What is Post-Partum Depression?

Birth and caring for a newborn baby is an emotional time. You’re body has gone through major changes, your hormones are rapidly changing, and you are making major adjustments in your life and routine to care for your baby. Looking at these facts, it is not surprising that 50% of women experience the post-partum blues - a short-lived period of being more easily emotional, tearful, irritable, or sad.

For 10-20% of women, these feelings become longer lasting and more intense, and it becomes post-partum depression. This condition presents similarly to major depressive disorder, commonly with:

• Low mood, or irritability

• Low energy

• Little interest or pleasure from things you usually enjoy

• Feelings of guilt - these feelings often center around feeling like you are a bad mother or that you are not connecting to your baby

• Altered sleeping patterns (beyond that for caring for a baby)

• Altered eating habits (overeating or undereating)

• Excess fatigue

• Poor concentration

Depression, and post-partum depression, is more than just feeling sad. It affects you physically and mentally and it impacts your ability to live your life. One of the biggest concerns for post-partum depression is that it affects your ability to bond with and care for your baby.

Identifying Post-Partum Depression

The term post-partum depression can be misleading, as it commonly starts during pregnancy. Around your 26 week visit, your doctor will ask you to complete the Edinburgh Depression Scale. This helps to identify if you may be feeling symptoms of depression or are at risk for post-partum depression. Your doctor may have you complete this scale again after delivery to help identify post-partum depression.

One of the best ways to identify post-partum depression is to talk about it. Your doctor will ask you about your mood, your emotions, and how you are coping at your post-partum visits. We also encourage you to bring up your concerns about your mood or post-partum depression. We also realize it can be a very difficult thing to talk to about at a time when you are feeling vulnerable.

Your family and support system can help you to recognize signs of post-partum depression. Make sure they are educated on the signs of post-partum depression and can check in with you if they start to notice them in you. You and they should also be aware of some of the risk factors for post-partum depression that might make you more likely to develop it:

• depression before or during your pregnancy

• not having a partner in the pregnancy

• being very young during this pregnancy

• your baby needing to go to the NICU

• a traumatic delivery (even if you and baby were well afterwards)

• abuse during or after your pregnancy

• pregnancy complications - high blood pressure, diabetes, preterm birth, etc

Managing Post-Partum Depression

One of the key messages about post-partum depression is this:

You should never be made to feel guilty or shamed for having post-partum depression and needing support.

This can be a difficult thing to tell yourself when you are in a depressed state. Your doctors and support system should take extra care to make sure you are not made to feel that way at any point.

Counselling

One of the main parts of management of post-partum depression is counselling. This usually starts with your doctor in the office, to help you learn about and understand post-partum depression and how it may be affecting you. It will likely involve making plans for close follow up visits and identifying small, doable steps to help you get through this depression.

Formal counselling with a registered counselor can be extremely beneficial. There are several counselors in Kamloops who have sub-specialties in post-partum depression. They will often help you learn the techniques of cognitive behavioural therapy (CBT), a proven technique for managing depression and anxiety.

Social Connections and Support Groups

Depression can be an isolating feeling, even more so when you are trying to look after a baby at the same time. Connecting with your friends, your family, and other new mothers can be very therapeutic. Joining a group for new moms and babies often helps to normalize some of the struggles you are facing that might be adding to feelings of guilt or anxiety.

Healthy Lifestyle and Self-Care

Self-care often sounds like a buzzword without much meaning. It is crucial for the management of post-partum depression, though. Self-care refers to making sure you take time to look after yourself and recognize your own needs. It looks different for everyone, but may include:

• Having your partner or family look after your baby for a few hours to allow yourself a break

• Doing meditation or mindfulness

• Taking a relaxing bath or shower

• Exercising or taking a walk

• Taking a nap

• Going for coffee with a friend

It is also important to try and keep the structure of a healthy lifestyle. A balanced diet with lots of fruit and vegetables combined with regular exercise can be as effective as an anti-depressant.

Medication

For some women, their post-partum depression is severe enough that an anti-depressant is needed. Again, you should not feel guilt, shame, or weakness for this. Like any other medical condition, sometimes a medication is needed to help manage it. Most anti-depressants can be used while breastfeeding - you and your doctor will figure out which medication is the best option for you. Keep in mind that an anti-depressant is not a quick fix. It does not replace the management strategies talked about above. Instead, it should be used with these to help manage your symptoms and allow you to recover.

Emergencies in Post-Partum Depression

In some cases of post-partum depression, there are severe enough symptoms that it becomes an emergency. You and your support system should be aware of these emergencies so that you can recognize and get help appropriately. This usually means seeing your doctor immediately in the office or going to the emergency room.

Emergencies in post-partum depression include:

• Thoughts or plans of suicide

• Thoughts of harming or killing your baby

• Thoughts of harming or killing someone else

• Symptoms of psychosis - seeing or hearing things that other people cannot, becoming paranoid or suspicious, having excessive energy, or inability to sleep

If any of these occur, call your doctor or 911 right away.

Some women may hesitate to report these symptoms because they are worried about their baby being taken into care or if they will be allowed to continue caring for their baby. We want to reassure you that once these symptoms are managed and stable, you and your baby will be able to get back to your usual routine together. The bigger concern is that if these symptoms are ignored, there is a risk for harm to you or your baby that can never be undone.