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What is Postpartum Depression?Postpartum depression refers to the range of physical, emotional and behavioral experiences that a new mother faces and finds challenging.   It ranges from mild to severe depression and can occur anytime during the first year after childbirth.History of Postpartum DepressionPostpartum Depression is not a condition that anyone just heard of recently… the condition already existed way back in history. Back in 700 BC, the Father of Medicine, Hippocrates, wrote reports about women experiencing emotional difficulties after childbirth.  In 1850s, Postpartum Depression was then defined by medical professionals as a mental disorder. During the 19th century, women decided against reporting the symptoms they’re suffering from for fear of being institutionalized and diagnosed with neuroticism or insanity.  On the other hand, women who reported the symptoms were subjected to unusual, various treatments.  Upon diagnosis, women were usually prescribed with Valium, a medication to treat anxiety disorders. But one of the unusual treatments that is being subjected to women who reportedly suffered from these emotional difficulties is Electroshock therapy. It wasn’t the case of taking the medication or enduring the electroshock therapy that kept women from voicing out that they suffered from Postpartum Depression, it was more of shame that other people will think of them as insane. But as of present, women are empowered to share their postpartum experiences to others, not only to shed light that this condition isn’t something we should be ashamed of, but to let other women know that they are not alone and that together we can work on finding ways to address it.How PPD affects the bodyAs it was mentioned before, Postpartum depression is very broad and complex that there are students, professionals and experts who continuously conduct research to better understand the illness. Some studies link the rise and fall of estrogen and progesterone in the blood to postpartum depression. In 2013, a group of researchers led by Laura Glynn, a psychology professor from Chapman University, found a biological link between elevated Placental Corticotropin-releasing hormone (pCRH) and Post-partum depression. The hypothalamus regularly secretes the Corticotropin-releasing hormone to stimulate the pituitary gland in releasing the Adrenocorticotropic Hormone (ACTH). The ACTH, in return, stimulates the adrenal glands to produce a hormone called cortisol, which helps the body manage stress. But during pregnancy, while the hypothalamus is doing its job to regularly secrete the CRH, the placenta produces its own hormones and that includes the corticotropin-releasing hormone known as pCRH.During the study, it was found out that women with pCHR levels that continuously go up have been consistent with reports of postpartum depression not too long after giving birth. The imbalance of the said hormone has inhibited the regulation of stress and other hormones that would begin to balance after the pregnancy. The diagram from the Chapman University study shows how the elevated pCRH is linked to PPD.  Who are at risk of PPD? Postpartum depression can affect any woman, at any time, regardless of their age, their ethnic background, race or economic status. As one of the indicators of women’s mental health along with history of depression, stress, and social support, postpartum depression and the other indicators are linked to four risk factors: smoking, use of alcohol, use of non-prescription drugs, and women’s history of physical and sexual abuse. The graph shown on the next page is taken from the website and it shows how these risk factors and postpartum depression are interrelated.  The above graph shows each specific risk factor that happened in a specific timeframe and its relation with the occurrence of the postpartum depression symptoms.  This also shows that the history of physical or sexual abuse is the most prevalent risk associated with PPD.How does PPD affect a person’s daily life? Postpartum depression affects not only the person who has it, but also the newborn she has given birth to. This illness affects the relationship of the mother and the baby in its entirety. The interaction between the two occurs less as mothers who are affected by PPD will pay less attention to their babies. This in turn affects the behavioral development of the baby.  Studies have shown that children may not perform well on some developmental task, compared to children whose mothers were not depressed. It is then emphasized how important it is to detect PPD early.Signs and Symptoms of PPDIt is not unusual to hear about after-birth depression nowadays, but depression can actually begin anytime in pregnancy.Before we discuss the signs and symptoms of Postpartum depression, it is best to understand how one can differentiate it from the other postnatal mood changes. The first one is what we call “baby blues,” which are common and considered normal for mothers. They begin in 2 to 4 days after the baby is born and the symptoms are usually mild. Rapid mood swings, feeling helpless, worried, irritable or anxious, and sometimes, a new mother cries for no reason. Postpartum Psychosis occurs in 1 to 2 mothers in every 100 childbearing women within the first 4 weeks after delivery. This type of postnatal mood change is quite extreme that interventions are needed right away. The woman with this diagnosis is feeling extremely confused and hopeless, finds herself unable to sleep, develops distrust of other people, starts seeing  or hearing things that are not there, and the worst case is, she starts having thoughts on harming herself, her baby or even other people around her.The Postpartum depression falls somewhere between the baby blues and postpartum psychosis. The signs and symptoms of Postpartum Depression may be overlooked  and that contributes to inaccurate diagnosis. Some signs that are quite subtle but relevant are delivered through slip of the tongue, the tone and emotion displayed by a woman. The common signs and symptoms are usually seen on how they react and interact with people. The examples are the following: extreme anxiety (moody, irritable, restless), sense of failure, feelings of guilt, sleep disturbances (oversleeping or being unable to sleep), appetite disorders (eating too little or too much), excessive concerns about the baby, and suicide ideation (thinking of harming herself and the baby). Diagnostic Tests and Procedures How does a child-bearing woman find out whether she’s suffering from postpartum depression? If a woman or anyone from her family suspects the child-bearing woman having the early signs of depression, it is best to see a health care provider. The health care provider (usually a physician), can help a woman figure out the symptoms she’s feeling as the condition is very broad and it’s usually a different experience for every woman.  Patients who are at risk may be considered for the EPDS screening. Edinburgh Postnatal Depression (EPDS) consists of a 10-item self-rated instrument and this is used widely to screen for postpartum depression. If a patient scores 13 or greater, then that person should be assessed for depression.  In some cases, even though the score is less than 13 but the patient said yes or confirmed that she experiences the one in item number 10 (suicidal ideation), then she is considered for the assessment. Once a woman is diagnosed with postpartum depression, another instrument called Mood Disorder Questionnaire is used to assess and detect manic features. Another tool that is used to screen PPD is Postpartum Depression Screening Scale (PDSS) which is developed by C.T. Beck and R. K. Gable. Basically, this is a 35-item, self-report screening tool that considers seven symptom areas to detect depression: emotional lability, mental confusion, sleeping/eating disturbances, anxiety/insecurity, loss of self, guilt/shame, and suicidal thoughts. And because this screening tool goes in depth in each area, the PDSS has a sensitivity of 94% in detecting depression. Women who scored 80 or more are diagnosed with depression. For the women who scored 16 (not depressed) should be tested every three months for the first year after giving birth. Treatments of PPD Upon early recognition and diagnosis of Postpartum depression, the health care provider shares treatment options and helps the new mother make an informed decision regarding the treatment. Treatments include antidepressant medications to help regulate the moods. It is important to let the patient know that the medication may take a week or so before they get to notice the medication’s effect. For breastfeeding mothers, Selective Serotonin Reuptake Inhibitors are recommended most by experts. Other forms of treatment include counseling therapy. Its two types of therapy are: Cognitive Behavioral Therapy which helps people recognize and come up with ways on how to change their negative thoughts and behaviors, and Interpersonal therapy which focuses on empowering patients into understanding and working through their problematic personal relationships. For a severe form of postpartum depression, the most effective yet is considered the most stigmatized treatment is the Electroconvulsive therapy. This type of therapy involves the application of electrical stimulation to produce a seizure in the brain of the patient and this treatment can be repeated if necessary to achieve the expected response.The costs of having the illness It was reported on 2016 that a survey was conducted by Statistics Canada in year 2012 to determine how much the illness costs per year. Depression in general, costs the Canadian government $ 32.3 billion in lost gross domestic product. According to Louis Thériault, vice-president of public policy for the Conference Board, the probable underlying cause is a large proportion of Canadians have unmet mental health care needs. He said that this has a huge consequence to the economy as it impedes the optimal function a Canadian can perform.Current Research on PPD There’s a recent application called PPD ACT that was launched by the Women’s College Hospital, which they already brought here in Canada after a successful launch in United States of America and Australia. That app is designed to help the researchers understand the interaction of genes and the environment in predicting which women are at risk in developing PPD.    There’s also the Rush University Medical Center that seeks women with PPD diagnosis for an experimental research study to treat postpartum depression using Transcranial Magnetic Stimulation (TMS), a non-invasive medical treatment to treat clinical depression.

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