Trigger warning: Depression and Suicide
Two years ago, 25-year-old Prajna Hebbar lost her friend, Priya*, to Postpartum Depression (PPD). She is still filled with a lot of guilt and questions and the death haunts her to this day.
“The loss of one of my closest friends to Postpartum Depression hit me hard and still does today. It made me realize we should always check in with loved ones, even when social media portrays a happy facade. She was a jovial, fun-loving girl who adored her daughter, but she was suffering internally with the challenges of new motherhood. I never thought she was going through such mental trauma,” Prajna told Financial Express.com.
While talking about her Prajna couldn’t help but reminisce how brave and strong Priya* was. “I still can’t believe what happened to her…she used to post happy pictures on social media…she used to be there for others…boost other people’s confidence…I was in touch with her brother and even he had no idea what she was going through mentally,” she revealed.
Unfortunately, in our society, when a woman gives birth, the focus often shifts to the baby, and we forget to ask about the mother’s well-being, she pointed out.
“The most disheartening thing is that I only read her blog about Postpartum Depression, where she narrated her story through a character, after her death. I still feel miserable for her. Maybe if I had read the blog while she was alive, I could have helped her,” she told Financial Express.com.
Priya* was 24-years-old when she gave birth to her first child. A year later, she died by suicide.
“I was in tears when I read her blog after her death. I wish I could help her,” Prajna said.
Globally, an estimated one in seven women can develop some form of Postpartum Depression. However, in India, the figure is closer to one in five. According to the World Health Organization (WHO), about 10 percent of pregnant women and 13 percent of women who have just given birth experience a mental disorder, primarily depression globally.
In developing countries, this is even higher, i.e. 15.6 percent during pregnancy and 19.8 percent after childbirth. In severe cases, mothers’ suffering might be so severe that they may even commit suicide, the global health body revealed.
The WHO also maintains that suicide is an important cause of death among pregnant and postpartum women. Although psychosis is much less common it may also lead to suicide and in some cases even harming the newborn.
What is postpartum depression?
Postpartum Depression is a type of depression that happens after having a baby. According to Dr. Roli Banthia, Consultant, Department of Obstetrics and Gynaecology, Yatharth Super Speciality Hospital, Noida Extension, it is a multifaceted mental health disorder that emerges in the aftermath of childbirth, affecting a significant portion of new mothers worldwide.
“It typically emerges within the first few weeks to months following delivery, although it can develop up to a year postpartum. The exact cause of PPD is multifactorial, involving a combination of biological, psychological, and social factors. Hormonal fluctuations, particularly a rapid decrease in estrogen and progesterone levels after childbirth, are thought to contribute to the onset of PPD,” Dr. Banthia told Financial Express.com.
She also said that sleep deprivation, physical discomfort following delivery, changes in identity and lifestyle, and the stress of caring for a newborn can exacerbate underlying vulnerability to depression.
Dr. Neelam Suri, Senior Consultant Obstetrician and Gynaecologist, Indraprastha Apollo Hospital, New Delhi informed that it can interfere with a woman’s ability to care for herself and her newborn baby.
Some of the risk factors include a history of depression or anxiety, lack of social support, and complications during pregnancy or childbirth.
What is the status of postpartum depression in India?
In India, Postpartum Depression is a significant public health concern, affecting a substantial proportion of new mothers. Dr. Banthia maintains that several factors contribute to the heightened vulnerability of Indian women to PPD.
“Cultural attitudes toward mental health issues often discourage women from seeking help or acknowledging their symptoms, leading to underreporting and undertreatment of PPD,” she told Financial Express.com.
It is noteworthy that the prevalence of Postpartum Depression in the world is estimated to range from 10 to 30 percent.
“In India, about 22 percent of mothers suffer from Postpartum Depression. Several factors contribute to making Indian women more vulnerable to developing Postpartum Depression. One major factor is the cultural and societal expectations placed on new mothers in India. There is often immense pressure to fulfill traditional gender roles and responsibilities, such as caring for the household, in-laws, and the new baby, all while recovering from childbirth,” Dr. Suri told Financial Express.com.
This overwhelming burden, coupled with a lack of emotional and practical support, can take a toll on a woman’s mental health, she said.
Additionally, the stigma surrounding mental health issues in Indian society can prevent women from seeking help or discussing their struggles openly, exacerbating the problem, Dr. Suri explained.
Meanwhile, Dr Gitanjali Natarajan, Clinical Psychology – Director, Niyama Digital Mental Healthcare highlighted that the lack of awareness about Postpartum Depression as a medical condition results in undiagnosed cases and delayed access to mental healthcare.
“Traditional practices such as going to parental home at 7 months of pregnancy and being there for three months post-delivery ensures adequate support for child care. However, nuclear families and migration to far-off places of work, results in women not getting the support as they used to earlier,” she told Financial Express.com.
‘Diagnosis is difficult due to hidden signs’
A diagnosis of Postpartum Depression is made when the female experiences a major depressive episode during the period following childbirth, usually 4 weeks to 6 months.
Dr Natarajan told Financial Express.com that the main symptoms of postpartum depression, besides the usual depressive symptoms of low mood, lack of interest, fatigue, and worthlessness feelings are – difficulty bonding with the baby, feeling incapable of childcare, heightened feelings of helplessness and thoughts of harming oneself or the baby.
Diagnosing postpartum depression is challenging as there are many hidden signs and symptoms. According to Dr. Banthia, there are challenges in identifying and treating women with postpartum depression, because of the limited focus on physiological developmental aspects of gestation and postpartum.
“Also, different factors such as cultural and economic factors, personality traits, a community’s lack of knowledge, negative attitude towards depression and limited family support might cause depression,” she told Financial Express.com.
She also highlighted that Postpartum Depression can have serious implications for both maternal and child health outcomes.
“Mothers with PPD may experience difficulties bonding with their infants, leading to disruptions in the mother-infant relationship and impaired emotional development in the child. PPD can also impair a mother’s ability to care for herself and her baby, resulting in neglect of basic needs and delayed medical care. The impact of PPD can vary in severity and duration, with symptoms ranging from mild mood disturbances, commonly referred to as “baby blues,” to more severe and persistent depressive symptoms that interfere with daily functioning,” Dr. Banthia explained.
Meanwhile, Dr. Suri explained that Postpartum depression typically occurs in three phases.
“The first phase, known as the “baby blues,” occurs within the first few days after childbirth and is characterized by mood swings, crying spells, and anxiety. This phase usually resolves on its own within a few weeks. If the symptoms persist or worsen beyond this initial period, it may progress to the second phase, which is postpartum depression,” she told Financial Express.com.
The third and most severe phase is postpartum psychosis, a rare but serious condition that can involve delusions, hallucinations, and a risk of harm to the mother or the baby, Dr. Suri added.
According to Dr. Natarajan, the different stages within the postpartum period can influence the experience of depression differently:
- Baby Blues (1-2 weeks after childbirth): Affects 80% of new mothers, with symptoms such as mild mood swings, tearfulness, anxiety, fatigue, and difficulty sleeping, and resolves on its own in 1-2 weeks
- Onset of Postpartum Depression (4 weeks- 6 months after childbirth): More severe symptoms of depression and anxiety causing considerable emotional challenges.
- Long-Term Postpartum Depression: A chronic condition if left untreated, can significantly impact a woman’s well-being and her ability to function in daily life.
‘Underdiagnosis and underreporting of Postpartum Depression is a significant challenge’
Healthcare professionals face several challenges in treating postpartum depression, which can impact the quality of care and outcomes for both the mother and the child. According to Dr. Natarajan, two main challenges Healthcare professionals in India face are:
- Due to social stigma, the women with PPD and their families may drop out from the treatment of that health professional when a mental health problem is diagnosed
- and referred to a mental health professional. So often health care professionals do not talk of mental health problems explicitly even if they are able to diagnose them.
The scarcity of qualified mental health professionals reduces the accessibility of mental health care. Traveling far during the postpartum period, or coming to the hospital another day just for the sake of consulting a mental health professional may not be viable options.
According to Dr. Suri, underdiagnosis and underreporting of Postpartum Depression is one of the significant challenges.
“Many new mothers may not recognize the symptoms or may be hesitant to seek help due to cultural stigma, fear of being judged, or lack of awareness. This can delay timely diagnosis and treatment, potentially exacerbating the condition. Additionally, healthcare providers may not have adequate training or screening tools to effectively identify and assess postpartum depression, leading to missed opportunities for early intervention,” she told Financial Express.com.
Another challenge lies in the complexity of treatment options and the need for a multidisciplinary approach.
“While pharmacological interventions such as antidepressants can be effective, they may pose risks during breastfeeding and require careful monitoring. Non-pharmacological therapies, such as cognitive-behavioral therapy and support groups, can be beneficial but may not be readily available or accessible in all areas. Coordinating care among obstetricians, psychiatrists, therapists, and other healthcare professionals can be challenging, but it is crucial for providing comprehensive and personalized treatment plans for each patient,” Dr. Suri highlighted.
Are all women at risk of developing Postpartum Depression?
Postpartum Depression is a serious and potentially debilitating condition that can have far-reaching consequences for both the mother and the child. While the exact causes are not fully understood, research has identified several crucial factors that can increase a woman’s susceptibility to this condition, Dr. Suri said.
One of the most significant risk factors is a history of depression or other mental health issues, either during pregnancy or in the past. Hormonal fluctuations, particularly the rapid drop in estrogen and progesterone levels after childbirth, can also play a role. Additionally, women who experience complications during pregnancy or delivery, such as preterm birth or postpartum hemorrhage, are at an increased risk.
Lack of social support, stressful life events, and a history of trauma or abuse can also contribute to the development of postpartum depression.
Dr. Natarajan highlighted that all pregnant women have some level of risk for developing Postpartum Depression. But not everyone will experience it. “Adequate social support from partners, family, and friends, is a strong protective factor against developing PPD. Women who have healthy coping mechanisms to manage stress and adequate self-care are at lower risk for Postpartum Depression,” she said.
It is important to note that while certain factors may increase the risk, postpartum depression can affect any woman, regardless of her background or circumstances.
The doctors emphasise that early recognition and treatment are crucial for managing the condition effectively and minimizing its impact on both the mother and the child. Healthcare providers should be vigilant in screening for postpartum depression and providing appropriate support and resources to new mothers.
According to Dr. Banthia, history of depression or anxiety, traumatic childbirth experiences, hormonal fluctuations, and social stressors. “While not all women will develop Postpartum Depression, those with predisposing factors may require additional support and monitoring during the postpartum period,” she told Financial Express.com.
How Postpartum Depression is treated in India?
Postpartum Depression requires prompt recognition and treatment. In India, various treatment options are available, ranging from counseling and psychotherapy to medication and support groups.
Dr. Banthia also revealed that treatment options for Postpartum Depression from a healthcare perspective typically involve a combination of pharmacotherapy, psychotherapy, and social support.
“Healthcare providers may prescribe antidepressant medications to alleviate depressive symptoms and restore neurotransmitter balance in the brain. Additionally, patients can be referred to mental health professionals for psychotherapy, counseling, and support groups,” she added.
According to Dr. Natarajan, non-pharmacological treatments include psychotherapy, help mobilizing additional support and facilitating lifestyle changes such as getting enough sleep, eating a healthy diet, and exercising regularly.
“Antidepressants that regulate brain chemicals like serotonin and norepinephrine that help mood regulation are the most often used pharmacological treatments or medications. Options that are compatible with breastfeeding are followed during PPD,” she told Financial Express.com.
When to know that it’s time to see a doctor?
New mothers must be aware of the signs and symptoms of Postpartum Depression, such as persistent feelings of sadness, irritability, difficulty bonding with the baby, and thoughts of harming oneself or the baby.
According to Dr. Suri, if these symptoms persist for more than two weeks and interfere with daily functioning, it is time to seek professional help.
“Gynecologists play a vital role in screening for postpartum depression during routine postpartum visits and can provide referrals to mental health professionals, such as psychologists or psychiatrists, who can offer specialized treatment. In severe cases, hospitalization may be recommended to ensure the safety of the mother and the baby,” she told Financial Express.com.
Meanwhile, Dr. Banthia, common indicators to seek consultation include persistent feelings of sadness or hopelessness, changes in appetite or sleep patterns, difficulty bonding with the baby, and thoughts of self-harm or harming the infant.
Need for increased awareness
It is essential to acknowledge that Postpartum Depression is a medical condition that requires professional treatment, just like any other health issue.
Dr. Suri highlighted that educating expectant mothers about the risk factors, signs, and symptoms of postpartum depression during prenatal visits can help promote early recognition and seeking timely assistance.
“Additionally, it is crucial for gynecologists to foster an environment of open communication and provide non-judgmental support to new mothers. Encouraging them to express their feelings and concerns without fear of stigma can make it easier to identify and address postpartum depression. Collaborating with mental health professionals, such as psychologists and psychiatrists, can ensure a comprehensive approach to treatment, combining medication, counseling, and support groups as needed,” She told Financial Express.com.
Ultimately, the goal should be to prioritize the well-being of both the mother and the baby, ensuring a smooth transition into parenthood, she added.
According to Dr. Natarajan, some things that are not often spoken about regarding Postpartum Depression but can be important are:
- Anger and irritability are common symptoms that are often not recognized symptoms of Postpartum Depression and cause costly interpersonal misunderstanding and distancing among family members.
- Partners can also experience PPD due to factors like sleep deprivation, adjusting to new responsibilities, and witnessing their partner struggle. However, conversation
- around PPD often centres on mothers, while postpartum experiences of men are often overlooked
- PPD can recur with future pregnancies
- Recovery is possible
*Name changed on request
DISCLAIMER: If you or someone you know is struggling with their mental health or in distress contact the Vandrevala Foundation’s helpline (+91-9999666555) which is available in 11 languages including English and can be accessed via telephone or WhatsApp 24×7. You can also contact Fortis Hospital’s National Helpline number 91-8376804102 which is available 24×7. You can also contact the Government Mental Health Rehabilitation Helpline ‘KIRAN’ at 18005990019 which is available 24×7.
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