Mental Health Awareness Month: Let’s talk about postpartum depression

Now that your baby is here, you’re experiencing feelings of sadness that won’t lift. Could this be more than the baby blues? Dr Bavi Vythilingum, a psychiatrist specialising in women’s mental health at Netcare Akeso Kenilworth, offers insights into postpartum depression.

There are many unfortunate misconceptions about postpartum depression (PPD), says Dr Vythilingum. She adds that there’s also a common misperception among women who experience depression, either during pregnancy (perinatal depression) or in the postpartum period, that they are inherently unequipped for successful parenthood. “Women with postpartum depression are often seen as being bad mothers or not grateful enough for their new baby. It’s important to note that this is not true and the hallmarks of clinical depression, including feelings of apathy, helplessness and hopelessness, affect the mother’s ability to mother. Once perinatal or post-partum depression is identified, there are highly effective treatment options.”

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Glamour: Could you explain what postpartum depression is, and how it differs from the so-called “baby blues”?

Dr BV: The “baby blues” refers to the fairly common hormonal changes after childbirth, usually three to five days later when the mother’s milk comes in. The baby blues shouldn’t last more than two weeks and are not so bad that they interfere with the mother’s ability to function. If they last more than two weeks and the mother’s functioning is affected, or if there are thoughts of suicide, self-harm or harming the baby, this is post-partum depression and professional help must be sought.

Glamour: What are the typical symptoms of postpartum depression that new mothers should be aware of?

Dr BV: The most common features are depressed mood, feeling down or low, and feeling bad about yourself; not being able to bond with the baby, or not being interested in the baby. A lot of moms with postpartum depression may be very anxious about the baby. They may be unable to sleep, even when the baby sleeps. They are low and apathetic, and it often really interferes with their ability to care for themselves and for their child. Postpartum depression is also a risk factor for mental illness in the affected mother’s children, particularly as they become young adults. It is really important that we address it with regard to intergenerational health.

Glamour: How prevalent is postpartum depression? Are there certain factors that increase a woman's risk of experiencing it?

Dr BV: In South Africa, the rates of perinatal and postpartum depression are well above the global average. Studies suggest that approximately 10 to 11.9% of women worldwide experience perinatal depression, however in South Africa the research (including data from Brittain et al., 2015, Manikkam and Burns, 2012, Rochat et al., 2011, Van Heyningen et al., 2016, Dewing et al., 2013, Peltzer et al., 2018 Stellenberg and Abrahams, 2015) indicates that between 30 and 40 percent of South African women experience perinatal depression.

The greatest risk factor is having had a previous episode of perinatal depression. Other risks include having a history of mental health challenges, such as depression or anxiety. A substance or alcohol abuse disorder is another serious risk factor, particularly if the mother is still using these substances during pregnancy. These women are considered high risk and should be treated with care and empathy. Another risk factor is having an unwanted baby, although this should not be generalised to unplanned pregnancies as many pregnancies that are unplanned are greatly welcomed. Other aspects that may increase the likelihood of perinatal depression include having an unsupportive partner or a situation where there is intimate partner violence.

Glamour: What are some of the challenges women face in seeking help or acknowledging they may have postpartum depression? How does postpartum depression affect a woman’s daily life, relationships and overall well-being?

Dr BV: The biggest issue is stigma. Women are very scared that people will see them as “bad mothers”, “mad” or “crazy”, and will blame them. Women are also often afraid that their children will be taken away from them if they seek help. Addressing this stigma is another reason why awareness of perinatal depression among women is absolutely crucial. We need to emphasise the need for self-compassion among women who are experiencing depression around this time in their lives.

Glamour: What role do partners and family members play in supporting a woman experiencing postpartum depression?

Dr BV: Social support, especially from significant others, family and friends, is so valuable to women at this vulnerable time. Mothers should be supported and affirmed, not just in practical terms like cooking a meal or looking after the baby, but also through giving them emotional support and reassuring them that they are good mothers, although they are ill during perinatal depression.

Glamour: What are the available treatments or therapies and how effective are they?

Dr BV: If a diagnosis of perinatal depression is reached, the mother and family should receive holistic multidisciplinary treatment with support from all their healthcare providers, including the gynaecologist, the paediatrician, and the clinic sister, for example. Perinatal depression can be treated with psychotherapy, also known as talk therapy, and medication. Talk therapy is very effective, particularly for mild to moderate depression, and many women benefit from this. However, for moderate to severe depression, or for a mother who has thoughts of suicide or harming herself or her baby, medication is indicated. Nowadays, there are many medications that are very safe to use during pregnancy and breastfeeding. Mothers can take these medications safely and get better; there is no need for them to suffer. Where appropriate, taking prescribed medication for moderate to severe perinatal depression is better for you and the baby because it gets you well and allows you to really take care of yourself and your child.

Glamour: Are there preventive measures or strategies women can adopt during pregnancy or postpartum to reduce the risk of developing postpartum depression?

Dr BV: Unfortunately, there are no clear preventive strategies for perinatal depression. At this time we don’t know how to prevent it, but we do know very well how to recognise it early and get moms into treatment. It is therefore very important that we screen all pregnant women for perinatal depression and get them treatment early. It’s crucial that we recognise perinatal depression for the serious health problem it is and help affected mothers by providing the treatment and support that they deserve. Expectant parents are more likely to recognise the symptoms and seek professional help early if they are informed.

Glamour: How important is it for healthcare providers to screen for postpartum depression? What advice would you give to new mothers about seeking support if they suspect they might be affected?

Dr BV: In my professional opinion, all women should be screened for perinatal mood symptoms during pregnancy and for postnatal depression after giving birth. There are simple, accurate screening tools available to identify signs of both these conditions.

Top 5 tips for new moms navigating postpartum depression

1. The first step is to recognise depression. This is why it’s important for all women to be screened during pregnancy and after giving birth.

2. Talk to your partner, a trusted friend or loved one about what you are experiencing to seek emotional support.

3. Seek professional help from your obstetrician or mental health professional who will be able to provide you with a proper assessment and initiate treatment.

4. Once you have seen your obstetrician and mental health professional, follow their advice. Sometimes it’s hard for us to hear that we need therapy or medication, but if that is what is prescribed for you, participate in therapy and take your medication. It will help your baby.

5. Follow through with your therapy. If you are prescribed eight or 12 sessions of psychotherapy, go to all of them. Not going jeopardises your mental health. Similarly, medication is often prescribed for a long period, between six and eight months for an initial episode. The reason for this is that even though you may feel better in a week or two, you are at risk of relapse unless you complete the course. Relapse is bad for you, and it is bad for your baby, so be sure to complete the course of medication prescribed. In any mental health emergency, or for advice in accessing mental health care for yourself or a loved one, please look for support.

Netcare Akeso offers a 24-hour crisis line on 0861 435 787 . Trained counsellors are available to talk to you without judgement and can guide you through the various options for assistance. The South African Anxiety and Depression Group (SADAG) also provides a 24-hour suicide crisis helpline on 0800 567 567