Congratulations, New mom!! But why aren't you happy?

A new mom feeling low, not able to connect with their babies, feeling overwhelmed, feeling irritated, feeling anger and lonely are talks we seldom hear and even if we do, we ignore it as it may not be fitting the flamboyant description of Motherhood we like to give. 

Motherhood is a miracle, a beautiful inexplicable phenomenon. Agreed. But it was also be all of the above and for some lovely woman it could get even more intense. The question is, do we blame, criticize and black mark her for not feeling as per expectations or do we understand her situation and do everything possible to support her? support her for her well-being and the family's well-being? 

To remove the stigma associated with PPD, it is important to be aware of its causes too. PPD is not a crime, it's a health condition that needs to be addressed and taken care of. This posts intends to educate about the causes of PPD, next post would provide qualitative ways in which a mother can be helped by family and friends and her psychological journey

What is Postpartum Depression?

After giving birth, a new mother goes through many biological, environmental and psychological changes. Biologically, she experiences a sudden drop in estrogen and progesterone's levels right after birth followed by a rise in prolactin and oxytocin levels. Prolactin is the hormone that instigates the production of breastmilk and Oxytocin is the hormone that surges and gives Mother the high and the nurturing instinct right after birth. The initial days after birth can be overwhelming, tiring and demanding while the mother recovers physically from birth along with meeting the demands of the new born baby, however signs of Postpartum Depression begin to show by 6 weeks postpartum

By the time the mother is about 3 to 6 weeks, most mothers and families have a routine for the new born and the mother has also become familiar with the care taking and demands of the baby. The maternal hormones are still not as they were at pre-pregnancy, however, this is the time a mother can be most susceptible to Postpartum Depression. Some of the behavioral signs of postpartum depression could be:

- Lack of interest in hygiene

- Lack of interest in mundane activities such as eating

- Lack of social interest 

- Sudden and frequent episodes of crying

- Feeling hopeless, guilt and pessimism

- Irritability, anxiety and anger 

- Fatigue and Insomnia

- Difficulty in concentrating 

- Physical conditions such as headache, digestive disorders ad cornic pain that does not alleviate even after treatment 

PPD can be very well treated with counseling in most cases and accompanied with medication in case of few more mothers. The intensity of PPD also varies from mild to severe. Severe occurrences of PPD can be classified as psychosis and needs immediate medical intervention 

What causes Postpartum Depression

The causes of PPD in terms of influence

- High chances of PPD occur when the mother has a history of depression or anxiety, is genetically prone to depression and anxiety (family history of depression), Extremely stressful life events, Depression and anxiety during pregnancy, Lack of social support, Domestic abuse 

- Moderate chances are childcare stresses, maternal neurosis, mothers of infants who are specially abled/ intense temperament

- Mild chances: Marriage conflicts, taking care of the baby alone, maternal complications.

If we have to view this from another perspective, we could classify on the basis of Biological Causes.

Biological causes

When a woman is pregnant there is a high level of estrogen and progesterone's to enable to journey of Pregnancy and child birth. Once she delivers, there is a sudden plummeting of these hormones and an increase in oxytocin and prolactin. Oxytocin helps in bonding of the mother and baby and prolactin enables the production of breastmilk. 

Estrogen levels have an impact on increasing occurrence of PPD. Estrogen causes the renewal of the generation of damaged neurons in the brain and leads to production of brain neurotransmitters. In the hypothalamus region , estrogen helps in regulation of temperature and sleep. A reduction in this hormone is found to impact Postpartum depression

Oxytocin, called the happiness hormone in lay man's language, is a hormone that regulates emotions, emotional responses and social interactions. Reduced levels of oxytocin could causes depression and anxiety in new mothers. The levels of oxytocin here is not determined by the success of breastfeeding, however when a mother experiences mood swings, depression and anxiety a good support system and education is required to ensure she continues breastfeeding.

Prolactin, though a lactating hormone also has an impact of the mood of the mother 

Serotonin and Tryptophan levels in the blood also impacts the occurrence of Postpartum Depression. Serotonin is a monoamine neurotransmitter that is synthesized through the enzymatic route from the amino acid of tryptophan. Serotonin completely depends on the individuals diet. while a diet rich in protein helps the body rebuild and repair, a diet rich in carbohydrates enables secretion of serotonin and tryptophan. A protein diet would have reverse effect. Nutritionally when the Tryptophan levels reduce below 15%, it increases the chances of PPD.

Thyroid Hormones, the relationship between thyroid hormones and occurrence of PPD requires more study to be done. However, we can say that this hormones does impact PPD going by the fact that pregnancy does change the functioning and demand of Thyroid in the body. Secondly, depression in general is found to be associated with dysfunctioning of the thyroid gland.

Social causes:

- Emotional support system: The support of the partner during the postpartum period is essential. The new member brings in many changes in the relationship shared by the partners but it is essential to keep communication and intimacy continued as it helps a woman share her emotional state with her most trusted member in the family. Physical and emotional intimacy reduces the risk of PPD

- Relationship with family members and social circle: The relationship the woman shares with her family and friends do have an influence. A woman to woman bond, empathy, help with older children or household chores etc. play a significant role. This is also one of the reasons all ancient traditions across the globe have elaborate customs and tradition that are undertaken till today. These traditions root from the importance of providing the mother the physical and emotional care required and to make her feel supported by the community

- Informed Decision Making: The more a mother in informed of what to expect regarding the new born baby, her health conditions, and choices for herself and baby and allowed to make decisions. This empowers the woman and the mother she now is. The decision making process and he responsibility is borne with information and objectivity rather than fear and guilt.

Lifestyle

Nutrition: Among the factors related to lifestyle, factors of food intake patterns, sleep status, exercise, and physical activities may affect postpartum depression. It was observed that sufficient consumption of vegetables, fruits, legumes, seafood, milk and dairy products, olive oil, and a variety of nutritious may reduce postpartum depression as 50%

Sleep: Evidence shows that there is a relationship between less sleep and postpartum depression. A mother who gets less rest and is fatigued is also prone to PPD. Chronic sleep deprivation affects glucose metabolism, inflammatory processes, social communications, mental health, and the quality of life. In addition, acute episodes of sleep deprivation affect the immune system and increase inflammatory markers such as interleukin-6 and tumour necrosis factor while these inflammatory factors have been seen more in women with postpartum depression.

Exercises: There is also some evidence to suggest that exercise and physical activity have significant benefits in reducing depression symptoms, which are comparable with medicinal benefits. Moderate physical activity in the third trimester of pregnancy has lowered the postpartum depression scale at 6 weeks after the delivery

A possible mechanism is the effect of exercise on mental conditions of women by increasing the endogenous opioids and endorphins, which improve the mental health. Exercise also increases self-confidence and will eliminate negative self-assessments caused by depression. In addition, exercise will help women focusing on the environment around and solving their problems

Sources 

https://www.who.int/mental_health/prevention/suicide/lit_review_postpartum_depression.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561681/