Postpartum Depression - Causes, Symptoms and Treatment. MF.

At the end of pregnancy, during childbirth the expectant mother becomes passive, loses control over the situation, at the same time a feeling of disturbing unusualness arises, and some women suffer it badly.

The birth of a child makes a woman identify with her parents, find out how they performed their parental functions. In the period of maternity, there is a reactivation of conflicts and injuries, insufficiently worked out in childhood and adolescence.

From normal temporary depression, which happens to many women in the first days after childbirth, postpartum depression is more deep, longer and with a disrupted ability to do anything. Subsequently, the gradual extinction of the main manifestations occurs and a tendency to a chronic course arises, since the disease does not recognize and does not consider it necessary to treat neither the mother nor her environment, because the birth of a child by definition should be a happy event. However, about 20% of women, even a year after the birth of the child, are still in a depressed state.

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After birth, 10-15% of women experience a typical depressive episode, but only 3% of this diagnosis is established and treated. The picture of the disorder is characterized by the same symptoms as the major depression. A number of scientists generally consider postpartum depression to be only one of the variants of the clinical picture of a major depressive disorder.

Symptoms of postpartum depression

During a mother's examination, the following symptoms of depression are most often found: anxiety( accompanied by palpitation, headache, panic, obsessive actions);subjective feeling of sadness and sadness;lack of strength;tearfulness;insomnia;impaired appetite, depressed mood, a sense of loneliness, the idea of self-abasement. Periodically, the theme of remorse is expressed, which is expressed in the perception of yourself as a bad mother and in a sense of shame.

One of the typical signs of postpartum depression is the unwillingness of mothers to seek help. This can be explained by the deep sense of guilt that they experience, facing the difficulties associated with caring for the child. Many mothers expect that "maternal love", to which they will be covered after childbirth, will solve the problems of adaptation to the child, whereas the process of forming this connection depends on a long( several months) mutual learning. The mothers are disappointed, which can cause a sense of guilt, which is the basis of depression. In addition, some mothers believe that only they are responsible for the child. Daily cares require physical and mental strength from them and cause a feeling of helplessness, intensified by isolation.

The most significant is the incidence of a worsening of mood in the mother between the third and ninth months after the birth of the child.

Three months after his birth, the most common symptoms are: irritability, depressed mood and anxiety. Symptomatic at 3, 9 and 15 months is similar. A string of symptoms of depression is accompanied by a gloomy vision of the future and an inability to carry out daily activities.

Schematically, there are two groups of mothers:

, the former either had a conflict with their own mother, or they felt a lack of maternal feelings. They find it difficult to accept certain aspects of sexuality and motherhood;
second difficult to get rid of unpleasant experiences, or they believe that they are not able to control life events;often in such women in a history of depressed depression.

Factors for the development of postpartum depression

A huge role is played by social, psychological, interpersonal and biological factors.

low socioeconomic status,
in the past depressed or depressed in any of the family members,
alcoholism,
weak support from the family,
severe during pregnancy
severity of depression during pregnancy;
negative life events.
age over 40,
belonging to ethnic groups of African descent,
lack of professional education,
insufficient activity of spouse,
complete discontinuation of labor before delivery,
early termination of work in first or second trimester of pregnancy,

As the factors preventing the development of severe depressive symptoms, we can name the following:

Hypertension of the mother;
Mother's Emotion;
High internality in the field of family and interpersonal relationships.

Forecast of postpartum depression

Given that in most cases, postpartum depression is not detected and untreated, there is a risk of the disease becoming chronic.
Maternal depression affects the condition and development of the child. Children suffer, since mothers lack interest in interacting with them, as well as reaction to any manifestation of them. Children at an early age especially need a physical contact "skin to skin", care, communication. Depression of the mother negatively affects the development of the child, especially the sense of security, internal mechanisms of self-defense, concentration, development of speech. Also, according to a number of researchers, the mother's depression seriously affects relations in the family, which can also have a negative impact on the child.

It should be noted that emotional disorders, personality development, self-esteem in the child is closely related to the state of the mother. Therefore, very often children whose mothers experienced postpartum depression have difficulty expressing feelings and a tendency to depression, conditions of increased anxiety.

In the first place, the emotional sphere suffers from babies. Thus, a number of studies( Baz LL, 1999) show that children of mothers with postpartum depression show less positive emotions, they have less expressed interest in people and subjects. They do not synchronize their behavior with the behavior of their mothers to the extent that infants from non-depressive mothers do and express less discontent when separated from their mother. Moreover, the babies were unhappy with the communication with the depressed mother and "left" from him. This "depressive behavior" is also manifested when interacting with extraneous adults who do not suffer from depression.

In some cases, postpartum depression may turn into a more serious disorder - postpartum psychosis. This disease occurs in 1-2 of 1000 parturient women. Among the symptoms of the disease - hallucinations, delusions and thoughts of suicide. Women with postpartum psychosis need immediate medical attention and, as a rule, hospitalization.

Bek Depression Scale

Instruction:

This questionnaire consists of 21 approval groups. Read carefully and choose the number( O, 1, 2 or 3) of the statement that best reflects your state of health during the last week, including today's day. If several statements in the group seem to be suitable for you, circle each of them. Make sure you read all the statements in each group, before making a choice.

0 I do not feel upset, sad.
1 I'm upset.
2 I'm always upset and can not turn it off.
3 I'm so frustrated and unhappy that I can not stand it.

0 I'm not worried about my future.
1 I feel I'm puzzled about the future.
2 I feel that nothing awaits me in the future.
3 My future is hopeless, and nothing can change for the better.

0 I do not feel like a failure.
1 I feel that I have suffered more failures than other people.
2 When I look back at my life, I see a lot of failures in it.
3 I feel that as a person I am a complete loser.

0 I get the same satisfaction from life as before.
1 I do not get the same satisfaction from life as before.
2 I no longer get satisfaction from anything.
3 I'm not completely satisfied with life.and I'm tired of everything.

0 I do not feel guilty about anything.
1 Quite often I feel guilty. Most of the time I feel guilty.
3 I constantly feel guilty.

0 I do not feel that I can be punished for anything.
1 I feel I can be punished.
2 I expect that I can be punished.
3 I feel already punished.

0 I'm not disappointed in myself.
1 I was disappointed in myself.
2 I am disgusted with myself.
3 I hate myself.

0 I know that I am not worse than others.
1 I criticize myself for my mistakes and weaknesses.
2 I always blame myself for my actions.
3 I blame myself for everything bad that happens.

0 I never thought to commit suicide.
1 I have thoughts of suicide, but I will not implement them.
2 I would kill myself
3 I would kill myself if I had the chance.

10)

0 I do not cry more than usual.
1 Now I cry more often than before.
2 Now I'm crying all the time.
3 I used to be able to cry, but now I can not, even if I want to.

11)

0 Now I'm irritable no more than usual.
1 I'm more annoyed than ever.
2 Now I feel constantly that I'm annoyed.
3 I became indifferent to things that used to irritate me.

12)

0 I have not lost interest in other people.
1 I'm less interested in other people than before.
2 I almost lost interest in other people.
3 I completely lost interest in other people.

13)

0 I postpone decision making sometimes, as before.
1 I postpone the decision more often than before.
2 I find it more difficult to make decisions than before.
3 I can no longer make decisions.

14)

0 I do not feel that I look worse than usual.
1 I'm worried that I look old and unattractive.
2 I know that in my appearance there have been significant changes that make me unattractive.
3 I know that I look ugly.

15)

0 I can work as well as before.
1 I need to make an extra effort to start doing something.
2 I can hardly force myself to do anything.
3 I can not do any work at all.

16)

0 I sleep as well as before.
1 Now I sleep worse than before.
2 I wake up 1-2 hours earlier, and it's hard for me to fall asleep again.
3 I wake up a few hours earlier than usual and can not fall asleep anymore.

17)

0 I'm not tired anymore than usual.
1 Now I'm getting tired faster than before.
2 I'm almost tired of everything I do.
3 I can not do anything because of fatigue.

18)

0 My appetite is not worse than usual.
1 My appetite is worse than before.
2 My appetite is now much worse.
3 I have no appetite at all.

19)

0 Recently I have not lost weight or weight loss has been negligible.
1 I lost more than 2 kg lately.
2 I lost more than 5 kg.
3 I lost more than 7 kr.

20)

0 I'm not worried about my health anymore than usual.
1 I am worried about problems with my physical health, such as pain, upset stomach, constipation, etc.
2 I am very concerned about my physical condition and it's hard for me to think about anything else.
3 I am so concerned about my physical condition that I can not think of anything else.

21)

0 Recently, I have not noticed a change in my interest in sex.
1 I have less sex problems than before.
2 Now I'm much less interested in sexual problems than before.
3 I completely lost my sexual interest.

For the answers 0 is awarded 0 points, 1 -1 points, 2 - 3 points, 3 - 4 points.

The total number of points is calculated( in case if not one, but several statements are selected, they are also considered).

Evaluation of results.

0-9 - absence of depressive symptoms.

10-15 - mild depression( subdepression).

16-19 - moderate depression.

20-29 - severe depression( moderate severity).

30-63 - severe depression.

Treatment of postpartum depression

It is necessary to consult a doctor if symptoms of postpartum depression:

- do not disappear after two weeks;
- your condition worsens;
- it's hard for you to take care of a child;
- do you think about harming yourself or your baby.

The early treatment of postpartum depression will help to speed up your recovery. If you think that you are starting to develop postpartum psychosis, immediately consult a doctor. Do not wait and hope for an improvement in your condition. Postpartum psychosis can cause life-threatening consequences. Usually, there are no unambiguous reasons for postpartum depression, because any physical and emotional factors of a lifestyle can serve this state, all of which can play a role in its lightning development.

Mild depression usually disappears on its own for several days to two to three weeks. But at the same time, try to get as much time as possible for rest, as soon as you can. Accept help from relatives and friends. Communicate with other moms. This can improve your emotional state, you can get from them the support that you so need. Do not drink alcohol, which can exacerbate mood swings even worse, and also negatively affect your baby when breastfeeding.

Do not interfere with the advice of the therapist. You can find effective ways to cope with your symptoms and solve problems that concern you. Such counseling is also useful for family or relationship therapy.

With severe and severe depression, you need to contact a psychiatrist or neurologist. Treatment is done with antidepressants and hormonal drugs, but keep in mind that breastfeeding because of treatment may need to be canceled.

Postpartum psychosis, as the most severe stage of depression requires immediate treatment and often in the hospital, with the use of antipsychotics, antidepressants, sedatives, electroconvulsive therapy. A child, of course, for a while will have to part with his mother. Awareness of this perspective sometimes helps to overcome postpartum depression alone.

Keep a healthy and active lifestyle. Include exercise, do morning exercises, go for a walk with the baby every day. Eat healthy and non-caloric foods and in no case do not drink alcohol. Do not put pressure on yourself. Forget some of your expectations about an ideal family and do what you can, and leave the rest. Ask for help from your family or friends when necessary. Find also time for yourself. When you feel that the world is spinning around you, darkens in your eyes, take a little time to relax. Dress, get out of the house, and also visit a friend or do some errand. Avoid loneliness and isolation. Tell your partner, family or friends about how you feel. Ask other mothers about their experiences and do not forget that the best way to take care of your baby is to take care of yourself.