Postpartum depression: what it is, how to recognize it, how to overcome it

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The black mood

You're finally a mom. You have "passed" a more or less difficult and painful birth and you can embrace the little life you have carried in your womb for nine months. Your mood is sky high and you can't wait to go home to start looking after your baby on your own.

Or maybe not. Maybe you feel sad, anxious, you cry for nothing, you can't concentrate on your little one as you would like. Or everything goes well for several weeks, but at some point something changes: you no longer feel happy as in the beginning, but exhausted, devoid of stimuli, overwhelmed by dark thoughts and would like to spend the days in bed instead of dedicating yourself to your own care. son.

Why all this? What happens? These could be symptoms of postpartum depression, a psychological disorder that can manifest itself at various levels of severity: from mild and transient forms that take the name of baby blues, to full-blown and more lasting depressions, up to postpartum psychosis, much rarer but also more serious.

In this article

  • symptoms and signs
  • causes and risk factors
  • how to intervene
  • prevention

Symptoms and signs of the baby blues and postpartum depression

It is not always easy to realize that something is wrong, also because often affected women tend to underestimate, minimize or hide symptoms, also to correspond to the idea of ​​motherhood as a happy oasis recognized on a social level. "Birth is by definition a happy event, and in general it is difficult to understand why a new mother should feel bad in such a moment. But it is possible and also frequent" explains psychiatrist Franca Aceti, head of the operating unit of Mental hygiene of emotional relationships and post-partum at the Umberto I polyclinic in the city.

Some signs, however, can help you understand that there is some problem. In case, no fear: therapeutic strategies are available today that allow you to face it and overcome it.

The most common symptoms

"The most common symptoms concern the so-called baby blues or maternity blues" says Mauro Mauri, director of the UO of University Psychiatry 2 of the Pisa University Hospital and head of a research group dedicated to perinatal depression. "It is a kind of post-partum sadness which usually affects 3-4 days after the birth of the baby and lasts a maximum of one week ", during which you can suffer from

  • labile mood, with an easy tendency to cry,
  • sadness,
  • anxiety,
  • irritability,
  • memory and concentration difficulties.
The baby blues is not a real disorder, but an almost physiological and very frequent condition, which can affect up to 80% of mothers.

In the vast majority of cases, this sadness passes by itself: just stay close to the mother, support her, try to give her a hand if she has some difficulties, for example with breastfeeding and, if she has already returned home from the hospital, give her a way not to get too tired and to concentrate on the baby. Sometimes, however, the sadness persists and becomes a real one postpartum depression, a disorder that affects 10-15% of mothers and usually manifests itself from the third month to the first year after childbirth.

In this case the symptoms are those typical of depression:

  • anxiety and worry,
  • depressed and depressed mood, with a tendency to see everything black,
  • loss of interest or pleasure in doing things,
  • sleep disturbances - you may suffer from insomnia or, conversely, sleep too much -
  • changes in appetite, which may be (much) poorer or more abundant than normal.

"In addition, there are manifestations related specifically to motherhood, such as the sense of inadequacy with respect to taking care of the child"Aceti specifies. In practice, one feels incompetent, unable to meet the needs of the little one.

Small signs of a hidden problem: tips for self-diagnosis

Doing a self-diagnosis of postpartum depression is not a simple thing: sometimes the discomfort is strong and evident, while other times the symptoms are more subtle, perhaps bordering on severe fatigue, which is quite normal in the first few months of the baby's life, as all sleep patterns have been altered.

Not to mention that often it is the woman herself who minimizes, underestimates or hides her feelings, convincing herself that she is just a little tired. "Everyone around her is happy with the baby's arrival, they think she should be too and her mother adapts to this situation, she feels she can't afford to be sad, even if she is" says Mauro Mauri.

However, some signs of discomfort can come, especially if the new mother tries to pay attention to what he feels inside himself every day. If fatigue is normal, other sensations should sound alarm bells: for example, deeply sad or irritable mood, agitation, feelings of inadequacy and lack of self-confidence, loss of interest or pleasure in doing things, difficulties with attention, concentration and memorization, sleep or appetite disturbances.

Obviously, sleeping badly a couple of nights or feeling down for a few days is not enough to conclude that there may be a problem: let's talk about symptoms lasted for at least two to three weeks.

Post Partum Depression: causes, main symptoms and how to intervene? This podcast is answered by Dr., Clinical psychologist, individual and group psychotherapist, specialist in sexology and forensic psychology.  

Why it happens: causes and risk factors

Baby blues

We must distinguish between baby blues and actual depression. In the first case, it is mainly the abrupt hormonal changes that intervene in the mother's body immediately after childbirth and the strong psycho-physical stress associated with labor and delivery. Other factors that can contribute are physical fatigue, normal anxiety linked to increased responsibility, the possible presence of disagreements with the partner and family members regarding the management of the child.

Postpartum depression

With regard to the postpartum depression true, the causes are not fully known. "Again, there is probably a biological basis given by the hormonal changes typical of pregnancy and the period after birth, on which other factors are grafted," says Mauri.

The main risk factors listed in the scientific literature for postpartum depression are:

  • having suffered from anxiety or depression during pregnancy;
  • having suffered from anxiety and depression previously, even before pregnancy;
  • family history for psychiatric disorders (i.e. having close family members who suffer from it);
  • live or have recently lived very stressful situations, such as bereavement, separation, loss of work;
  • live a condition of poor family or social support, with precarious emotional relationships and lack of social networks to refer to in case of difficulty;
  • economic difficulties or precariousness;
  • suffer from premenstrual syndrome o premenstrual dysphoric disorder;
  • suffer from thyroid function disorders.

"Some studies suggest that even having resorted to assisted fertilization techniques may represent a risk factor "adds Franca Aceti. The role of the childbirth experience is more controversial: A review article of the scientific literature just published in the journal Midwifery suggests that traumatic and negative childbirth experiences may indeed contribute to the onset of postpartum depression, but this is a factor whose real weight is yet to be clearly defined.

What happens to the baby if the mother is depressed

A mother with postpartum depression can react to her baby in two different ways. "Some women - explains psychiatrist Franca Aceti - hire a hyper control attitude: they are always worried about something (the baby's weight, growth, sleep, cleanliness) and check a thousand times if the child is breathing, sweaty, how much he has eaten, if he is clean and so on. In all of this, however, they lose sight of the child's real needs, who may not be hungry but is forced to take more milk, or may be bored but not taken out for fear of the cold. Other mothers, however, feel so inadequate as to neglect the child, delegating to others - the grandmother, the partner, a nanny - her almost complete care ".

Either way, what happens is that the possibility of getting in tune with the needs of your child is lost, which is the first and fundamental step in building an attachment (the relationship modality that the little one establishes with his mother in the first years of life and will influence his way of interacting with the world) of a safe type. "In the first months of life, the mother has to decode the signals that are sent by the child - his crying, his screams - to make sense of his first life experiences. But he cannot do it if she is herself anxious or even in panic "says the expert.

Scientific studies say that if mom's postpartum depression is not treated, babies can experience emotional, but also cognitive disorders - there may be attention deficit - and physical, with increased risk of allergies and sensitivity to infections.

"More rarely, in the cases of postpartum psychosis, which are particularly severe forms of depression, the child can become such a source of anguish for the mother that she can come to hate him and manifest aggressive fantasies towards him. This can lead to infanticide, which, however, also has other contributing causes ", concludes Aceti.

How to intervene

If you realize that something is wrong, that time is passing, and symptoms like sadness, distress, apathy, sleep disturbances and so on do not ease, the best thing to do is to talk to someone about it. It could be the general practitioner, or a psychologist or psychiatrist specialist, perhaps within health facilities present in the area, such as psychosocial centers or counseling centers.

The specialist will advise what to do, depending on the severity of the situation. "Sometimes, just the simple fact of talking about it with someone improves the situation. Many anxieties and fears are magnified by keeping them hidden, because we think we are the only ones to experience them, when they are rather common" underlines Mauri.

Le possibility of intervention are located on three main levels:

1. Self-help

If the symptoms are really very light, if it is baby blues or a little more, you don't need to do anything specific, but some small precautions are certainly of great importance:

  • Do not hide the discomfort, but talk about it with your partner, family, friends;
  • Try to rest as much as possible: fatigue is a strong ally of depression;
  • Try to follow a healthy diet and do some physical activity, perhaps outdoors.

2. Psychological therapy

There are several types of psychotherapy that can help address and overcome postpartum depression, both alone and in association with drug treatment. Among these, in particular, the cognitive behavioral therapy.

3. Drug therapy

There is no denying it: depression in general is still considered a "minor" disorder, something not to worry too much about and specific drugs for this disorder are often viewed with suspicion, especially when it comes to administering them during delicate stages of life, such as pregnancy. or breastfeeding.

"If someone has heart pain everyone is worried, and they recommend taking this or that drug. If someone suffers from a mood disorder, they don't worry, they minimize themselves, they neglect themselves. the disorder must be tackled with the tools available, which also include drugs"declares Cesario Bellantuono, psychiatrist and perinatal psychopharmacologist, author of a recent volume dedicated to psychiatric drugs in pregnancy. These are, for example, antidepressant and anxiolytic drugs: some formulations are safe even during breastfeeding and can be taken with confidence.

A shield against depression

Some strategies may represent protective factors against the onset of depression. They may not be able to prevent it completely, but they can mitigate it, or help the woman cope better, giving her strength and support. Let's see what they are:

  • The possibility of a good rest in the first weeks after childbirth. We know it well: with a newborn at home, the first thing to jump is the rhythms of sleep, but the mother must try to sleep as much as possible, for example by resting when she rests the baby. In this regard, it may be helpful to ask family members for help in carrying out small household chores, and to limit visits from relatives and friends in the first days after returning home.
  • An adequate, balanced diet, with foods rich in omega 3 fatty acids (fish, nuts, flaxseed oil) and low in exciters such as alcohol and coffee.
  • A good supply of vitamin D: to stock it up, a healthy life in the open air is enough, but eventually you can ask the doctor to check the dosage with a blood test, to evaluate if supplementation is needed.
  • A good relationship with the partner, who in the first weeks after giving birth has the delicate and beautiful task of supporting her mother and not leaving her alone while "learning" her new profession.
  • A good network of family and friends, which for example can offer valuable help with housework.

Sources for this article: interview with Franca Aceti, head of the Mental Hygiene Unit for emotional relationships and post-partum at the Umberto I polyclinic in the city; interview with Mauro Mauri, director of the UO of university psychiatry 2 of the Pisa university hospital and head of a research group dedicated to perinatal depression; Interview with Cesario Bellantuono, psychiatrist and perinatal psychopharmacologist; Article on post partum and psychology, from the site of the psychiatrist and psychotherapist Claudia Ravaldi; Information material from the English Health Service.

Read also:

  • 10 tips for a happy mother. So you prevent postpartum depression
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  • Depression in pregnancy and after childbirth: it is possible to overcome them
  • Postpartum depression: find help here
  • Why this sadness? Baby blues and postpartum depression
  • The app that recognizes postpartum depression

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