Symptoms and treatment of postpartum depression. Types of complications after childbirth: prevention and treatment Postpartum depression in women treatment

WHAT ARE THE CAUSES AND RISK FACTORS FOR POSTPARTUM DEPRESSION?

As with other mental health disorders, there is an opinion about the genetic predisposition to the occurrence of postpartum depression.

Sudden changes in hormonal levels during pregnancy and after childbirth are considered biological factors contributing to the development of this condition. People who have experienced depression or anxiety in the past are at risk for depression during pregnancy or after childbirth. An interesting fact is that men are also subject to changes in the hormonal background during pregnancy. Also important concomitant factors are stress associated with any complications during pregnancy or childbirth and stress before caring for a child.

Additional risk factors associated with the development of postpartum depression are also low self-esteem, low socioeconomic status, lack of social support before and after childbirth, problems between spouses, including the experience of violence on behalf of a partner.

WHAT ARE THE SYMPTOMS AND SIGNS OF POSTPARTUM DEPRESSION?

Symptoms of postpartum depression appear during depression or up to four weeks after childbirth and include the following:

• Feelings of deep sadness, emptiness, emotional numbness, irritability, anger.
• Feelings of irritability and anger.
• Tendency to end relationships with family, friends, or avoiding pastimes that the patient usually enjoyed.
• Constant apathy and fatigue, sleep problems, overeating, loss of appetite.
• Strong feelings of worthlessness and inadequacy. Strong feelings of concern and anxiety associated with the child or lack of interest in him.
• Thoughts of suicide or fear of harming the child.

Postpartum psychosis is much less common and is a severe form of postpartum depression. Symptoms include the following:

• Hallucinations (voices or visions that don't exist)
• Thoughts of harming a child
• Severe depressive symptoms.

HOW DO DOCTORS DIAGNOSIS POSTPARTUM DEPRESSION?

There are no tests to accurately determine postpartum depression. In this regard, medical professionals diagnose the disease by collecting a complete medical, family and psychological history of the patient. The advantage for patients is that the healthcare professional takes into account all aspects of the patient's life and environment. This includes, but is not limited to, gender, sexual orientation, cultural, religious, ethnicity, and socioeconomic status. The health worker may conduct a physical examination of the patient or allow the patient's personal physician to perform such an examination. The physical examination usually includes laboratory tests to assess the patient's general health and is done to identify health conditions that affect psychological symptoms.

Postpartum depression is different from the so-called baby blues, a sad state after childbirth, which is observed in most recent deliveries. In baby blues, there may be minor episodes of crying, sadness, irritability, anxiety, and confusion. Unlike the symptoms of postpartum depression, the symptoms of baby blues reach their peak by the fourth day after delivery and disappear by the 10th day, without causing inconvenience in the woman's daily activities.

Postpartum psychosis is a psychiatric emergency that requires immediate intervention due to the possibility of suicide or child homicide. Symptoms of postpartum psychosis usually begin within two weeks of delivery and include extremely disorganized thinking, bizarre behavior, hallucinations, and delusions. Postpartum psychosis is often a symptom of bipolar disorder, also called manic depression.

HOW IS POSTPARTUM DEPRESSION TREATED?

Training programs and support groups

Treatment for postpartum depression is the same for men and women. Parents of both sexes who received this diagnosis benefited enormously from being informed about the disease, as well as from the support of other parents who experienced such a situation.

Psychotherapy

Psychotherapy ("talk therapy") involves working with a trained therapist to identify ways to solve a problem and deal with any type of depression, including postpartum depression. It can act as a strong intervention, thereby producing positive changes in the brain. It is a particularly important alternative to drug treatment for women who are breastfeeding. In general, completion of this therapy takes from several weeks to several months. Further counseling is needed only for severe depression or other psychiatric symptoms.

Interpersonal Therapy: Helps relieve depressive symptoms and helps the sufferer develop more effective social and interpersonal skills. Interpersonal therapy uses the following two strategies to do this.

• The first is to inform about the origin of depression. The therapist should be sure to emphasize that depression is a common condition and most patients should expect improvement from treatment.
• The second strategy is to identify specific problems (for example, the stress of caring for a child or interpersonal conflicts). Once problems are identified, the therapist is able to set realistic goals for solving those problems. Together with the participation of the patient, various treatment techniques will be applied to achieve these goals.

Cognitive Behavioral Therapy: Helps alleviate illness and reduce the risk of recurrence by changing the way the patient thinks. In cognitive behavioral therapy, the therapist uses three techniques to achieve these goals.

• Didactic component: This phase helps to establish positive expectations from the therapy and establish interaction.
• Cognitive component: Helps to identify thoughts and beliefs that influence behavior, especially those that predispose the patient to postpartum depression.
• Behavioral component: uses behavioral modification techniques to teach the patient more effective problem solving strategies.

Medicines

Medical treatment for postpartum depression usually consists of the use of antidepressants. The main types of antidepressants used are selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine/dopamine reuptake inhibitors (NSRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (monoamine oxidase inhibitors (MAOIs).Selective serotonin reuptake inhibitors (SSRIs) affect brain levels of serotonin.For many clinicians, they are the first choice due to the high level of efficacy and overall safety of this group.Examples of antidepressants are listed below.Special name first , with the brand name in brackets.

Fluoxetine (Prozac)

Sertraline (Zoloft)

Paroxetine (Paxil)

Fluvoxamine (Luvox)

Citalopram (Celexa)

Escitalopram (Lexapro)

Vilazodone (Viibryd)

Vortioxetine (Trintellix)

Bupropion (Wellbutrin)

Mirtazapine (Remeron)

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

Desvenlafaxine (Pristiq)

Levomilnacipran (Fetzima)

Tricyclic antidepressants (TCAs) are sometimes prescribed for severe cases of depression or when selective serotonin reuptake inhibitors (SSRIs) or serotonin/norepiphrine/dopamine reuptake inhibitors (SNRIs) are not effective. These drugs affect many chemicals in the brain (neurotransmitters), especially epinephrine and norepinephrine (adrenaline and norepinephrine, respectively). Examples include:

Amitriptyline (Elavil),

Clomipramine (Anafranil)

Desipramine (Norpramin),

Doxepin (Adapin)

Imipramine (Tofranil),

Nortriptyline (Pamelor).

Approximately two-thirds of patients who take medication recover. For a noticeable improvement in mood, it is necessary to take the prescribed dose for two to six weeks. That is why stopping the drug before a visible improvement is undesirable. Monoamine oxidase inhibitors (MAOIs) are not often prescribed due to the popularity of selective serotonin reuptake inhibitors (SSRIs). Due to potential interactions, monoamine oxidase inhibitors (MAOIs) should not be taken with other medications or foods containing tyramine (found in aged cheeses, wines, and meats). For example, the monoamine oxidase inhibitors phenelzine (Nardil) and tranylcypromine (Parnate).

The atypical use of antipsychotic drugs is commonly practiced as an adjunct to normothymic drugs in cases of postpartum psychosis. Examples of neuroleptics:

Aripiprazole (Abilify),

Olanzapine (Zyprexa)

Paliperidone (Invega),

Quetiapine (Seroquel)

Risperidone (Risperdal),

Ziprasidone (Geodon)

Asenapine (Saphris)

Iloperidone (Fanapt)

Lurasidone (Latuda).

Normotimics outside the group of antipsychotics are also sometimes used along with antipsychotics in the treatment of postpartum psychosis, since bipolar disorder may also be present in some patients. Examples of normotics that are not included in the group of neuroleptics:

Lithium (Lithium Carbonate, Lithium Citrate),

Divalproex sodium (Depakote)

Carbamazepine (Tegretol), and

Lamotrigine (Lamictal).

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Roxanne Dryden-Edwards, MD The most important Best New Suicide Prevention Child and Teenage Suicide: An Unheard Cry for Love Any parental mistakes are reflected in the state of mind, and sometimes on the mental health of the child. Including errors that are not directly related to the child himself. Disagreements in the relationship between mom and dad or the absence of one of the parents affect children much more destructively than pedagogical errors proper. Moreover, children do not even have to know everything that happens between mom and dad or in the soul of a parent - I don’t know how, but it affects the child directly. For example, if mom cheats on dad, and even dad doesn’t know about it, not to mention the children, the children start to get sick or their behavior deteriorates. In psychology, this is called a "symptomatic family member."

Each doctor specializes in a certain kind of disease. An important rule that is the same for all forms of manifestation of depression: in no case should you delay with qualified help. At an early stage, this insidious disease is better cured than in an advanced form.

Depression is a serious illness, not just a bad mood. If a depressive state is not treated, it can lead to disruption of the cardiovascular system and other equally unpleasant problems. In addition, signs of depression can be symptoms of other diseases that affect the emotional state of a person. A bad mood does not appear for no reason, it can often be associated with impaired cerebral circulation, excessive fatigue and exhaustion of the body.

Therefore, with depression, it is better to seek qualified medical assistance and in a timely manner. To choose a suitable specialist, you need to understand what caused the serious condition of the victim of mental trauma and how far the disease has gone.

According to the severity of depression, it is classified into the following types:

1. Mild - characterized by minor changes in mood. It is the initial stage of the disease, easily treatable. Does not require medical intervention.
2. Medium (moderate) - which is a more advanced degree of the disease than a mild form. More difficult to treat. Requires a special approach. It is characterized by signs of the influence of the psycho-emotional state on physical factors: sleep disturbance, loss of appetite.
3. Severe - which is the most neglected and dangerous form of manifestation of the disorder. At this stage, intrusive thoughts may appear. Requires long-term specialized treatment.

The more severe the disease, the more serious and highly specialized treatment it requires. If the patient himself cannot decide on the choice of a doctor, then he can contact his general practitioner, and he will advise whom to choose, or prescribe treatment on his own.

The therapist is a general practitioner, and therefore he is also familiar with the signs of depression. But he can only treat a mild disease, more severe manifestations require highly specialized care. During the initial examination, the therapist will draw conclusions about the severity of the disease and try to identify the causes of its occurrence. According to the conclusion, the doctor will either prescribe a course of treatment on his own, or give a referral to other doctors: a psychotherapist, psychologist, psychoanalyst, psychiatrist, neurologist. If you wish, you can also contact the required specialist yourself - a referral is not required for this.

Narrow specialization

To choose which doctor to turn to for help with depression, you need to know the scope of each specialist. Each doctor has his own approach to healing and treats mental ailments of a certain severity and caused by a certain cause.

1. The psychologist helps patients tune in to an optimistic mood and overcome bad thoughts through conversations. Such a specialist heals only verbally without the use of any drugs. It cures mild forms of mental disorders. A psychologist cannot diagnose or prescribe medication.
2. The psychotherapist can heal orally, like a therapist, and can resort to medication if necessary. Psychotherapists often use hypnosis in their practice, thanks to which the patient learns to think positively. A psychotherapist can deal with moderate depression, but he does not treat acute mental illness.
3. A psychoanalyst is a kind of psychologist who is able to carry out some types of psychotherapy. But he has no right to make diagnoses or prescribe treatment.
4. The psychiatrist is able to cure moderate and severe forms of mental disorders. He independently diagnoses and prescribes treatment. A psychiatrist can prescribe medications, prescribe various types of therapies, and, if necessary, can prescribe inpatient treatment.
5. A neurologist can diagnose and treat depression associated with or caused by neurological conditions. Treatment prescribes only medication.

Each individual patient needs an individual approach to treatment: for some, medications help better, and for others, conversations. Therefore, there is no exact statement which doctor treats depression better than others. You can contact several specialists at the same time. It is noticed that the best effect in treatment can be achieved by combining medication and other types of treatment.

Treatment Methods

Sometimes it happens that the choice of a doctor is influenced not by the severity and neglect of the disease, but by the cause of its occurrence. For example, if stressful situations or major shocks became the cause of mental illness, then this is the so-called psychogenic depression. Psychologists, psychotherapists and psychoanalysts are engaged in the treatment of such a disease.

If a mental disorder is not an independent disease, but a consequence of other ailments, then a psychologist will not help. Here you need to contact another specialist who will prescribe the correct medication. Often depression is experienced by people who have impaired activity of the endocrine glands. Therefore, the soul aspect of a person's life will not return to normal until the body is cured. In this case, it is better to contact a therapist for help, and he will redirect to an endocrinologist.

Depression can also be caused by neurological diseases. In this case, in addition to signs of mental disorder, symptoms of neuralgia will appear: impaired coordination of movement, slowness of reflexes. For treatment, you need to go to a neurologist.

It happens that there are signs of depression, but the cause cannot be established. In such incomprehensible situations, you need to go to a psychiatrist - he specializes in all types and forms of mental disorders.

anxiety symptoms

Almost 60% of the world's population suffers from depression. It causes a lot of inconvenience to many, sometimes even leading to serious illnesses. Self-treatment of such an ailment can lead to a severe chronic form. Therefore, if the symptoms of a depressive disorder last more than 3 weeks, you should immediately seek medical help.

In order to detect this psychological illness in time, you need to pay attention to the following signs:

• anxiety state;
• dreary joyless thoughts;
• pessimistic outlook on life;
• irritability;
• low self-esteem;
• weakness, fatigue;
• sleep disturbance;
• loss of appetite;
• lack of sexual desire;
• isolation in oneself;
• periodic outbursts of anger;
• propensity to drink alcohol.

Depression, left on its own, can lead to suicidal thoughts or serious health problems. If you find symptoms of depression in yourself, in no case should you close yourself. Need to ask for help. Even in the complete absence of financial opportunities, you can always contact a psychotherapist at a polyclinic or a psychiatric dispensary for free.

And it should be remembered: only timely professional treatment can guarantee a full recovery.

One in five mothers experience mental health problems after giving birth. Even if the entire period of pregnancy passed quietly, and the birth of a child brought a feeling of cloudless happiness, this is not a guarantee that the newly-made mother will not face such a phenomenon as postpartum depression. Why do these mental disorders occur? How to deal with them? Let's search about answer questions that are relevant for many young mothers together.

Causes of postpartum depression: how can it be avoided?

As a rule, the first month as a mother brings a lot of joy to a woman: she takes care of the baby with pleasure; waking up, in a hurry to fulfill their new duties; connects the husband and household to the upbringing of the child; makes friends with other young mothers and so on. It would seem, why be sad? Live and be happy. But, after a month, most women find that feeding and swaddling a baby does not bring such joy as before, the emotional upsurge disappears, fatigue appears, a feeling of physical weakness, unwillingness to get up in the morning. Often, against the background of such a depressed state, the sexual attraction to the spouse disappears.

In addition to everything, there is also a fear that the young mother cannot cope with caring for the child, with his upbringing, and the husband, in the absence of sex, will leave for another woman. What is this state? How to deal with depression after childbirth? Let's figure it out.

Let's start with the fact that it is not only possible, but necessary, to fight against such a state. It is best to stop the signs of postpartum depression at an early stage so that they do not lead to the development of serious mental disorders. However, in order to know how to prevent bouts of depressed mood, it is important to recognize the causes of its occurrence.

So, the provoking factors of postpartum depression are:

• unwanted or difficult pregnancy;
• problems with breastfeeding;
• conflicts with the father of the child;
• pathologies of the nervous system diagnosed before the birth of the baby;
• excessive physical activity;
• financial problems;
• moral exhaustion;
• lack of help from relatives and friends;
• unjustified expectations.

Of course, all of the above causes of a depressive state are only part of a huge list of factors provoking a mental disorder in a woman. Often they are dictated by social and living conditions. But the emotional state of a young mother directly depends on her thoughts and daily mood. Therefore, psychologists recommend to nullify all negative emotions that arise during this period. How to achieve harmony with yourself and the world around you?

Experts identify a number of factors that, to one degree or another, contribute to a decrease in the likelihood of symptoms of postpartum depression.

First, pregnancy planning. Preliminary preparation for future motherhood, including reading specialized literature, courses for young mothers, conversations with a psychologist, allows a woman to prepare for a new stage in her life.

Secondly, timely treatment of emotional instability, tearfulness and irritability of a newly-made mother will help stop the development of depression at an early stage.

And, thirdly, the psychological support of pregnancy. If you have previously experienced mental health problems - panic attacks, seasonal manifestations of depression, etc., then during pregnancy it is important to visit not only the antenatal clinic, but also the psychologist's office. An experienced specialist will select the necessary therapy to eliminate the slightest symptoms of depression. In addition, his advice is very useful for maintaining a stable emotional state after the birth of a baby. So do not neglect the help of psychologists if you need it.

Postpartum depression in women: signs and manifestations

Now let's talk about the most important thing - how to recognize the manifestations of this depressive state in young mothers. How severe can postpartum depression symptoms be?

Experts identify a number of signs that indicate a depressive state in young mothers. Firstly, these are regular complaints of suffering due to loneliness and excessive fatigue. A woman constantly wants to cry, she has sharp mood swings, uncontrollable outbursts of anger. Secondly, panic fear about the health of the newborn. Moreover, anxiety is often replaced by suicidal thoughts, a gloomy vision of the future. Thirdly, often a woman herself provokes conflict situations, daily tantrums and becomes just the same "grumpy woman." In addition, she often manifests hatred and aggression towards her husband and child. Let's pause a little at this stage and consider these signs of postpartum depression in more detail.

hatred for husband

Such a symptom, as a rule, develops already at the stage of progressive depression, which is accompanied by a feeling of panic and anxiety, a strong heartbeat, loss of appetite, regular headaches, and insomnia.

If in this situation the spouse perceives the woman not as a sick woman, but simply as a boring wife, then the newly-made mother's hatred for him only intensifies. Lack of intimate life, weight gain during pregnancy, betrayal of a spouse - all this only "adds fuel to the fire." Any conversations about relationships with her husband end in scandals.

And the aggression to the child

This is the most dangerous stage of depression in women. With early postpartum psychosis, the mother may even declare the refusal of the child or feeding the baby. In some cases, aggression takes place in a latent form. At an unconscious level, the newly-made mother wants to destroy her offspring. With an open form of aggression, a woman shows physical strength in relation to the child, constantly screams. In this state, it is important to protect the mother from contact with the baby and take appropriate measures to treat the manic-aggressive symptom.

How to treat severe postpartum depression?

It is important to understand that postpartum psychosis is a very serious mental illness that requires timely treatment. Otherwise, depression will drag on for many years, and it will be very difficult to get a woman out of this state. In addition, a severe form of the disease may be accompanied by manic, suicidal thoughts in relation to the child and husband. And this should not be allowed under any circumstances.

And antidepressants

If you have symptoms of postpartum depression, do not try to solve the problem yourself. Seek help from a doctor who, depending on the type and complexity of the condition, will suggest the necessary treatment. As a rule, postpartum depression is treated on an outpatient basis, with suicidal tendencies - in a hospital.

To date, in the treatment of this disease, psychotherapy, the use of antidepressants, tranquilizers, neuroleptics are used. These medications, as a rule, contain psychotropic and hormonal substances that allow you to normalize the mental and emotional state of the patient. True, they do not act instantly. But 100% help to cope with postpartum depression. During treatment with antidepressants, you will have to stop breastfeeding.

Treatment for postpartum depression: Dr. Komarovsky

In the treatment of postpartum depression, Evgeny Olegovich recommends not being afraid to discuss her depressed state with the newly-made mother. The woman herself may be embarrassed to talk about depression, and social isolation only exacerbates the situation. The patient should know that thousands of women, including world famous ones, suffer from a similar disease. And they don't do it alone.

It is also recommended to discuss the factors that led to the depressive state. Maybe the husband is not paying enough attention? Or is the child being too restless? It makes sense to talk about the importance of taking care of yourself. Discuss the possibility of rest and nutrition for the mother. Engage her in moderate exercise that can be combined with a walk in the fresh air with the child.

It is important to help a woman feel faith in her abilities, to encourage her maternal instincts. If she needs professional help, be sure to find a good psychologist or psychotherapist.

How long does postpartum depression last?

This question is asked by almost all women suffering from mental health problems after the birth of a baby. The duration of postpartum depression depends on the mother's desire to fight the disease.

The attitude to the problem of the mother's environment is also important. If a woman is in no hurry to seek qualified help from a psychologist, believing that the problem will be solved by itself, then postpartum depression can last for several years, periodically fading and flaring up with relapses. When a newly-made mother does not hesitate to ask for help, talks with a psychologist, loved ones, shares her anxieties, then negative emotions slowly fade. In addition, if relatives take on some part of the housework and give mom a rest, then all manifestations of depression pass quickly enough.

What to do if postpartum depression persists?

A prolonged depressive state is one of the unpleasant consequences of the disease in question. In this case, a depressed mood accompanies a woman for several years. Quite often, a complication of depression is manifested by suicide attempts. The causes of prolonged depression are the illness of the child, the breakup of the family. In a fit of despair, the mother completely abandons the baby. In such situations, it is imperative to seek the help of a psychotherapist. Unfortunately, it is quite difficult to solve the problem on your own.

The help of a husband, close people with prolonged postpartum depression is also very important. A woman should feel supported by the environment. Therefore, it is better for her to go to the doctor's appointment with the person she trusts.

Postpartum depression in men

We all know about the existence of crises in family life. They are the turning point in a relationship. And the crisis of the appearance of a child is the most insidious, since it radically changes the usual way of life of an already formed family.

With the advent of a child in the house, a man is given less attention, he has a number of responsibilities that do not always bring joy. In addition, dad has to work harder to support both his wife and baby. This significantly undermines the husband's mental health, resulting in depression. Lack of intimate life, scandals and screams, showdown with her husband spur men on to return home from work as late as possible or leave the family altogether. In such a situation, it is important not to “break wood”.

If your spouse is capable of calm dialogue, talk to him and explain that you understand the severity of the situation and are trying to cope with the new role of parents. Tell him how you appreciate his care and understanding, how important what he does for your family. The husband must understand that you will definitely overcome this difficult period for your life together.

If talking does not help, it makes sense to seek help in solving male postpartum depression from a family psychologist.

At the end of our article, I would like to remind you that it is important to perceive this condition as a serious illness, in which neither the mother herself, nor the husband, nor anyone around is to blame. And sometimes it is very difficult to overcome it with an effort of will. You will not say to a patient with the flu or diabetes: “Pull yourself together!”. In the case of postpartum depression, this also does not work. Only moral support, care and attention helps a woman feel happy and loved and overcome depression.

Remember this and don't worry!

Especially for - Nadezhda Vitvitskaya

The joy of motherhood is often overshadowed by psychotic symptoms that occur in women in the first weeks after a happy event. They are much more common in primiparas than in those who give birth for the second time. There is no need to confuse postpartum blues with psychosis, which means bipolar and schizoaffective personality disorders, recurrent (monopolar) depression with recurring episodes, and other serious pathologies. However, regardless of the severity and form, it is necessary to treat postpartum depression, otherwise the depressed psychological state will adversely affect the health of not only the mother, but also the child.

Women sometimes experience depression after giving birth.

Somatic and psychogenic factors are related to the development of disorders:

1. biological stress. Childbirth is always complicated by blood loss, functional disorders, poor health.
2. Endogenous disorders- a genetic predisposition or a shock that arose against a reduced emotional background.
3. post-traumatic stress. The mother's psyche is depressed by nervous overwork or strained relationships in the family, unwillingness to take responsibility for the child.
4. Problems in intimate life. Decreased libido is not only due to physiological reasons. Claims to appearance, fear of a new pregnancy, mental discomfort lead to subconscious rejection of a partner.

The main reason is hormonal changes.. During pregnancy, estrogen and progesterone levels rise significantly. After childbirth, within 3 days, it decreases sharply, causing sharp mood swings. A direct relationship has been proven between melancholia and prolactin, a hormone produced by the pituitary gland that controls stress, is responsible for maternal instinct, body weight.

Types and symptoms of postpartum depression

The first signs are easy to identify by behavior. The young mother becomes irritable, complains of weakness, insomnia. Nervous excitement can increase or be replaced by apathy. Classify 3 degrees of depressive syndrome:

1. On the initial stage slight mood swings are noted, which are explained by fatigue, sleep disturbance. Despite episodic destructive manifestations, it is still difficult for a woman to control the emotional background.
2. For second phase characteristic: isolation, silence, the appearance of irritation, anger, negative reactions.
3. The most difficult - third when a person cannot adequately perceive reality. She falls into agitation - the strongest emotional arousal, rushing around the house or hanging in a stupor.

Postpartum blues develops according to different scenarios. The most common neurotic syndrome. It occurs against the background of exacerbation of existing diseases, often accompanied by asthenovegetative disorders. Violations are expressed in the form of a bad mood, unmotivated outbursts of anger, loss of appetite, claims to oneself and others.

Protracted melancholia is considered the most severe form of postpartum depression.

The most severe form is prolonged melancholy. Its insidiousness lies in the veil of the symptoms, which are easily confused with the fatigue and blues that are typical of this condition. The disorder can last for years or take a schizoid form.

Postpartum depression with delusional ideas manifests itself in the form of its own failure. The woman blames herself for her inability to take care of the baby, to provide him with care, care, safety. Some get:

• to clouding of consciousness;
• disorientation;
• memory lapses;
• hallucinations.

May be haunted by thoughts of suicide. However, this disorder usually occurs 1-2 weeks after delivery, is rare, and is classified as a psychosis. It is formed gradually, so others may not always notice oddities in behavior. If left untreated, most likely, the condition will turn into severe prolonged depression with the appearance of phobic and obsessive (obsessive) conditions.

The syndrome usually occurs when the image of the mother is idealized, inventing an image and scenario that the mother tries to follow. The slightest inconsistencies in the invented picture cause anger, reproaches addressed to them. Otherwise, the woman hopes that someone else will take care of the baby. Faced with reality, she understands the degree of responsibility for the baby. Internal protest leads to conflicts and uncontrolled breakdowns.

The course of the disease is complicated by somatic symptoms, manifested in the form of vegetative syndromes:

• headache;
• tachycardia;
• asthma attacks;
• weight loss.

There is a high probability of getting a severe form for mothers with borderline disorders. It is worth alerting those who have had episodes of depression in history or during the period of bearing a child, the pregnant woman suffered a deep emotional shock.

What does the doctor prescribe

At the first suspicion of melancholia, you can quickly calculate the condition using psychological screening. In the public domain, tests for postpartum depression are offered according to the Edinburgh scale or according to the Maantogomery-Asberg, Hamilton self-questionnaire. Based on the symptoms for the last week, you need to answer 10 questions, compare the results with indicators and determine psychopathological phenomena.

A controlled condition is not a reason for a visit to a specialist. Following psychogenic rules allows you to adjust your mood on your own. If a person is in a passive or agitated state for more than 2 weeks, it's time to see a doctor. Otherwise, incorrect patterns of behavior will adversely affect the attitude towards the child, lead to the development of secondary diseases in the mother. It is not a fact that after 6 months, along with adaptation to new conditions and restoration of hormonal levels, the problem will disappear. It is possible that after 9 months a new wave will come. Postpartum depression a year after childbirth will have to be treated for a long time and hard.

Postpartum depression needs treatment

Therapy is selected by a neurologist, psychiatrist and gynecologist. The medicine and doses are prescribed exclusively according to indications. The treatment regimen includes:

1. Antipsychotics to eliminate delirium, catatonic phenomena (excitation and stupor) - chlorpromazine, triftazin.
2. Normatimics for mood stabilization - sodium valproate, carbamazepine.

In severe and moderate forms, antidepressants are usually prescribed. Sometimes electroconvulsive therapy is prescribed. Psychoses are more often treated in a hospital setting.

The patient is offered:

1. Cognitive Behavioral Therapy. It will help to rebuild thinking, reactions, behavior, attitude towards yourself and the child.
2. Interpersonal will allow you to quickly adapt to the role of a parent, to comprehend the degree of responsibility.

Antidepressants for postpartum depression

First of all, provoking factors are eliminated. Regardless of whether a woman is breastfeeding or not, the doctor prescribes drugs of the SSRI group - selective serotonin reuptake inhibitors of the third generation.

All types of pharmacological agents, including monoamine oxidase inhibitors, tricyclic and atypical antidepressants, have a positive effect on the hormones of joy and pleasure - norepinephrine and serotonin, and stabilize the mental state. Each of them acts on the body in different ways.

Compared with tricyclines, selective ones are much milder, they do not have side effects such as drowsiness, increased heart rate, and other unpleasant symptoms. The principle of action is local inhibition of serotonin reuptake by receptors. This:

• fluoxetine;
• paroxetine;
• citalopram;
• fluvoxamine.
• sertraline.

Severe postpartum blues is treated with venlafaxine. The medicine in microdoses passes into breast milk and is considered safe for mother and baby.

Postpartum depression can be treated with antidepressants

Preparations from the tricyclic group: azafen, fluorocyzine, coaxil and others act similarly, and also do not harm the health of the baby. The exception is doxepin. However, these funds are difficult to tolerate by the mother, can cause tremors, weight gain, dyspepsia. The latest generation of drugs include mirtachaline with a pronounced sedative effect and other side effects. The choice depends on the psychopathological syndrome.

1. Inhibitors with a sedative effect are prescribed when aroused.
2. With inhibition, analogues with a stimulating effect are shown.

If activating agents are used for anxiety, this will provoke an exacerbation of neurotic symptoms and aggravate the condition. More often than others, the hormonal drug "Estradiol" is prescribed. In small doses, apomorphine is prescribed for mood.

How long to take antidepressants

You don't have to believe in the addiction myth. Properly calculated intake scheme is not addictive. The first changes are noticeable in the third week, more pronounced - after 8 weeks. To get a stable result, the medicine is drunk for six months. A year is taken to prevent relapse. If there were bouts of melancholy before pregnancy, a longer intake is indicated.

When the mother feels relieved and sees no point in continuing the treatment, there is no need to suddenly interrupt the course. Withdrawal from SSRI inhibitors occurs consistently under the guidance of a psychotherapist. Otherwise, temporary symptoms characteristic of the flu will appear - headaches and muscle pain, weakness. Uncontrolled states are possible - nervous excitement or apathy. Subjective signs depend on the psychotype of a person.

If a woman drank inhibitors before pregnancy, after childbirth she should consult with a psychotherapist about the advisability of further use. During lactation, the body is rebuilt - it becomes more sensitive and reacts differently to synthetic components. The doctor will adjust the doses or suggest an alternative.

Treating postpartum depression at home

You should not rely solely on pharmacological preparations. Women with a mild form of melancholy may well cope on their own. During this period, it is important to play sports. Jogging in the park, visiting the pool, doing yoga or Pilates affect the secretion of joy hormones (endorphins), in general, control the hormonal profile. At the same time, the muscles will be tightened, the previous forms will return. Aesthetic pleasure from appearance is stimulated by dopamine receptors in the brain, which affect vitality and motivate action. Shopping visits to a beauty salon will replace a session with a psychotherapist.

Walking with your baby can help you get out of postpartum depression

• long walks with a child in the park;
• tactile and emotional contact with the baby;
• communication with other mothers.

It is important to allocate personal time for yourself, and at least temporarily shift some of the responsibilities to your husband or relatives.

Non-traditional methods are offered for home treatment. The most suitable melotherapy is the treatment with music. Acoustic signals of different ranges and the sounds of nature have a positive effect on the psyche. It is good if the room is filled with plants, and intense yellow and blue light pours out of the lamps.

Ethers of citrus, rose, clary sage, geranium restore mental balance. It is enough to put a couple of drops on a light bulb so that the bedroom is filled with subtle aromas. You can add 5 drops of oils to the bath.

Acupuncture helps a lot. When exposed to nerve receptors, needles activate energy flows. The main thing is to find a competent doctor.

Prevention

Psychological preparation for childbirth begins during pregnancy. This is especially true for women prone to melancholy. They need increased care of the husband and attention of relatives.

It is important that the family has harmony and love.

It is necessary to read the relevant literature, study the recommendations of doctors in order to psychologically prepare for the role of a mother. In some cases, professional support is needed. After individual counseling, it will be possible to painlessly survive a difficult period.

“I don’t want to and I can’t do anything, I just cry and run to smoke. Even the cry of a child annoys me, ”some women who have recently given birth describe their condition in approximately the same way. Severe postpartum depression, and these are precisely its signs, according to statistical indicators, occurs in 12% of new parents.

The situation is also complicated by the fact that the environment, and the mother herself on maternity leave, do not always consider such a phenomenon to be a serious illness. And yet, depressive moods after childbirth are a pathology, and if left to chance, it often leads to serious consequences for both mothers and children.

At the end of the third trimester, many women begin to worry about themselves and, above all, the child. Anxiety arises due to a certain loss of control over the situation, not always pleasant emotions and sensations. Anxiety grows even more when mommy realizes that she cannot live up to the image of the “perfect mother”.

Most likely, many have an idealized idea of ​​a mother on maternity leave: a rosy-cheeked toddler, a newly-made mother sparkling with happiness and the proud head of the family nearby. Imagine what happens to the psychological state of a woman in the first month after childbirth, when a newborn baby makes serious adjustments to her life.

What is postpartum depression in new mothers? Despite the ambiguous attitude to such a phenomenon in society, in medicine it is considered a rather serious illness - a form of depressive disorder that develops during the first months of the mother's interaction with the newborn.

Depression is inherent in about 12% of mothers who have given birth, but only 2-4% receive qualified support after the diagnosis is established.

In fact, experts say that mild episodes of postnatal depression occur in almost half of women on maternity leave.

It is necessary to separate depression from the usual blues, despondency that occurs in the first month after the birth process. A moping woman sometimes describes her feelings in the same words (“I cry”, “I can’t sleep”, etc.), but at the same time she is happy from the appearance of a child in her life.

Sadness and melancholy usually pass in a month or two, in addition, these conditions do not require any specific help. What are its characteristic differences?

1. Postnatal depressive disorder usually occurs within a few months after the birth of a newborn, but its signs can appear up to a year after birth.
2. The symptoms of postnatal depression not only last significantly longer (from 5-6 months to a year or more), but also differ in the severity of all manifestations and the inability to do anything. The symptoms are very similar to those of other types of depressive disorders.
3. The spleen usually disappears completely in a month (a little more), while postnatal depression often becomes chronic. Such a “disguise” arises from the woman’s non-recognition of this condition and unwillingness to ask for help (mother has to play the socially approved role of a happy and caring parent). A fifth of women with depression do not notice an improvement even after 2-3 years!
4. Psychologists believe that postnatal depression causes a mother to rethink the role of her own parents in raising children. Such identification becomes the reason for the activation of various problems and conflicts that were not worked out in childhood.

In addition to the above features, postnatal depression is characterized by a woman's categorical refusal of medical or psychological assistance and the inability to cope with the problem on her own. The reason for this is the feeling of guilt - "I can not take care of the child, so I'm a bad mother."

The situation is constantly deteriorating, and it “falls” to everyone: the child, the husband, the rest of the household, and other relatives who do not understand the reasons for the low mood and reproach the newly-made mother for insufficient attention to the baby and maternal responsibilities.

Forms of postpartum depression

Postnatal depressive disorder can occur in various forms, each of which differs in special signs, their severity and duration. Let's consider them in more detail.

neurotic depression

This type of postnatal depressive state usually occurs in mothers who had certain neurotic disorders before giving birth. Since the birth process is a stressful situation, there is an exacerbation of existing disorders.

In this case, the woman is observed:

• irritability, anger and aggressiveness;
• hostile attitude towards close people;
• constant panic;
• cardiopalmus;
• increased sweating;
• loss of appetite;
• insomnia and other sleep disorders;
• sexual problems;
• fear for one's health, especially acute at night.

In addition, it is common for a mother to experience her own lack of independence. Her self-esteem drops sharply, as a result of which she begins to emotionally depend on the people around her.

postpartum psychosis

This type of postnatal depressive disorder has its own characteristics. So, for mothers in this state, a feeling of guilt, lethargy, loss of orientation in certain situations, and inability to recognize relatives are characteristic.

In particularly severe cases, a woman may develop obsessive thoughts after childbirth that relate to the idea of ​​suicide or the desire to harm her own newborn child.

Postpartum psychosis is quite rare in new mothers - in four out of a thousand women in labor. Its symptoms appear in the first month after the birth of the baby - within 10-14 days.

It is impossible to say exactly how long it will last, because sometimes its prerequisite is a manic-depressive psychosis in the mother.

This is the most common form of postnatal depression. However, it is rather difficult to define it, since it “masquerades” as a variety of problems that are associated with the care and upbringing of children.

Protracted postpartum depression develops gradually, and it begins with the usual blues, which continues after returning home. Women are constantly tired, but relatives attribute this condition to the birth process.

Distinctive signs are constant irritation and tearfulness. But it is extremely unpleasant for mother to hear children's tears, and she blames herself for this and for insufficient care. Guilt also arises because caring for a child does not bring happiness to a woman.

A protracted course of postnatal depressive is most often observed in two types of mothers:

1. Women with hysterical manifestations or with obsessive fears of doing something wrong, especially if it concerns a child.
2. Individuals who were deprived of maternal tenderness and affection in childhood.

How long the depression will last is impossible to determine. Usually the time interval does not exceed 10 months or a year. However, in especially severe cases, the process of closing in itself can last 2-3 years.

General signs

As can be seen, different types of postnatal depression have distinctive characteristics. However, experts identify several symptoms that occur in all varieties of such a psychological condition. Among them:

Somewhat less often, in mothers, the above features can be combined with suicidal thoughts or with a desire to harm the child. Such thoughts often arise simultaneously with the unwillingness to approach the newborn at all.

A woman's well-being especially worsens in the time interval from three to 10 months after the birth of a baby. When the child turns the third month of life, the mother actively progresses irritability and anxiety.

Many specialists associate the occurrence of postnatal depressive disorder in a newly-made parent with changes occurring at the psycho-emotional, social, and physiological levels.

Despite the fact that there is still no clearly proven connection between the depressive mood in mothers and the hormonal background, this factor is not discounted. The assumption has the right to exist, since the level of certain hormones changes in women in position.

During the bearing of a child, the amount of female sex hormones increases by almost 10 times, and after delivery, a significant decrease in such indicators is observed - almost to the level at which they were before conception.

In addition to hormonal changes, the mother is “threatened” with colossal changes in all aspects of life with a newborn child. The psychology of women who have given birth is changing, changes are also taking place in social status. Such "transformations" seriously increase the risk of postnatal depression.

In addition, experts identify several factors that can provoke the development of symptoms of a depressive state in mothers who have given birth:

1. hereditary predisposition. These words mean the features of the nervous system that a woman adopts from her own parents. More specifically, a mother with a weak nervous system inherited from the older generation tends to react more sharply to various stressful situations, and there are a lot of them after the baby is born. In addition, the birth process itself is one continuous stress.
2. Physiological changes. In addition to jumps in female sex hormones, the mother has a change in the volume of thyroid secretions. As a result of this decrease, fatigue sets in, the mother has to do everything through “I can’t”, and this can end up in depression. After the end of pregnancy, metabolism, blood volume and even blood pressure change, all this affects the psychological health of the mother.
3. Fear of not meeting the "title" of the mother. Some anxious personalities strive to become a kind of "super mom" who manages to take care of the child, enjoy life, be a good wife and friend, and look good. In reality, it is impossible for a mother to approach such an ideal, as a result of which her self-esteem decreases, a feeling of helplessness appears. And that's not far from depression.
4. Lack of free time. The natural desire of any mother is to restore moral and physical strength after childbirth. However, almost immediately she has to perform household chores, take care of the baby. These chores are often combined with the process of uterine contraction, recovery after suturing the perineum or sutures from a caesarean section. Such time pressure often ends in depression.
5. Problems with breastfeeding. The process of becoming lactation brings mother not only pleasant emotions, but also a variety of difficulties. For example, the weaker sex after childbirth often expresses milk, feeds the baby at night (because of this, it is difficult to fall asleep). The lactation period is often accompanied by soreness during feeding. In addition, there is a temporary decrease in the volume of milk, repeated after a few months. We must not forget - the stagnation of milk secretion.
6. The selfishness of a woman. An unexpected factor, however, the fair sex does not always like to share the attention of others, even with their own children. Postpartum depression of selfish origin is especially characteristic of young and primiparous mothers. After giving birth, the mother has to rebuild the usual way of life for the needs of the baby, and she also needs to enter into “competition” for the attention of her husband. In addition, some mothers are not able to take responsibility for the child.
7. Shape changes. Some mothers begin to almost panic when they notice changes in appearance that are the result of pregnancy and the birth process. Gained pounds, stretch marks or sagging breasts - all this, coupled with low self-esteem, leads to real depression.
8. Lack of finance. It is not always possible for a mother to provide a child with a decent infancy. Because of this, a woman begins to consider herself a bad mother, which again causes a depressive state, which is aggravated by other prerequisites (psychological characteristics, low self-esteem).
9. Problems with a partner. The process of labor activity often leads to further difficulties with sexual life. First, there are various physical limitations. Secondly, fatigue, accompanied by reduced libido. Thirdly, sometimes women even have an extremely negative attitude towards sex in the first few months after childbirth.
10. Unfavorable atmosphere. This cause consists of several factors leading to postnatal depression. Among them may be the indifference of the husband, rejection from his relatives, the spouse's addiction to alcohol (he likes to smoke and drink with the child), the absence of any support.

In some situations, postpartum depression occurs after a spontaneous abortion or after the birth of a dead baby.

Consequences for children and spouse

What threatens postpartum depression in a mother for a child? First of all, a depressed woman is simply not able to fully fulfill her maternal responsibilities. Sometimes mommy refuses to even breastfeed her baby, because she does not feel love for him. What are the consequences?

• The development of the baby also slows down. The child does not sleep well, worries, in the future he may experience a variety of mental disorders (for example, a predisposition to depressive states).
• Due to the lack of skin-to-skin interaction, a variety of processes associated with emotional development suffer in a child. Subsequently, the baby may develop speech disorders (for example, logoneuroses), problems with concentration, etc.
• Children raised by mothers in a state of depression rarely show positive emotions, interest in contact with objects and loved ones. It is curious, but such a child tends to worry less when separated from his mother (other children have a sharply negative attitude towards such a development of events).

How does the stronger sex react to female postpartum depression? Men, of course, are unhappy with this behavior of the spouse. Some of them generally take a serious mental disorder as a kind of whim, and therefore refer to women's problems, respectively.

The stronger sex, of course, seeks to restore the former sex life, which usually cannot be achieved. It is no secret that among all the global changes in family life associated with the birth of a child, men strive, first of all, to maintain stability in the matter of intimate relationships.

In some situations, men also experience postnatal depression. Some of the reasons for its appearance in a certain way are in contact with developmental factors in women.

The stronger sex falls into a depressive "trap" because of the feeling of uselessness to the spouse, lack of finances, lack of sex, etc.

It is much easier to prevent the development of postnatal depression than to fight it later. Moreover, it is not known how long (days, weeks, months) the symptoms of this psychological disorder will pass.

So, postpartum depression is able to “go sideways” to both the mother herself, the child, and other household members. And do not think that this state will certainly not affect me. That is why it is not necessary to let this problem go by itself.

If a woman does not want to switch off from a full-fledged life for half a terrible year, it is necessary to act even before the time when she is on maternity leave. What to do?

Once again, we repeat the common rule: it is easier to prevent a disease than to try to get rid of it later. Postnatal depression is also a disease, so you don't have to wait for it to go away on its own. The help of a specialist is extremely important in such a situation.

If your condition after childbirth is expressed by the words “I’m crying, I can’t stop, no one understands me,” it’s time to help yourself and your child. Expert advice will help get rid of postnatal depression.

1. The doctor will help you deal with the problem. To save yourself from possible troubles, you must follow medical advice. For example, when prescribing medication, all the necessary procedures should be followed. However, it is strictly forbidden to take medicines on your own, even if the women's forum says that "such and such a remedy saved me."
2. Don't give up on the support of your loved ones. The help of a spouse or mother-in-law is not something shameful, but an important necessity, especially when you cannot get rid of negative thoughts on your own. A husband, mother, grandmother or close friend will help you get out of the emotional "trap". Accept their support before you cross the line.
3. No need for a new mother to be ashamed of being overweight. Remember that you, at least half the due time, ate for two, so extra pounds are a completely natural phenomenon. Do not go on diets according to the recommendations of "well-wishers". Natural feeding helps to get rid of excess weight, so do not neglect breastfeeding, especially in the first month.
4. Try to negotiate with your spouse about short-term "holidays". Going to the cafeteria, going to the pool or shopping, walking around your favorite place - all this will distract from the need to constantly be with the child. Believe me, no one will think that you are a terrible mother, leaving the baby to the "arbitrariness of fate."
5. As we have already noted, the stronger sex pays special attention to the intimate side of married life. Try to talk to your husband about this topic, very calmly and tactfully. If you do not want to make love, give serious arguments. For example, a month or a half is the restoration of the uterus. This argument is better than the words "I don't care about sex right now." By the way, making love is another effective method to escape from postnatal depression.
6. Try to get away from kitchen chores for a while, since it is much more important for a child to spend more time with mom than to watch her culinary talents. Perhaps the stronger sex in the person of your spouse will take on the responsibility of preparing dinner.
7. Postpartum depression is often exacerbated by lack of sleep. when mommy has been trying to earn the title of “supermom” for a year or longer. Have you put your child to sleep? Lie down next to each other for at least 10 minutes. Believe that the opinion “no one can replace me” is erroneous. A woman is more likely to get rid of depressive thoughts if she acquires a baby monitor or shifts part of her worries to household members.
8. Include foods enriched with calcium-containing foods and ascorbic acid in your own diet. These substances help to get rid of a depressive state in some situations as effectively as drugs. This recommendation is another argument in favor of abandoning various food restrictions.
9. A newly-made mother will get rid of postnatal depression if she does not refuse to communicate with friends and close friends on maternity leave. Talk to other women who have a similar problem. Probably, one of them coped with depressive thoughts and blues. In any case, even emotional support is the floor of a successfully completed business.
10. Mom will soon cope with the problem if she walks more often with the child. Firstly, it is a change of scenery, and secondly, it is always useful to breathe fresh air and walk some distance. By the way, this will help in a more natural way to lose those extra pounds.

Often, the monotony of actions seriously complicates the course of postnatal depression. Follow these tips through “I can’t”, focusing on the benefits for yourself and the child.

Therapeutic measures

Therapy for postnatal depressive disorder involves observation, examining the woman, collecting information and comparing symptoms.

If the doctor suspects that a hormonal shift is the cause of postpartum depression, he or she may suggest taking a blood test to determine the level of certain hormones.

Experts identify only two effective ways to get rid of a depressive state: taking special medications and psychotherapeutic techniques.

1. If the condition is caused by a hormonal shift, a drug is prescribed to correct it. Another group of medicines is the latest generation of antidepressants, which maintain the necessary balance of hormones (in particular, serotonin). Some mothers are afraid to take antidepressants for fear of harming the baby or losing breastfeeding. However, a tense and irritated mother is much worse for the baby than medications allowed during feeding.
2. Mommy will cope with difficulties sooner if she uses the help of a qualified psychotherapist. Moreover, a specialist can offer NLP, psychoanalytic techniques, a hypnotic method to solve the problem. It all depends on how severe postpartum depression a woman has. In addition, psychologists often suggest using the methods of the family or cognitive psychotherapeutic school. These techniques work on deeper problems, youthful or even infantile complexes, which smoothly flow into adulthood and lead to depressive moods.

Postpartum depression is a complex psychophysiological condition, the course of which depends on many factors. Sometimes the spleen passes in a few weeks, in other cases it takes about two to three years.

In many ways, the effectiveness of treatment is associated with the ability of a woman to get used to a new role, the desire to get out of the vicious circle. However, the support of the spouse and the help of close relatives is no less important.

Hello, I'm Nadezhda Plotnikova. Having successfully studied at SUSU as a special psychologist, she devoted several years to working with children with developmental problems and advising parents on raising children. I apply the experience gained, among other things, in the creation of psychological articles. Of course, by no means do I pretend to be the ultimate truth, but I hope that my articles will help dear readers deal with any difficulties.