Wednesday 19 June 2019

Lupine Publishers-Journal of Reproductive Medicine

Postpartum depression also known as postnatal depression is a non psychotic depressive disorder of variable severity and it can begin as early as two weeks after delivery and can persist indefinitely if untreated. Most of the time, it occurs within the first three month after delivery. The illness can cause distress and impair a mother’s ability to carry out her normal tasks, care for herself and care of her baby. It is a clinical depression with symptoms that can include a feeling of fatigue, social withdrawal, sadness, changes in sleeping and eating patterns, and guilt (including related to ability to care for the infant), crying, loneliness and low self esteem lasting longer than two weeks or beginning two weeks or more after delivery [1,2]. The term “Post¬partum Depression” encompasses several mood disorders that follow childbirth. Important developments in the study of PPD include its association with symptoms of anxiety and bipolar disorders in addition to those of depression [2].
Becoming a mother can be difficult this is due to a major psychological shift from viewing oneself as a woman who is pregnant to viewing oneself as a new mother. This major emotional shift may create problems. Following childbirth, seesawing emotions and heightened emotional responses may occur [3]. The biological mechanism of PPD is believed to coincide with that of major depressive disorder. Depression in general is a disease of neuronal circuit integrity, which has been shown in studies by a reduction in brain volume of individuals diagnosed with major depressive disorder. Interestingly, the amount of volume loss correlates directly with the number of years of ill¬ness. Stress and depression act to reduce numerous brain pro¬teins that promote neuronal growth and synapse formation, and antidepressant medications have been shown to increase these and other protective proteins, thereby reversing the mechanism of depression.

These underlying neurobiological changes result from developmental interactions between genetic susceptibility and environmental factors (i.e., the psychosocial stresses ac¬companying motherhood) rather than a simple “chemical im¬balance,” as previously believed. Specifically, the neurobiolog¬ical effects of rapid postpartum hormone withdrawal predispose women with established risk factors to PPD. An interesting distinction that makes PPD unique from other depressive disorders is that it is marked by a prominent anxi-ety component. This may be why so many cases of PPD are missed, as many clinicians use the Patient Health Question¬naire which covers depressed mood and dysphoria, but not anxiety-as their primary screening technique. The stress of caring for a newborn or even the circumstances surrounding labor and delivery may precipitate the first symp¬toms of PPD.

Multiple risk factors for postpartum depression have been suggested as no single cause has been identified. Personal vulnerability, personal traits and social factors such as unplanned pregnancy occupational instability, single parenthood and marital discord have been cited. The effects of postnatal depression on the mother, her marital relationship, and her children make it an important condition to diagnose, treat and prevent. The mother unable to provide care to her infant as manifested by decreased adherence to regular check up well baby visits and increased frequency health care provider’s visits due to infant problems. Lastly depressed mothers have lower rates of gratification and enjoyment in their mothering role compared with non-depressed mothers. The patterns of symptoms in women with postpartum depression are similar to those in women who have depression unrelated to childbirth apart from the fact that the content may focus on the delivery or baby. Evidence from epidemiological and clinical studies suggests that mood disturbances following childbirth are not significantly different from affective illnesses that occur in women at other times.

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