Postpartum fearful dream: postpartum depression

Postpartum Fear: Postpartum Depression

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Giving birth in a woman’s life is undoubtedly an event that radically changes her life and way of life. Men’s memories of military service and women’s memories of birth compete head-to-head. It will require a certain recovery period for women to return to their former healthy psychological state, from their hormone levels to postpartum.

When we talk about postpartum disorders, we usually think of postpartum depression. However, various disorders such as postpartum sadness, obsessive-compulsive behavior disorder, and psychotic disorders may occur.

In this study, while discussing postpartum depression, the findings in the studies on this subject, especially in the meta-analysis studies, will be discussed by scanning the literature. By sharing the findings in the reviewed articles, the phenomenon of postpartum depression will be tried to be explained and understood.

1. Postpartum Depression

Birth is a phenomenon that can trigger psychological problems. In DSM-5, a major depressive episode with peripartum onset is defined as postpartum depression when it occurs during pregnancy or up to 4 weeks postpartum (APA, DSM-5, 2013). While it defines it as postpartum depression, ICD-10 associates mental disorders that begin within 6 weeks after birth with puerperium (Öztürk, 1993).

Postpartum mothers often exhibit hostile attitudes, may be low-tolerant and neglectful, less responsive to infants’ needs. In addition, studies have shown that the postpartum depression of the mother also affects the depression of the father. Mothers are often characterized by temporary mood lability, insomnia, irritability, agitation, and erratic behavior. Although biological factors related to postpartum depression have been suggested, its specific etiology is unclear. (Shorey et al, 2018)

2. Factors Related to Postpartum Depression:

2.1. Breast-feeding

Another important issue after birth is the mother’s breastfeeding. Not only in terms of meeting a physical need, but also the basis of secure attachment is a regular breastfeeding relationship. As mothers who experience postpartum depression sometimes do not want to breastfeed their children, the physical and mental development of their children may be adversely affected. In addition, the anxiety and the feeling of helplessness of mothers who do not have enough milk that they cannot feed their children enough are also a condition that can be seen in postpartum depression. In both cases, studies have shown that there is a significant relationship between breastfeeding of that baby and the mother’s postpartum depression. (Xia et al, 2022)

2.2. Father’s depression

In addition, postpartum depression is not only a phenomenon seen in mothers, but also postpartum depression can be seen in fathers. Postpartum depression in fathers increases the risk of postpartum depression in mothers. Paternal postpartum depression can have many negative effects on the health of the whole family, and conditions such as fatigue, insomnia, loss of appetite, and suicide risk that impair quality of life and social interaction may occur for fathers. Studies have shown that as a risk factor for postpartum paternal depression; unemployment, financial distress, low social support, perceived stress, history of mental illness, childbirth, maternal postpartum depression, and low marital relationship satisfaction. (Wang et al, 2021)

2.3. Personality characteristics

Studies have shown that there is a significant relationship between clinical depression and personality traits. Certain personality traits increase vulnerability to depression. When postpartum depression was examined, results similar to clinical depression were obtained, but a significant and high degree of correlation was found between postpartum depression and neuroticism. Again, a significant and strong relationship was found between the anxious and vulnerable personality style and postpartum depression. (Puyane, M, 2022)

2.4. Perinatal Pain

Perinatal pain refers to pain that occurs from the 28th week of pregnancy. Pain is a risk factor for postpartum depression. Can births where pain can be reduced by methods such as epidurals, and sufficiently relieved pain, reduce the risk of postpartum depression? Although studies at this point show that there is a relationship between the two variables, it has been revealed that investigating other factors such as anxiety experienced during pregnancy, perceived stress, previous stressful life events, and lack of social support is necessary to reduce the risk of postpartum depression. (Mo, J et al, 2022)

2.5. Pregnancy Weight Gain

It is important for this process to monitor the amount of weight gained during pregnancy and the weight of the mothers who will give birth in routine controls. Excessive weight gain or insufficient weight can adversely affect the mother and baby during pregnancy. The studies carried out are in this direction. Increasing health awareness, healthy weight management during pregnancy and developing strategies to achieve this, preventing excessive weight gain and underweight are some of the strategies that can be applied to prevent postpartum depression. (Qiu, X et al., 2022)

2.6. Gestational Diabetes

High blood sugar during pregnancy is a glucose intolerance condition. It occurs in the body of pregnant women who do not have a history of diabetes. Gestational diabetes can cause serious problems for mother and baby and is a common problem. It usually occurs between the 24th and 28th weeks of pregnancy. When the stress caused by chronic disease treatment is added to it, it has been seen in studies that diabetes in pregnancy is among the risk factors that can develop postpartum depression. (Azami, M et al, 2019)

3. Situation in Turkey:

In studies on postpartum depression in Turkey, its incidence was found to be high, especially in rural areas. Studies conducted in Turkey have shown that the highest risk factor is familial problems. The difficulties brought by a traditional family are an important risk factor for Turkish women. Again, socio-economic inadequacies, spouse’s status and working status, insufficient education, early marriage, unplanned pregnancy, stressful events during pregnancy are among the risk factors. (Ozcan, NK et al, 2017)

4. Postpartum Depression Treatment

Medication, psychotherapy and physical therapy are used in the treatment of postpartum depression. Of these, psychotherapy is the first-line treatment approach in the treatment of postpartum depression. Antidepressant medications are among the options for patients who have severe symptoms and refuse to receive psychotherapy. Women who develop postpartum depression are significantly more likely to have lower levels of vitamin D than women who develop postpartum depression.(Ogiji, J, & Rich, W., 2022)

Medications used for postpartum depression mainly include depression, anxiety, and psychosis-resistant drugs, as well as sedative hypnotic drugs and mood stabilizers. Since the drugs taken during this period are likely to pass to the baby through breast milk, the drugs should be chosen carefully and should be safe for the baby. Again, as it is given to normal patients, the drugs used by the patient before, drug allergy history, drug side effects and the wishes of the mother should also be taken into account when determining the drug.

In a meta-analysis study conducted in the People’s Republic of China, SSRI and SNRI group drugs are the main drugs for postpartum depression. In clinical practice; Escitolopram, Sertraline and Venlafaxine are primarily used in the treatment of postpartum depression due to their effectiveness. Especially Sertraline is the most preferred drug in the People’s Republic of China. Studies on postpartum breastfeeding are limited at the drug point of view, and up-to-date and comprehensive studies are needed. (Wang, X. and Sun, K., 2022)

The effects of psychological interventions through psychotherapy on postpartum depression have been positively demonstrated by many studies. At this point, interpersonal psychotherapy is seen at the forefront of studies. This school is a short-term therapy school that focuses on staying in the moment and states the situation among people with depressive symptoms. When studies compared individuals who received only drug treatment and those who received therapy and drug treatment together, the group who took both together showed a significant improvement in their social problem solving skills and depression level compared to the first group.(Spinelli MG, Endicott J., 2003)

Source

1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Arlington (VA): American Psychiatric Publishing; 2013.
2. Azami, M, Badfar, G., Soleymani, A., Rahmati, S., The association between gestational diabetes and postpartum depression: A systematic review and meta-analysis, diabetes research and clinical practice 149 (2019) 147–155, https ://doi.org/10.1016/j.diabres.2019.01.034
   Mo, J, Ning, Z., Wang, X., Lv,F., Feng,J., Pan, L., Association between perinatal pain and postpartum depression: A systematic review and meta-analysis, Journal of Affective Disorders 312 (2022) 92–99 , https://doi.org/10.1016/j.jad.2022.06.010
3. MO Öztürk, B Uluğ (Translation Ed), World Health Organization. ICD-10 Classification of Mental and Behavioral Disorders, Ankara: Turkish Nervous and Mental Health Association Publication, 1993.
4. Ogiji, J, and Zengin, W., An exploratory study of vitamin D levels during pregnancy and its association with postpartum depression, Psychiatry Research Communications 2 (2022) 100021, https://doi.org/10.1016/j.psycom.2022.100021
5. Qiu, X, Zhang,S, Yan,J., Gestational weight gain and risk of postpartum depression: A meta-analysis of observational studies, Psychiatry Research 310 (2022) 114448, https://doi.org/10.1016/j. psychres.2022.114448
6. Özcan, NK, Boyacıoğlu NE, Dinç H., Postpartum Depression Prevalence and Risk Factors in Turkey: A Systematic Review and Meta-Analysis, Archives of Psychiatric Nursing 31 (2017) 420–428, http://dx.doi.org/ 10.1016/j.apnu.2017.04.006
7. Puyane, M, Subira, S., Torres, A., Roca, A., Personality traits as a risk factor for postpartum depression: A systematic review and meta-analysis, Journal of Affective Disorders 298 (2022) 577–589, https ://doi.org/10.1016/j.jad.2021.11.010
8. Shorey, S., Chee, CYI, NG, DE, Chan, YH, Tam, WWS, Chong,Y,S., Prevalence and incidence of postpartum depression among healthy mothers:A systematic review and meta-analysis , Journal of Psychiatric Research 104 (2018) 235–248, https://doi.org/10.1016/j.jpsychires.2018.08.001
9. Spinelli MG, Endicott J. Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. American Journal of Psychiatry. 2003;160(3):555-562.
10. Wang, D, Li, Y., Qui, D., Xiao, S., Factors Influencing Paternal Postpartum Depression: A Systematic Review and Meta-Analysis, Journal of Affective Disorders 293 (2021) 51–63, https://doi .org/10.1016/j.jad.2021.05.088
11. Wang, X. Ve Sun, K. Real-world pharmacological treatment of patients with postpartum depression in China from 2016 to 2020: A cross-sectional analysis, Saudi Pharmaceutical Journal 30 (2022) 1418–1425 , https://doi.org /10.1016/j.jsps.2022.07.002
12. Xia, M, Luo, J., Wang, J., Liang Y., Association between breastfeeding and postpartum depression: A meta-analysis , Journal of Affective Disorders 308 (2022) 512–519, https://doi.org/ 10.1016/j.jad.2022.04.091