for the husband, caregiver and close family member to identify this situation. It becomes important that people understand that it is a mental illness and can be cured.”

First cousins are at risk First-degree relatives are found to be at a major risk of developing PP psychosis if they have a family history of bipolar disorder, depression, anxiety disorder and previous history of psychosis. Dr Priyamvada Reddy, consultant obstetrics and gynecologist at Apollo Hospitals said, “In these cases, it is the mother who has to get immediate attention and care hence she requires hospitalisation and there has to be a trained personnel to take care of the baby. It is very important to not handover the baby to the mother when she is going through an episode of depression as it can be very harmful for the child. Breastfeeding has to be withheld in acute cases where the mother is very delirious. Also, while selecting medication for the psychiatric treatment, care has to be taken that it does not harm the production of breast milk.”

Difficult to recognise symptoms Recognising the symptoms of post-partum is very difficult for the relatives as they don’t know whether it is unusual. Some of them take it as trauma after delivery and do not consider it as mental illness. Dr Neelima T., senior gynaecologist of Krishna Institute of Medical Sciences Hospital said, “Often the partner and relatives realise only after harm is done to either mother or child. This is very dangerous and can prove fatal at times. Hence, it becomes important for the gynaecologist and the team of paramedics to be alert and also guide the relatives when such episodes are noted in the hospital set-up.”