What is postnatal depression?
Postnatal depression is depression that occurs within a year after giving birth. After delivery, you may experience a range of emotions including excitement, joy, and anxiety. You may even feel sad or depressed. Having a baby is a life changing event that can trigger different reactions in different people influenced by social, psychological, and biological factors.
A state of feeling low, emotional, and teary two to three days after giving birth, and up to two weeks is called “baby blues” and it is normal. However, if it continues beyond two weeks, and is increasingly worsening then it is postnatal depression.
Postnatal depression can further present with helplessness, hopelessness, excessive worry, inability to enjoy things you used to find pleasure in, fatigue, insomnia, low energy, changes in appetite, inability to bond with the baby, and in severe cases intrusive thoughts of accidentally or intentionally harming the baby or yourself.
Untreated postnatal depression may have adverse effects on the mother, baby, and the family system and treatment is therefore imperative. Good news is that postnatal depression can be treated! Treatment options include antidepressant medication and psychotherapy. The focus of this article is on psychotherapy.
What is psychotherapy?
Psychotherapy, also called talk therapy, is a process of treating a wide variety of mental health illnesses (such as depression and emotional difficulties) which involves talking to professionals such as clinical social worker, professional counselor, psychologist, or psychiatrist. It may be conducted in an individual, family, partner, and/or group settings. It helps to cope with everyday life stressors.
Psychotherapy is the first line of treatment in depression, particularly in postpartum depression. Most breastfeeding women prefer psychotherapy over antidepressant medication due to concerns of risks to the baby, despite the fact that several studies have shown that most antidepressants have minimum to no adverse effects.
How does psychotherapy for postpartum depression work?
Psychotherapy works by relieving symptoms of depression through educating new mothers about changes they can implement themselves (including healthy diet, hydration, sleep, support, and exercise).
Depressed women tend to have negative thought patterns which contribute to their depression. The aim of psychotherapy is to break the negative thought pattern and replace with a positive mindset.
When the mother is emotionally feeling better, her unconscious thoughts can be uncovered by asking about childhood experiences. Psychologists believe that we are the products of our past experiences. Our distress and behavior are influenced by our life experiences. Therefore, digging into the past may bring understanding, self-awareness, and corrections. Then new ways of thinking may be cultivated changing our beliefs or instincts.
Which therapies are recommended for postnatal depression?
There are many psychotherapy methods that can help with postpartum depression including:
Interpersonal Psychotherapy (IPT)
It is one of the most effective modalities of therapy for treatment of depression with high recovery stats, as shown in research studies. This therapy is time limited, taking three to four months. IPT helps patients to understand that postnatal distress arises from:
Unresolved grief
Interpersonal disputes- the commonly occurring one is after birth. Research shows that most new mothers report to receive less support than they need from family, friends, and partners. The lack of support is more prominent with their partners. The unmet expectations result in disputes.
Transition in roles- such as becoming a mother, changing jobs; and
Interpersonal deficits- which is problems relating to others.
IPT therefore teaches new mothers how to express their emotions without arousing conflicts, communication skills, and how to relate to others. Thus, offering immediate relief of symptoms, improving interpersonal functioning, and building the required social networks.
Cognitive Behavioral Therapy (CBT)
Helps mothers to recognize and change negative thoughts and behavior patterns that result in depressed moods, and substitute them with positive thoughts and approvable behavior. It identifies problems and provides solutions to them. It is believed to help with several mental health disorders including depression, anxiety, eating disorders, and trauma related disorders.
Dialectical Behavioral Therapy
Is a specific type of CBT that regulates emotions. It helps with management of chronic suicidal thoughts, borderline personality disorders, eating disorders, and post-traumatic stress disorder. It instills skills that help people take charge of their emotions and feelings to break inappropriate behaviors.
Psychodynamic Therapy
Helps patients understand that their current distress and behavior is paved or influenced by earliest childhood experiences and that recurring inappropriate thoughts and feelings occur unconsciously. When patients acknowledge this fact and accept that their childhood experiences play a role in who they are at present, then they are better equipped to let go of the past and heal. After which, new appropriate beliefs may be cultivated. In the sessions a therapist may ask about relationships with parents as well as other past experiences to uncover the unconscious way the patient thinks. With understanding and self-awareness, the patient may be self-validated and less judgmental of herself.
Psychoanalysis- it is a more intensive form of psychodynamic therapy with more sessions.
There are many more models of psychotherapy that help in the management of depression but the above are more relevant and commonly used in the treatment of depression.
Does psychotherapy work?
Psychotherapy has been proven to improve negative emotions through improving the brain chemistry and body behavior. Research shows that psychotherapy alleviates symptoms of depression. About 75% who enrolled in psychotherapy testifies that it is helpful and beneficial.
How can I find a psychotherapist?
As established, psychotherapy is offered by different professionals including psychiatrists, psychologists, social workers, and counsellors. Your doctor may refer you to any of these outlined professionals. Some medical aid schemes cover counselling and they may list the mental health professionals they work with.
What are the effects of untreated postnatal depression?
Untreated depression may cause serious illness for the mother, baby, and family at large. Some of the effects include:
Mother:
You may develop chronic depression.
You are at higher risk for smoking, abusing alcohol, and using illicit drugs.
PND may affect your ability to interact with the baby.
Thoughts of harming a baby, either accidentally or intentionally.
Suicide. Research shows that suicide remains an important cause of maternal death in low- and moderate-income countries.
Poor response to the baby’s ques.
Child:
Poor mother to child interaction results in decreased cognitive function and the child may develop behavior problems and emotional disorders such as anxiety.
This article is written by Dr Katleho Tau (MBChB-UKZN)
References:
1. Stuart S. Interpersonal psychotherapy for postpartum depression. Clin Psychol Psychother. [Internet]. University of Lowa. 2012 March-April; 19(2):134-140. Avail from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141636/
2. Fitelson E, Kim S, Leight K. treatment of postpartum depression: clinical, psychological, and pharmacological options. Int J of Women’s Health. [Internet]. Columbia University Medical Centre. 2011; 3:1-14. Avail from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039003/
3. Kripke K. 8 Types of Psychotherapy for Postpartum Depression Treatment. [Internet]. Postpartum Progress. Avail from: https://postpartumprogress.com/8-types-of-psychotherapy-for-postpartum-depression-treatment
4. Mental health foundation. Postnatal depression. [Internet]. Mental health foundation. 2022. Available from: https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/postnatal-depression
5. Parekh R, Givon Lior. What is psychotherapy. [Internet]. American Psychiatric Association. 2019. Avail from: https://psychiatry.org/patients-families/psychotherapy
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