Do you’ll remember the movie “Abhimaan” starring Amitabh Bachchan and Jaya Bahaduri? Just try to recollect the condition of Jaya Bahaduri in that movie. After her so called abortion she starts remaining aloof, doesn’t talk much, and has disturbed sleep and also avoids social interaction. This condition comes under a category of disorders called post-partum psychiatric disorders.
This category includes 3 main illnesses: post partum blues, post partum depression and post partum psychosis. These are more common during birth of the first child and usually seen within first four weeks following delivery.
Post-partum blues:
It is the most common of all in almost 85% of deliveries, post-partum depression in 12-13% of deliveries. Least common is post partum psychosis i.e.1-2 per 1000 deliveries.
Post partum blues can be considered normal during the post-partum period as observed in most of women. It is characterised by mild depression, irritability, worrying, mood swings, fatigue and crying spells. Treatment includes only reassurance and encouragement to rest adequately and the symptoms resolve in two weeks. If it doesn’t resolve then there is a need to consult a psychiatrist.
Post-partum depression:
Symptoms usually begin 3-4 weeks post delivery. It includes sleep disturbances, decreased appetite, sadness, worrying about the baby’s health, doubts on being able cope up with caring for baby, occasional thoughts of harming the baby and sometimes suicidal ideation also can be seen. Treatment includes medications and psychotherapy i.e. family and marital therapy.
Post-partum psychosis:
It is rare amongst all mentioned here. Here main symptoms are getting very irritable, aggressive behaviour, suspiciousness that the child is not hers, delusion such as that the child is defective or dead, sometimes hearing voices that order her to kill the child. There also can be mood swings; avoidance of infant, disorientation or confused behaviour. Post-partum psychosis is an emergency due to risk of the mother harming child or self. The best thing to do is to admit the person and start medications, usually antipsychotics and mood stabilizers.
The etiology of the post-partum disorders includes biological, psychological and social causes. In biological causes; genetics, hormonal changes, low serotonin and endorphins are included. Psychological causes include unexpected pregnancy, ambivalence towards pregnancy, inadequate mother model, conflicts with own mother. Social causes are lack of support from husband, poor social support and low socio- economic class.
A point to be noted is that these disorders are more common in subsequent pregnancies. So you need to be vigilant when she is pregnant the next time.
The author is a Psychiatrist at LTMG Sion Hospital, Mumbai
Do you know the no-drug approach treatment for mild to moderate depression ?