“What is happening to me? Why am I so anxious, worried, guilt-ridden, sad, with a sense of hopelessness, and prone to mood swings?” wondered new mother Prerana, who, just a few weeks ago, was desperately waiting to hold her bundle of joy.
Little did she know then that her sense of hopelessness, feeling like she was doing nothing right was actually postpartum depression (PPD), which, despite the joy of bringing a new life into the world, can make the experience of motherhood challenging and isolating.
The postpartum (or postnatal) period is the period that starts soon after childbirth, and is usually said to last for about six weeks.
“Prerana is not alone. One in five women experience postpartum anxiety or depression, and one in 10 go through the same during pregnancy. It is important for everyone around the woman to be aware, and she gets support if she needs it,” explained Dr Prabha S Chandra, Professor and Head of Psychiatry at Nimhans.
Nimhans and HaploCare event for PPD
She was speaking after a programme organised by Nimhans and HaploCare, a digital healthcare platform, to provide solutions for evaluating mental health among mothers in clinics and supporting self-assessment.
The programme was held on the occasion of Maternal Mental Health Day, observed worldwide on 3 May.
Haplocare and NIMHANS is proud to present a free online seminar on May 3rd, 2023 at 2pm IST, to celebrate World Maternal Mental Health Day under the theme "Stronger Together".
For registering scan the QR code or click the link given in instagram page of @HAPLOCARE. pic.twitter.com/C3cZKf26q5
— NIMHANS, Bengaluru (@NIMHANS_BLR) May 2, 2023
The event organised by Nimhans included talks by experts in the field of maternal mental health, including psychiatrists, psychologists, and social workers.
The speakers discussed various aspects of PPD — also often called the “baby blues” — including its causes, symptoms, and treatment options. They also highlighted the importance of early diagnosis and timely intervention to ensure the well-being of both the mother and the baby.
Many women who attended the event spoke about their own struggles with PPD and the challenges they faced in seeking help. The event provided them with a safe space to discuss their concerns and connect with others who were going through similar experiences.
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What is postpartum depression?
The birth of a baby is often seen as a joyous occasion, but for some women, it can be a time of overwhelming sadness and anxiety. PPD is a form of clinical depression that affects many new mothers around the world. It typically occurs after childbirth and can last for several months or even longer, if not treated properly.
“PPD is a serious mental health issue that can have a significant impact on a new mother’s ability to care for her baby and herself. It is important to recognise the signs and symptoms of PPD and seek appropriate support and treatment,” explained Dr Ashwini N, a clinical psychologist from Bengaluru.
Postpartum depression can have a significant impact on the mother’s mental health, as well as the development of the infant.
“In India, PPD is a major public health concern, with an estimated 1 in 5 women experiencing PPD after giving birth,” said Dr Prabha.
Meanwhile Dr Alok Kulkarni, noted psychiatrist from Hubballi told South First, there is a difference between “baby blues” and PPD. With baby blues, the symptoms, though similar, may last only between four to six weeks following delivery.
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Causes of postpartum depression
PPD is caused by a combination of physical, emotional, and environmental factors. After childbirth, a woman’s body undergoes significant hormonal changes that can affect her mood and emotions.
“Sleep deprivation, lack of social support, and the stress of caring for a newborn can also contribute to the development of PPD. Women who have a history of depression or anxiety, or who have experienced a traumatic birth, are at a higher risk of developing PPD,” explained new mothers, who were part of the virtual event.
Interestingly, of the participants was a woman who had adopted a child and she spoke about how she went through PPD too.
Asha shared about how she went through this “pressure to perform” and, after constantly being told that what she was doing may not be the right thing, her own insecurities and guilt played so much on her mind that it worsened her existing anxiety issues.
“This example tells us that PPD is not only for biological parents, but even adoptive parents can go through PPD. It is important to be aware of these issues,” said Dr Prabha.
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Symptoms of postpartum depression
Mental health experts explained that symptoms of PPD can vary from person to person, but some common signs to look out for include:
- Persistent feelings of sadness, hopelessness, or worthlessness
- Anxiety, irritability, or restlessness
- Difficulty sleeping or sleeping too much
- Loss of interest in activities that were once enjoyable
- Fatigue or lack of energy
- Difficulty concentrating or making decisions
- Changes in appetite or weight
- Thoughts of self-harm or suicide
- Sense of loneliness
Doctors said that these symptoms may begin within the first few weeks after giving birth or they may develop gradually over time.
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Increasing number of women with PPD
Unfortunately, PPD is often underdiagnosed and undertreated, and many women suffer in silence due to the stigma associated with mental health issues, especially in India.
Speaking to South First, Dr Amit Malik, Founder and CEO of Amaha, a mental health organisation, said,
“Our psychiatrists and therapists have been seeing an increasing number of mothers with psychological difficulties, largely post-childbirth.”
He explained that many women present with what appears to be relationship difficulties, whilst others come for anxiety, fatigue, low mood, or difficulty in feeling attached to the baby.
Assessments administered by the experienced clinicians at Amaha often reveal the presence of underlying postpartum depression, Dr Amit noted.
Dr Prabha also agreed that the number of cases has gone up and that could also be due to awareness of PPD and people seeking help.
“Irrespective of any section of society, caste or community, educated or not, any woman can experience PPD,” explained Dr Ashwini.
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“The advice that comes, even though some may be with good intention, can also be a trigger for PPD. For example, a family member discouraging breastfeeding because ‘it is not enough for the baby’ and forcing bottle feeding. If it’s a working parent, then there is already separation anxiety and when she is constantly reminded of how ‘she was not present when the baby was crying’ or milk not being sufficient and so on, it can and will trigger anxiety, depression, and sense of guilt too,” said Prerana.
Another mother spoke of how neither the paediatrician nor family members informed her about the sleepless nights once the baby arrived or the lactation difficulties that she could possibly face.
Almost all the participants expressed how important it was for the partner to be with them and added that their physical absence could worsen the PPD.
Participants also spoke about the importance of people at the work space to be aware of PPD and be empathetic towards new mothers.
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Red flags for family members to identify PPD
Doctors and the new mothers experiencing PPD said that family members can play an important role in identifying the signs of PPD and providing support to the mother.
Dr Ashwini said that several times, families fail not only to support the new mother but they also undermine the emotions and feelings expressed by the women going through PPD. She said that it is important to look for some red flags like:
- Changes in the mother’s behaviour or mood, such as crying frequently or withdrawing from social activities
- A lack of interest in the baby or difficulty bonding with the baby
- Expressing feelings of guilt or worthlessness
- Difficulty sleeping or eating
- Unusual or excessive fears about the baby’s health or well-being
- Talking about self-harm or suicide
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Treatment for postpartum depression
PPD is a treatable condition and early intervention is key to a successful recovery. Dr Amit said that in maternal mental health cases, the approach is to arrive at an early diagnosis for the best outcomes for the mother and the baby.
“The care planning by our experienced and highly-trained mental health professionals can include talk therapies like cognitive behavioural therapy, medication if required, and involvement of the extended family to ensure the recovery and safety of both the mother and the baby.”
Meanwhile, Dr Prabha added that mild problems can be handled through self-care and listening circles, where women talk to each other, including online programmes.
Nimhans is also conducting studies on maternal mental health and community health interventions with music engagement (CHIME) for mothers. They are also collaborating with HaploCare.
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Dr Prabha said, “At Nimhans, we have a specialised service — every Friday from 9 am to 2 pm — and at the Nimhans Centre for Wellbeing, it is on Tuesday afternoons. Mothers are provided support by a team of psychologists, psychiatrists, social work professionals, and infant development specialists,” she explained.
Treatment options include:
- counselling or psychotherapy where mental health professional can help mothers work through their feelings and develop coping strategies
- medications like antidepressants may be prescribed
- support groups, like at HaploCare, can be provided where mothers going through similar experiences can connect to provide a sense of community and support
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(For those in need, contact Nimhans’s perinatal mental health helpline: +91 81057 11277)