Postpartum Depression: When Physiology Meets Psychology

By B.L.Sindhuja .

Medical Writer | Pharm.D

What Really Occurs Post Partum?

Giving birth is not only a memorable event in mother's life ,  but also a major physiological process that involves many changes in the body. That includes progesterone and estrogen levels drastically drop after childbirth, affecting neurotransmitters that regulate moods and emotions in the brain such as serotonin, dopamine, and norepinephrine (1).

Physiological recovery needs and sleep deprivation create stress at an internal level in the body.

From a clinical perspective, the body’s neurological and endocrine systems undergo rapid changes .

When Does Psychology Come Into Play?

As the body adapts, the mind is concurrently going through the process of experiencing a big change in its life.

A new mother must adjust her identity, care-giving, and societal roles. The expectation of instant joy and attachment is inherent since olden days, and when the actual situation fails to meet those expectations of others, it leads to Accumulation of negative thoughts.

Self doubt, guilt, or feelings of incompetence, while it's psychologically rooted, are also biologically influenced. This triggers the interaction of biology and psychology in the body (1).

Baby Blues,” or is it?

Mild alterations in mood state, which can be labeled as “baby blues,” are normal and generally subside within two weeks. Postpartum depression is characterized by being more enduring in nature.

The clinical symptoms of postpartum depression are:

• Moodiness and anhedonia

• Tiredness not consistent with the expected tiredness after childbirth

• Sleep disruptions unrelated to the needs of the baby

• Dietary variations

• Feeling guilty, worthless, and helpless

• Concentration difficulties

• Anxiety, mostly related to the health of the baby

• Suicidal thoughts in the severest cases

Why is the need of paying Medical Attention to This Condition?

The condition does not occur in isolation; rather, it entails many dimensions.

Undiagnosed postpartum depression can result in impaired mother-child relationship, caregiving difficulties, and increased chances for the child to develop certain problems related to development and behavior. Moreover, it may also lead to the emergence of chronic depression (3).

Pharmacologically speaking, early detection provides a better prognosis for the patient.

What Is the Interaction between Physiology and Psychology in This Condition?

There is a connection between physiology and psychology concerning PPD.

Due to hormonal fluctuations, one experiences decreased ability to deal with negative emotions and changes in neurotransmitters balance. This increases susceptibility to negative thinking. Such thinking triggers stress reactions and causes increased production of cortisol.

In turn, that leads to further disturbance of neurochemical balance.

What are main management strategies?

The management of PPD involves mainly using both pharmacotherapy and non-pharmacotherapy interventions.

Pharmacotherapy Approach

SSRIs have been the drug of choice for moderate and severe cases of PPD since decades (4)

• Mostly used SSRI’s are Sertraline, Fluoxetine, Paroxetine

• Acts by Blocking the serotonin uptake and Increasing neurotransmitter availability at synapses

• Main Therapeutic use Mood stabilization

Individuals who are nursing babies are advised to use Sertraline because of the low risk of passing on the medication to the baby via breast milk. However, individualization of treatment is required for each patient.

Other treatment options can include SNRIs in case of resistance to treatment.

Psychological Therapy

Cognitive Behavioural Therapy (CBT) is key in management in PPD (5)

• Maladaptive thought identification

• Thought restructuring

• Coping skills improvement

Interpersonal therapy (IPT) is effective as well as used especially for dealing with role changes and interpersonal relationships.

Is Sleep a Therapeutic Approach?

Absolutely! Restoring sleep is one of the important goals of therapy.

Lack of sleep leads to neurochemical imbalances and emotional disturbances in the body ,  Regulated rest, joint caregiving and sleep hygiene techniques are very effective in this case.

Is Physical Activity Clinically Useful?

Physical activity plays the role of an adjunct treatment.

It promotes the release of endorphins, decreases the level of cortisol, and generally improves mood. Even low physical activity like walking can have some therapeutic effect if done consistently.

Crucial role of Social Support in Treatment?

Social support is an important parameter for beneficial therapeutic outcome .

Emotional support, assistance, and social connection can reduce to built stress and psychological problems in the process.

Conclusion 

Postpartum depression is neither an opposition nor a dichotomy between body and mind. It is rather the subtle intersection of the two. “Healing happens when the stories of physiology and psychology no longer operate independently.”

The combination of pharmacology, psychological therapy, rest, and socialization can make recovery not only a certainty but a stable one as well.

Disclosure: 

The material in this paper is meant for educational purposes only and should not be regarded as medical advice. Consult your doctor for any issues related to health.

Reference 

1. Stewart DE, Vigod SN. Postpartum depression: pathophysiology, treatment, and emerging therapeutics. Annu Rev Med. 2019;70:183–196.

2. O’Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol. 2013;9:379–407.

3. Meltzer-Brody S, Stuebe A. The long-term psychiatric and medical prognosis of perinatal mental illness. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):49–60.

4. Weissman AM, Levy BT, Hartz AJ, et al. Pooled analysis of antidepressant levels in lactating mothers. Am J Psychiatry. 2004;161(6):1066–1078.

5. Cuijpers P, Brännmark JG, van Straten A. Psychological treatment of postpartum depression: a meta-analysis. J Clin Psychol. 2008;64(1):103–118.

6. Tinyhood

7. DR. sekinat Adesina sIgns of postpartum disease .

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