Dr Haleema Sheikh, pictured, of The Marion Gluck Clinic explains how the possible causes of PPD can be grouped into biological factors, social factors, and psychological factors
Postpartum depression PPD is a complex mood disorder that can affect as many as 1 in 7 women after childbirth. It is more persistent and challenging than the ‘baby blues’ which affects about 75% of all women and starts on the fourth or fifth day after giving birth but usually settles quickly. PPD can emerge within four weeks post-delivery but may also manifest as late as 30 weeks post-partum so health practitioners should remain vigilant in trying to identify patients.
Pregnancy is a stressful high energy intensive period in a woman’s life where she is literally creating another human from her own body. A pregnant mother will give up her ‘good stuff’ to make the best baby that she can so looking after women’s lifestyle and health before getting pregnant and during pregnancy can have a significant impact on pregnancy outcomes including post-partum depression.
There appears to be a significant neuroendocrine component and changes in reproductive hormones in post-partum depression which set it apart from general depression. It arises from rapid shifts in numerous biological and endocrine systems, such as the immune system, the hypothalamic-pituitary-adrenal (HPA) axis, and lactation hormones.
The HPA axis, which regulates stress responses through cortisol our survival hormone undergoes changes during and after pregnancy and can play a significant role in the drop in mood. Additionally, rapid post-delivery shifts in hormones like estradiol and progesterone can trigger depressive symptoms in susceptible women. Hormones such as oxytocin and prolactin, which are involved in lactation, are also significant factors in PPD’s development, with decreased oxytocin levels being linked to depression and difficulties in breastfeeding.
PPD has some similarities to other types of depression yet has distinctive symptoms that may include feelings of hopelessness, guilt, worthlessness, irritability, and restlessness. Additionally, women with PPD may experience challenges with concentration, memory, and decision-making, along with a loss of energy, sleeping issues, and changes in appetite. In severe situations, PPD may lead to thoughts of self-harm and poor emotional bonding with the baby.
Alongside the emotional difficulties of PPD, the intensive physical demands of caring for a newborn and lack of sleep can often be overwhelming for many women. Our understanding of mental health issues is evolving and there appears to be a significant metabolic component with issues with brain energy production in the neuronal mitochondria (power house of the cell). The mitochondria can be affected by nutrition/ sleep/ toxins/stress and the better shape a woman is in going into pregnancy the more robust and resilient her brain mitochondria function will be during pregnancy and post-partum.
The possible causes of PPD can be grouped into biological factors, social factors, and psychological factors. This is helpful for healthcare professionals to be aware of to try to pick up at-risk and affected women early.
Biological Factors
In addition to the dramatic drop in estrogen and progesterone after childbirth autoimmune conditions such as Hashimoto’s thyroid disease and postpartum thyroiditis, an inflammation of the thyroid gland following childbirth, have been associated with various psychiatric disorders, including depression. These conditions involve a dysregulated immune system.
Social factors
Poor social support is a significant contributing factor in the likelihood of developing PPD- supportive relationships are protective and on an evolutionary level historically we were more likely to survive if we were part of a tribe because of cooperation. Isolation can put us into a survival state and persistent raised cortisol will exacerbate the drop in reproductive hormones post-partum. Thus, healthcare providers should be aware of such risks in single-parent families, domestic abuse victims and those who are struggling financially as well.
Psychological Factors
A previous personal history or family history of depression post-partum and those who have suffered from PMS/PMDD are more likely to develop PPD- important risk factors to be aware of and ensure support is put in early. Other risk factors include marital or relationship conflict, ambivalence about the pregnancy, pregnancy complications, and the strain of having a baby with special needs or a baby who cries a lot
The mainstream treatments for PPD are psychotherapy such as cognitive behavioural therapy +/- and psychotropic medication such as antidepressants. The main antidepressants used are SSRI’s which are thought to work by enhancing the serotonergic system in the brain.
However, there also appear to be other physiological processes which can be supported to provide holistic care and increase the likelihood of mainstay treatments working
The health of the gut microbiome plays a significant role in mood as 85% of the body’s serotonin is actually in the gut and there is more communicat