Postpartum Depression- The Great Masquerader

Dr.Shivani Salil

Psychology-of-anger-picture A baby’s arrival is surrounded with excitement and unbridled joy. The air is thick with expectation and advice flows in from all corners. And what with the media kicking up the dust, the pressure to look and feel happy just gets intensified. 

The new mommy finds herself in the centre of all this brouhaha. And naturally she too is expected to be all hunky dory about it. But what if that is not the case? No one tells her its ok to be overwhelmed, its ok to feel broken, its ok if she cannot smile and rather wants to burst in tears. Having given birth to a child automatically places her on this high pedestal where she must metamorphose, almost overnight, into the epitome of motherhood. 

Though things have slightly improved in the past few years in terms of these great expectations but a lot of people are still not aware of conditions like postpartum mood swings. These mood swings can range from mild 'baby blues' to postpartum depression (PPD) to a full blown postpartum psychosis. 

Postpartum Depression- The Great Masquerader

By definition, postpartum depression is a mood disorder that can affect women after childbirth. Mothers with PPD experience feelings of extreme sadness, anxiety, and exhaustion that may make it difficult for them to complete daily care activities for themselves or for others.

The biggest roadblock in diagnosing the condition lies in this definition…. 'Sadness', 'Anxiety', 'Exhaustion' and 'difficult for them to complete daily care activities for themselves or for others'.... First of all, these are subjective feelings which can normally vary from one person to another. What overwhelms me may be 'all in a day's work' for someone else.  PPD can be termed as The Great Masquerader because it hides behind what could pass of as 'normal'. Almost ten million cases of PPD are reported from India every year. This number could be much higher and probably goes undiagnosed because of lack of awareness. 

The countdown to motherhood is not as pleasant as it is projected to be. There are so many changes on physical and emotional level, that often the expecting mum cannot cope with it. To add to it is the hormonal roller coaster that she's on. All this are enough to trigger mood swings. And then comes the actual labour, the constant sleep deprivation and exhaustion. It's not an easy ride at all. Everyone around the new mum tries to ensure that she eats well and rests but often the mental aspect is overlooked. Which is why they do not know how to deal with it. Some are sympathetic and try to talk her out of it. Some ignore it and the worst are those who slot the mother as a cold woman who lacks the maternal instinct. They judge her with their limited capacity. What they aren’t aware of is, that this situation has absolutely no relation with what a mother does or does not do.

There are a host of symptoms a woman may experience. It could be sadness, despair, hopelessness, irritability, moodiness, outbursts of anger and tears, disinterest, changes in sleep and eating patterns, withdrawal from family and the baby, vague physical pain etc. This could be a passing phase that fades away in 1-2 weeks. These 'blues' are experienced by almost all new mommies. 

But sometimes these symptoms persist and/or worsen and things come to such a pass that they interfere with the woman’s ability to care for herself or her family. The mother has suicidal thoughts and might even want to harm the baby. This is what classically falls under the category of PPD. And it requires serious intervention. 

The key to diagnosis is the awareness of such a condition. Only then, one can look outward for help.  This help could be in the form of counselling with or without medication but it is imperative that it is sought. The vagueness of the symptoms requires a trained person to come with a diagnosis. The good news is that it is treatable and family and friends can help. They being the first interface would be the quickest to smell that something is not quite right. They can lend a sympathetic ear, offer emotional support and assist to the best of their capability with the daily chores and caring for the baby. 

And what if PPD is not recognized and left untreated? The course of depression is prolonged. The woman feels miserable and often feels guilty but helpless to get out of it. This takes its toll on the mother and the baby and the rest of the family too. The initial few months are imperative for the mother and child bonding. If this precious time is lost it can never be compensated. It tends to leave a permanent scar on the psyche of both. At its worst, sometimes the woman even resorts to taking the extreme step of causing harm to her child and herself.  

All of this is avoidable. As part of the antenatal care both the expecting parents need to be educated on this entity. Otherwise the things we do not know are never known to us. They need to be mentally prepared for the approaching parenthood. If it takes two to create a life, it requires two to rear it as well. Shoulder the responsibility, hold her hand if she lands up in the dark tunnel of depression. Know that it’s a phase that shall pass. Do not shy away from seeking help. Without that this tunnel may never end but with the right approach you can help her see light at the end of it. 

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