Causes of postpartum depression

Pregnancy, childbirth, and the onset of breastfeeding bring about rapid hormonal changes in a woman’s body. Hormonal fluctuations are associated with depression during pregnancy, postpartum depression, and postpartum psychosis.

During pregnancy, most hormones are produced by the placenta, while the ovaries are resting. Once the placenta is expelled, the ovarian function recovers slowly, with a delay of several months. After childbirth, the level of oestrogen collapses sharply. It may briefly collapse down to levels equivalent to that of menopause. As a result, the serotonin levels in the brain drop. This in turn causes a decline in mood. At the same time, as the amount of night sleep changes and the severity of stress grows, the numbers of stress hormones in the brain increases. This in turn further lowers the brain’s serotonin levels. In addition, the hormones that maintain breastfeeding keep the oestrogen levels low, which then allows a negative cycle to form with the hormone levels. The same hormonal changes occur in all mothers, and it is not known exactly why some get sick and others do not.

Sometimes postpartum depression can be caused by previous history with depression, e.g., having suffered from depression at an earlier stage in life or during pregnancy. One is also more likely to develop depression if they have a family history with the illness.

Childbirth may also be traumatising, which can also trigger depression. A childbirth experience is always individual and no one else can determine whether a certain childbirth has been difficult.

A difficult childbirth that has not been addressed can overshadow parenting throughout infancy. If the experience bothers you to such an extent that it interferes with everyday life and prevents you from fully enjoying the first year with your baby, we strongly recommend seeking help.

One’s own childhood mother-child relationship and the issues related to it can contribute to the onset of the depression. Becoming a mother can trigger a broader crisis in one’s own life: problems related to one’s own parents awaken when you are most distressed.

Changing life circumstances and challenges in social relations
As the baby finally arrives, life is bound to change completely. There is no “you time” and cracks in a romantic relationship can occur. Your own presuppositions about motherhood can be very different from what everyday life with the baby ends up being. Many mothers feel very lonely. There may not be anyone in your immediate social circle with a baby. The extended family and relatives may live far away. Loneliness, isolation, a sense of being different and a lack of support go hand in hand. According to some studies, the mother’s well-being is significantly better if the grandmother can provide support in caring for the new baby.

Symptoms of postpartum depression

Fatigue: The mother is abnormally tired and exhausted. Adequate rest and sleep do not eliminate the fatigue.

Difficulty sleeping: The mother may have difficulty falling asleep or she may wake up very early in the morning for no apparent reason. She may sleep restlessly and intermittently. She may also sleep so much that is it unusual.

Anxiety and worry: She feels very anxious, and the symptoms are often at their worst in the mornings. She finds it extremely difficult to relax. The overall state is tense and anxious.

Irritability: The mother reacts strongly to everyday adversity. For instance, she may be abnormally snappy and difficult towards her spouse.

Loss of enjoyment of life: The mother’s mood decreases, feelings of guilt and inferiority increase. Negative thoughts and feelings increase. It is difficult to experience joy and remember the good things.

Uncertainty about your own motherhood: She is unsure about her own ability to take care of the child. The mother may be wondering if she is doing things right and whether she dares to indulge in one activity or another. She may also fear doing it all wrong.

Being overly worried about the child: The mother is concerned about the child’s health, eating, sleeping, and whether the child is breathing. It is very difficult for a mother to leave her child for others to care for.

Depression, low mood: The mother may be depressed, unhappy, and constantly tired or tired at certain time of the day. They experience constant fluctuation between the good and bad moments and days.

Panic symptoms: Panic symptoms are severe and sudden physical symptoms such as palpitations, perspiration, anxiety, rapid breathing, and tension can occur. They can manifest, for example, as fear of being in public.

Obsessive thoughts: The mother may be, for instance, very scared of harming the baby.

Fears: The mother has unrealistic fears that are very strong given the situation. For example, she may be afraid of the death of herself or her baby.

Changes in appetite: Her appetite may almost completely disappear or increase markedly.

Troubles with sexuality: The mother’s sex drive can be greatly reduced or completely lost as feelings of pleasure disappear.

Physical symptoms: Sometimes depression can first appear as various physical symptoms. Signs may include an upset stomach, hair loss, mild increase in body temperature, night-time perspiration, vomiting, or light-headedness. Headaches, neck and back problems, various limb aches, chest pain, and gastrointestinal problems can also hide depression.

Treatment of postpartum depression

Start seeking help in these places:

• Maternity and child health clinic (neuvola)
• A public or private doctor, or a psychiatrist
• Psychologist, psychiatric nurse, later possibly a psychotherapist (reimbursement possibility by Kela)
• Psychiatric clinic or the emergency room
• Family counselling
• Äimä ry’s peer support, more information here
• In the event of an emergency, call the emergency number 112

Postpartum depression is mostly treated with conversational support (by a psychologist, psychiatric nurse, or a psychotherapist) or antidepressants. It is generally accepted that the combination of conversational aid and antidepressants is effective in the treatment of depression. For the mildly depressed, simple conversational help and light exercise may be a sufficient treatment – while also keeping in mind the healing nature of time.   

The more severely depressed often need medication to help them climb out of the deepest pit of depression.

Where can I get help for postpartum depression?

Some mothers may need regular appointments with a psychotherapist for several years to support them. Who is entitled to Kela-reimbursed rehabilitative psychotherapy? Receiving Kela’s rehabilitative psychotherapy requires, among other things, that:

• the applicant’s ability to work or study is threatened due to a mental disorder.
• the applicant has had an active doctor-patient relationship for at least three months after receiving a psychiatric diagnosis. The treatment has included the necessary medical, psychiatric, and psychotherapeutic examination and treatment.

Rehabilitative therapy can be implemented as one-on-one, group, family, or couples’ psychotherapy. The rehabilitative psychotherapy sessions are reimbursed up to 80 times a year and 200 times in total. Kela also reimburses so-called short psychotherapy.

Postpartum depression is a treatable illness with full recovery.

Is it depression or something else?

Postpartum depression can also be associated with other mental symptoms, such as anxiety, obsessive thoughts, panic-like experiences, or even panic disorder symptoms.  Sometimes depression can turn into a bipolar disorder. 

Anxiety: After giving birth, the mother may be severely anxious. What defines the sort of anxiety that one should act on? There is nothing worrisome in the situation yet if the new-born baby makes you as parents extra alert and very cautious. It is a natural fact that a very small child will not survive if the parents are not vigilant. Nevertheless, at worst, the mother’s anxiety can be overflowing and unbearable.

It is important to recognise when it is best to seek help for anxiety. The most valid way to measure one’s wellbeing is one’s ability to function in everyday life. Is the anxiety you are experiencing occasional or crippling? Can you enjoy your time with your baby? In case what you are feeling is intolerable or you feel scared of touching your own baby and the baby feels unfamiliar, contact a health care professional as soon as possible: a nurse, doctor, psychologist, or a psychotherapist (the text herein is based on an interview with psychologist Hannele Törrönen).

Bipolar disorder causes extreme mood swings that include highs (mania or hypomania) and lows (depression). The episodes can also be mixed. Mania is a period where the mood is euphoric, but quarrelling with loved ones often characterises this period. Conflict sensitivity is thus common in the mania phase. Hypomania, on the other hand, is a mild form of mania that can be compared to, for example, a flow state of mind. In bipolar disorder, depression is a period of decline characterised by, among other things, anxiety, and severe hopelessness.

10 questions about the medical treatment of postpartum depression

The respondent is Antti Ahokas, an associate professor and specialist in psychiatry.

1. There are dozens and then again dozens of antidepressants on the market. How does a health care professional decide which of them is the best option for the patient in question?
Choosing the right medication is always patient-specific. Given the triggering effect of hormonal factors, certain antidepressants work better in postpartum depression than others. Another important factor is an adequate dose. The dose of medication needed for postpartum depression is usually higher than what it would be for the same person in another context.

2. How do antidepressants function in the brain?
Antidepressants normalise brain neurotransmitters, the best known of which is serotonin.  Neurotransmitters regulate mood, anxiety, sleeping cycle, mental energy, etc. Depression symptoms are caused by changes in the concentrations of neurotransmitters and their interrelationships. The purpose of the medication is to balance these out.

3. What kind of side effects can the antidepressants have?
When you start a new medication, some people may feel light-headed and nauseous, but these symptoms will fade away when you continue taking the medication. The medicines used for postpartum depression are usually well tolerated. Some may experience a decrease in libido.

4. How quickly will the chosen medication chosen begin to take effect? 
It takes about two weeks for the effects to appear, but some users may feel the relieving effects way earlier.  

5.  What if the medication does not work? 
If the chosen medication does not work, it must first be checked that the dosage has been sufficient. If that does not help, we consider changing the medication or creating a combination of two different medicines.

6. Can I breastfeed if I use antidepressants? 
A significant proportion of mothers do not want to stop breastfeeding. With the current antidepressants, it is also safe to breastfeed. 

7. I saw people on an Internet forum saying negative things about the antidepressant I use, while praising another medicine. Could my health care professional possibly prescribe me the “good one”? It is true that in postpartum depression, certain antidepressants work far better than others. The treatment should be prescribed according to what the health care professional considers best together with the patient.

8. How and when does one come off the antidepressants? The time needed for the patient to use the medication is adjusted individually. According to an international recommendation, the minimum time is six months. There are no addictive predispositions related to antidepressants, so there is no maximum time. The medication is gradually phased out by reducing the dose.

9. Does a person that has previously been using antidepressants easily get sick again after coming off the medication? Postpartum depression is always a case-specific phenomenon, but some are at risk for recurrence.

10. Do antidepressants influence your personality or emotional state? Antidepressants do not change one’s personality; their principal function is to restore the psychological strength of an individual. The serotonin works to smooth both the good and the bad peaks on the emotional scale.

The ABCs of psychotherapy

What you should know about psychotherapy when you are starting treatment

A) Psychotherapy is a treatment method of mental health problems and various life crises and traumatic experiences through discussion. It aims to reduce mental suffering and support mental growth.

 B) The term psychotherapist may only be used in Finland by a person who has obtained the right to do so from Valvira (The National Supervisory Authority for Health and Welfare).  Health care professionals working as psychotherapists can be, for example, psychologists, psychiatrists, specialist nurses, social workers, or theologians.

C) Psychotherapy is an effective form of treatment proven by extensive research. Psychotherapy facilitates recovery, improves functioning in life, and provides tools for coping with later problems in life as well.

D) There are many different schools in psychotherapy, for example, psychoanalytic or psychodynamic, cognitive, integrative, solution-oriented, trauma psychotherapy, family or couples counselling, and early interaction psychotherapy.

E) When a new mother is caring for her small child, the mother’s own experiences of caring, neglect, or trauma in early childhood can easily arise. A mother suffering from postpartum depression may particularly benefit from psychodynamic individual therapy or early interaction psychotherapy. In early interaction psychotherapy, the relationship between the baby and the parent plays a major role. The whole family is always considered when planning and implementing the treatment.

F) Choose a therapist that you like! Before starting psychotherapy, there are usually 1-4 assessment visits, during which the psychotherapist maps the client’s life situation and problems and assesses the suitability of the treatment. If the partnership between you and the psychotherapist does not seem to be running smoothly, choose another professional.

G) For the psychotherapy to succeed, it is important that the client can actively engage in the contents and activities of the therapy and be able to talk about what is running through their mind and be motivated. The client needs to personally think that they need help for their mental problems.

H) The duration of psychotherapy varies from a few visits to 2-3 years. Individual psychotherapy sessions are usually arranged 1-3 times a week, 45 minutes per session.

I) There are no binding guidelines for psychotherapy fees, only indicative recommendations.  

J) It is a good idea to make a written agreement on the psychotherapy. In the agreement it would be good to agree on, among other things, the frequency, duration, cost, and payment methods of the sessions, the cancellation policy for the sessions, the termination of the psychotherapy relationship, and data protection issues. A psychotherapist is bound to absolute confidentiality.

The expert of the article is a psychotherapy specialist – integrative (YET) and early interaction (VET) psychotherapist Mirja Sarkkinen.