There are various forms of depression and the least common yet most dangerous amongst all is Post Partum Depression (PPD) - a type of depression that affects women after pregnancy.
Dr. Afshan Ashai, a psychiatrist and Medical Director of Prince William County CSB in Virginia described PPD in detail. Approximately 20 per cent of her pregnant patients in the past one year, carried symptoms of depression before or after delivery. A high percentage of the mothers had postpartum blues and experienced mood swings and crying spells. However, the duration of these symptoms is short and are not as severe as postpartum depression.
“The risk factors which can lead to PPD are a history of depression during pregnancy, past history of depression or other mental illness, family history of PPD, history of abuse, history of substance use, marital and financial problems, lack of social support, inability to breastfeed the baby, inadequate nutrition and lack of sleep,” explained Dr Afshan. “However, the major risk associated with PPD in severe cases is that the mother might try to harm herself or the baby.”
A few instances of PPD:
One shocking case of PPD as discussed by the Journal of Pakistan Psychiatric Society (JPPS) was of a 27-year-old woman who killed two of her babies due to PPD. “According to recent studies, at least 15-35 per cent of women in developing countries experience PPD,” shared Dr Afshan. The rate of PPD in Pakistan remains unclear but a number of studies indicate an approximate rate of 25 per cent. “I have seen Pakistani patients suffering from PPD in USA but the percentage was very low.”
Denial of the condition:
Unfortunately, seeing a psychiatrist is a stigma not only in Pakistani but in the Western Countries too. The most common response Pakistani patients give for not seeking treatment early is, ‘I didn’t think I was crazy’ or ‘what will my family and friends say when they find out I’m seeing a psychiatrist’.
“Women should be well aware of the complications if they choose not to seek treatment,” explained Dr Afshan. “PPD can lead to problems in a mother’s ability to take care of herself, her newborn and her other children. It can also lead to problems in mother-child bonding and untreated PPD can last up to one year or longer.”
Sometimes even if treated late, PPD can increase a woman’s risk of future episodes of major depression. Children of mothers who have untreated PPD are more likely to have behavioural problems and delays in language development.
Symptoms of PPD:
The symptoms include low mood, fatigue, irritability, anxiety, feeling unable to cope, lack of interest in activities, low energy, difficulty sleeping, changes in appetite and weight, thoughts of suicide and thoughts of harming the baby. In severe cases PPD also leads to paranoia and psychosis.
Seeking the right treatment:
According to JPPS, the culture in Pakistan makes women see faith healers and religious healers and in the end a local practitioner but seeing a psychiatrist is still a taboo in our society. “It is very important for a woman to be screened for depression during her pregnancy and weeks that follow her delivery,” said Dr Afshan. “In the USA, early formal screening by use of the Edinburgh postnatal depression scale is recommended; this can predict the risk of developing depression when administered 2-3 days postpartum depression.”
However, the most important thing is to educate mothers and family members about this illness and symptoms. The rate of recovery of PPD is high with proper treatment which could be counselling and use of psychotropic medications.
Pakistani social factor is the paragon as compared to any society and some studies have revealed that the incidence of PPD is lower in non-western countries. This is because of increased support that mothers in countries like Pakistan receive by their family members after their birth.
Dr. Afshan further shared, “Some physicians believe that administration of progesterone to the mother at birth can help prevent psychosis in females who have struggled with severe depression in previous pregnancies.”
Also, the use of oestrogen especially during delivery has been reported by physicians to help prevent the recurrence of depression. Use of vitamins has also been found to be beneficial.
However, there are other factors that contribute to an increase in stress in a country like ours - for example, giving birth to a female child and pressure from the family to breast feed the baby develops a sense of guilt in women who are unable to do so.