Postnatal depression is the most prevalent mood disorder associated with childbearing and affects 10 - 15% of women having children. This illness can have serious consequences for the affected woman, her husband or consort, the infant and other children in the family.

What is postnatal depression?
Postnatal depression is defined as a depression occurring within one year of childbirth. More than half of the affected women require treatment. Without the correct treatment, postnatal depression can last months. The most serious postnatal depressions are apparent in the first month after childbirth, but they can occur at a later time. The exact cause of postnatal depression is not known. It is felt that the great fluctuations in hormones following delivery cause chemical imbalances in the brain which result in depression. Postnatal depression is not the same as the baby blues.

What is baby blues?
Baby blues are considered a normal part of early motherhood. It is estimated that between 75% and 85% of mothers giving birth have “baby blues”. The vast majority of women after child birth have mood swings. One minute they are very excited and happy, and the next minute they start to cry for no apparent reason. Women having the baby blues may feel a little depressed, lose their appetite or have difficulty sleeping even when the baby is asleep. These symptoms usually start about 3 to 4 days after delivery and lasts for about 10 days. Baby blues is not postnatal depression.

What causes postnatal depression?
A number of factors are associated with postnatal depression. These include the following:
Psychological and social factors, such as the demands, obligations and responsibilities of being a mother.
Family factors such as the relationship a mother has with the child’s father, and the support she receives from other people.
Women who have an unexpectedly traumatic delivery may be particularly vulnerable for postnatal depression. Having a Caesarean section is also a risk factor for postnatal depression.
Women with a personal or family history of depression, and those who have had a previous postnatal depression, are at increased risk of postnatal depression.
Biological factors, including the hormonal changes that occur following childbirth, are associated with postnatal depression.
Age, number of children and social class are not associated with an increased risk for postnatal depression.

What are the symptoms associated with postnatal depression?
Most patients experience depressed mood or two or more weeks and have evidence of impaired function. Individuals may have the following:
• Reduced/increase appetite or weight loss/gain
• Sleep disturbances
• Loss of energy/fatigue
• Loss of libido
• Guilt
• Difficulty concentrating
• Suicidal thoughts/ideas
• Crying
• Pessimism
• Feeling inadequate

Detection
Fears of being thought of as a bad mother, or concerns about her child may prevent a depressed mother from disclosing how she feels. It is important for fathers and other close relatives to inform health professionals if they suspect that a mother is depressed so that she can be assessed. Sympathetic inquiry as to how she is feeling will often be sufficient.

What can you do if you think you have postnatal depression?
Many mothers are reluctant to seek early professional help but they should always do this as early treatment is important. In addition, the women with postnatal depression should do the following:
• Find someone to talk to about their feelings.
• Get help for some of the household chores.
• Try to get some exercise. Walking a few minutes every day is excellent.
• Be honest about how you feel.
• It is normal to feel overwhelmed after giving birth. Seek help.
• Do not be afraid to talk to your obstetrician about how you feel about yourself and your newborn.
• Talk to other mothers about your feelings.

Treatment
Once detected, it is vital to actively treat women with postnatal depression. There are a number of treatment possibilities available, and a variety of treatment settings. Doctors not trained in treating patients with postnatal depression women should refer such patients so they can obtain the correct treatment.

Support
Women with postnatal depression require the support of their husbands/consorts as well as other relatives and friends. During the treatment programme, the husband/partner and other family members should be involved. Fathers have a crucial role to play in the treatment of postpartum depression.

Conclusion
Postnatal affects many women of childbearing age but, sadly, many patients go undetected and untreated. Asking a few relevant questions during the early stages of pregnancy may identify some women who are at risk of postnatal depression, but it is important to detect its early signs (shortly after birth) and once professional treatment is given, at an early stage, many mothers with postnatal depression have a successful outcome.

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