Postpartum depression or ‘baby blues’? Signs new mums should not ignore

Dubai: It’s been six weeks since you gave birth and on the surface, everything seems in place – you’re feeding the baby, changing nappies and going through the motions of the day. Internally, though, there is a disconnect – a sense of heaviness that just doesn’t quit, watching yourself from the outside, doing everything you ‘should’ as a new mum. That, according to Dr Dalia Nagui Rizk, Consultant Psychiatry and GCAA Aviation Medicine Specialist at King's College Hospital Dubai, is just one of the ways a more serious challenge for new mums presents itself – postpartum depression (PPD). “Postpartum depression is a clinical mood disorder, not a personality flaw or a sign of weak character, which can begin during pregnancy or anytime within the first year after childbirth,” she said. And while the weeks after having a baby are often expected to be exhausting and emotionally overwhelming, there is an important distinction between the commonly experienced “baby blues” and postpartum depression. Dr Dalia Nagui Rizk, Consultant Psychiatry and GCAA Aviation Medicine Specialist at King's College Hospital Dubai Baby blues vs postpartum depression What is commonly referred to as baby blues has a lot do with the dramatic hormonal shift every woman experiences while going through pregnancy and childbirth. According to Dr Rizk, this affects up to 80 per cent of new mums and can involve tearfulness, mood swings and feeling overwhelmed for anywhere from a few days to two weeks. It is also something that resolves on its own. PPD, on the other hand, does not follow the same trajectory. “The baby blues feel like ‘a bad week’. PPD feels like ‘I don’t recognise myself, and it’s not getting better’,” Dr Rizk said. The World Health Organisation and large-scale meta-analyses place the prevalence of postpartum depression at roughly 10 to 15 per cent of new mothers, according to Dr Rizk. “So, in a room of 10 new mothers, statistically one or two are likely struggling,” she said. This percentage can be higher in groups that face additional stressors such as limited social support, financial strain, migration or a previous mental health history, she added. What causes postpartum depression? Dr Gregor Kowal, German Board-Certified Consultant Psychiatrist and Psychotherapist and Medical Director of CHMC German Clinic for Psychiatry and Psychology in Dubai, said PPD can be the result of a combination of biological, psychological and social factors during pregnancy and after childbirth. While hormones do play a role – with levels of estrogen and progesterone falling rapidly after delivery and other hormonal systems involved in sleep, mood and stress regulation changing as well – hormones alone do not explain why one woman develops PPD and another does not. “Persistent lack of restorative sleep can affect mood, concentration and emotional regulation and may intensify an existing vulnerability to depression,” Dr Kowal said. Dr. Gregor Kowal, Medical Director of CHMC German Clinic for Psychiatry and Psychology in Dubai Then there are a host of psychological and social demands that come with becoming a mother, according to Dr Kowal – changes in identity, increased responsibility, relationship conflict, lack of practical or emotional support, a traumatic delivery, pregnancy or birth complications, breastfeeding difficulties, financial or occupational stress and social isolation can all contribute to depressive symptoms, he said. “Postpartum depression is therefore best understood as a multifactorial psychiatric disorder rather than simply a consequence of hormonal changes after childbirth,” he said. What signs should you look out for? According to Dr Rizk, PPD can exhibit in any of the following ways: Mood: Persistent sadness, emptiness, hopelessness or unexplained crying spells lasting more than two weeks. Feeling a disconnect: Difficulty bonding with the baby. For example, going through caregiving tasks mechanically without feeling the emotional warmth one expects. Low energy: Exhaustion that isn’t fixed by sleep, appetite changes or physical aches with no clear cause. Thinking: Trouble concentrating, indecisiveness or intrusive thoughts, such as: “What if something happens to the baby because of something I did?” Self-perception: Overwhelming guilt or feeling like “a failure” as a mother, even when objectively caring for the baby well. Anxiety and irritability: Snapping at a partner over small things or experiencing a racing sense of dread. Severe warning signs: Thoughts of self-harm or harming the baby. According to Dr Rizk, this is a medical emergency requiring immediate care. Am I at a greater risk for PPD? There are certain factors that can increase a woman’s vulnerability to postpartum depression, or more serious conditions like postpartum psychosis. While PPD can occur after any pregnancy, including among women with no previous psychiatric history, Dr Kowal spoke about how one of the strongest risk factors is a previous episode of de