Overcoming postpartum blues

Mothers in South Africa are affected by perinatal depression

Friday, August 10 2018

Up to 40% of mothers in South Africa are affected by perinatal depression.It can be lonely, distressing and frightening, but support and effective treatments are available.

The birth of a baby can trigger a range of powerful emotions, from excitement and joy to fear and anxiety. It can also result in depression. Many new mothers experience “postnatal depression”, a clinical condition affecting women soon after childbirth. Baby blues are a normal experience that typically begin within the first two to three days after delivery, and may last for up to two weeks. But some new mothers experience a more severe, long-lasting form of depression known as postpartum depression. This may last until the baby is between six and 12 months old. Rarely, an extreme mood disorder called postpartum psychosis also may develop after childbirth.

Signs and symptoms
“Signs include mood swings, tearfulness, anxiety and difficulty sleeping,” says Dr Bavi Vythilingum, a psychiatrist at Akeso Clinic Kenilworth. “In more severe cases, these include a persistent feeling of sadness and a depressed mood lasting for two weeks or more, and may also include lack of interest, guilt and hopelessness.”

Because it’s a set of symptoms that often start to appear in the antenatal period, some medical professionals today prefer the term ‘perinatal depression’ to cover both pre- and post-birth depression, according to Vythilingum.

Additional signs that you or someone you know might be depressed include:

  • lack of enjoyment and loss of interest in the outside world
  • lack of energy and feeling tired all the time
  • trouble sleeping at night and feeling exhausted during the day
  • difficulty bonding with the baby
  • withdrawing from contact with other people
  • problems concentrating and making decisions
  • frightening thoughts – for example, about hurting the baby or harming yourself
  • thoughts about suicide

“Postpartum depression isn't a weakness,” she stresses. “It's simply a complication of giving birth. It’s very common in South Africa, with between 30 or 40% of mothers experiencing this form of mental illness. Although most of them are too afraid to talk about it, or even admit to it, this illness affects millions of women every year.”

What causes postnatal depression?
There is no single cause. Instead, it is generally the result of a constellation of factors, including:

  • a history of mental health problems, particularly depression, earlier in life
  • a history of mental health problems during pregnancy
  • having no close family or friends to support you
  • a poor relationship with your partner
  • having an unwanted child
  • recent stressful life events, such as a bereavement
  • hormonal changes caused by pregnancy

Even if you don't have any of these symptoms, having a baby is a life-changing event that can sometimes trigger depression.

Seeking treatment
Vythilingum says that although there is no evidence that there’s anything specific you can do to prevent the condition developing, it is always advisable to maintain as healthy a lifestyle as you can for yourself. If you have a history of depression, or other mental health problems, or if there is a family history of perinatal depression, it’s important to tell your doctor. They will be able to offer you appropriate monitoring and treatment, if necessary.

Seek help as soon as possible if you think you might be depressed, as your symptoms could last months or get worse and have a significant impact on you, your baby and your family. If your partner is pregnant, and you think they might be having problems, encourage them to seek help. Ignoring the issue could cause further breakdown in the relationship between the parents, and may result in poor growth and development of the child. In extreme cases, this may even lead to child abuse.

“With the right support, which can include self-help strategies and therapy, most women make a full recovery,” says Vythilingum. “It’s important to remember that depression is an illness like any other, and it can happen to anyone. Being depressed doesn't mean you're a bad parent. Don't struggle alone hoping that the problem will go away.”

Support and effective treatments are available. These include:

  • Self-help: Try talking to your family and friends about your feelings and what they can do to help, make time for yourself to do things you enjoy, rest whenever you get the chance and get as much sleep as you can at night, and remember to exercise regularly and maintain a healthy diet.
  • Therapy: Speaking to a psychologist or other mental health professional may be most beneficial.
  • Antidepressants: If your depression is severe, your doctor can prescribe a medicine that's safe to take while breastfeeding.

“Most people respond well to treatment, and can get back to feeling normal within a few weeks,” says Vythilingum. “Treatment should be continued for at least six months to prevent a relapse. She adds that it often takes time to adapt to becoming a new parent. Looking after a small baby can be stressful and exhausting, but prompt treatment can help you manage your symptoms – and enjoy your baby.

Facts and figures:

  • Worldwide about 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression.1
  • In South Africa this is even higher at 33%, which compares to 1 out of 3 women during or after childbirth.1
  • More women in developing countries experience clinical depression after childbirth, than those from high income countries.2
  • Virtually all women can develop mental disorders during pregnancy and in the first year after delivery, but poverty, migration, extreme stress, exposure to violence (domestic, sexual and gender-based), emergency and conflict situations, natural disasters, and low social support generally increase risks for specific disorders.2
  • Depression causes enormous suffering and disability and reduced response to the child’s needs. Evidence indicates that treating the depression of mothers leads to improved growth and development of the new-born and reduces the likelihood of diarrhoea and malnutrition among them.2
  • After the birth, a mother with depression suffers a lot and may fail to adequately eat, bathe or care for herself in other ways. This may increase the risks of ill health. The risk of suicide is also a consideration, and in psychotic illnesses, the risk of infanticide, though rare, must be taken into consideration.2