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How do I know if I have post partum depression or baby blues?

Mental Health Gynaecology Pregnancy
I gave birth to my second son about 4.5 months ago. Right from day 1 after leaving the hospital I stop getting much sleep. We didn't have a nanny and the husband tries to help as much as he can, but we have a 2-year-old who demand a lot of our attention too, so the husband is occupied with him pretty much. It doesn't help that the infant is much more difficult; he constantly cries and needs to be carried all the time, and has difficulty in falling asleep (unless I nurse him to sleep or carry him till he falls asleep). Maybe what I am feeling builds up over the months, I don't know. I feel like increasingly I cannot cope, with taking care of the elder kid and the younger kid. I get max 3 to 4 hours of sleep in between feeds at night, and I return to an alarming amount of work (new projects given not under my portfolio) after my maternity leave. I don't feel sad or angry all the time - when talking to friends I feel fine, when talking to my elder son I can muster enough joy to play, read, sing and chat with him. But when my elder son misbehave, when the younger son cannot stop crying, when the workload keeps piling up and I can't finish the work, I start losing it. I will beat the elder son for very minute things, throw temper at my husband when he is not at fault, or just cry uncontrollably in front of my husband or by myself. Today was even more alarming, I get giddy spells every now and then, several times throughout the day. And as of last weekend, I started wondering if I have post partum depression or it's just a minor case of baby blues.
DOCTOR’S ANSWER (2)

Thank you for asking such an important question. It is indeed important to make a distinction between postnatal depression and baby blues as the treatments for both conditions are vastly different. 

Every other woman would feel a bit weepy, moody, flat or unsure of herself on the third or fourth day after having a baby. This is usually called 'baby blues' or 'maternity blues.' Their mood usually improves after a week or so after the mother learns to get herself organised and deal with the challenges and excitement of motherhood. However, if the low mood persists for longer than 2 weeks, then the diagnosis of postnatal depression (PND) has to be considered.

PND usually starts within a month of the delivery but can have its onset up to 6 months following delivery. The condition can remain for months, or even years, if it is left untreated. It is wonderful that you have insight into your condition and decide to seek treatment. PND occurs in about 10% of women. 

Very often, the mother may need only reassurance, practical support and supportive counselling. What I would do will be to explore with the patient how she coped with stressful events in the past and how she can continue to mobilise her resources and skills to deal with the current challenges. Talking with other mothers may also help as many of them have embarked on a similar journey and encountered the same challenges. 

Sometimes the underlying causes of depression could stem from many other sources. For instance, a case whom I saw recently became depressed as her husband had an extra marital affair when she was pregnant and she only knew about it after her delivery. Some couples also have problems with their in laws who oftentimes have their own ideas of how small children should be brought up. Another case of PND that I treated some time ago had problems with housing and that took many months to get sorted out. 

In the management of postnatal depression, it is crucial to get the husband involved as well and he may also need help to adjust to parenthood.

There is some research that demonstrates that PND may affect the mother-infant relationship and the cognitive and emotional development of the infant. Hence it is important to seek treatment early. May I urge you to approach your family physician for an evaluation. You can also arrange to see a psychiatrist.

Take good care of yourself and your family. Cheers!


Dr Ng Beng Yeong
MBBS, MMed (Psychiatry), FAMS

NG BENG YEONG PSYCH MEDICINE CLINIC
3 MOUNT ELIZABETH
MOUNT ELIZABETH MEDICAL CENTRE
#15 - 05 Singapore 228510

573 views 5 Nov 2018

Sorry to hear that you're going thru such a difficult time. Motherhood is a really tough journey, especially when you're juggling work and family commitments without much help! Personally, I think you're doing a great job so far (I'm a mother too, and I don't know how you can do so much without help), so kudos to you for the hard work and resilience. :) 

To clarify your doubts about what you're going through, perhaps I can explain go into details on the definitions of the individual conditions you're concerned about:

Postnatal blues is a period of emotional lability which develops within the first 10 days postpartum, and peaks around 3-5 days. While some mothers may experience frequent crying episodes and anxiety, some may also experience elation. These changes are usually related to hormonal changes associated with childbirth, coupled with stress and adjustment to life with the little one. However, if these symptoms persist beyond 2 weeks, we may need to consider a more severe form of mood disorder. 

Peripartum depression (which includes postpartum depression), on the other hand, develops during pregnancy or in the 4 weeks following delivery. Common symptoms include:

- low mood most of the day, nearly everyday

- diminished interest or pleasure in activities 

- changes in appetite in weight and appetite

- sleep disturbances 

- fatigue or lethargy 

- feelings of worthless or excessive guilt 

- reduced ability to concentrate 

- suicidal ideations

However, I understand that you're currently 4.5 months post partum, so I assume you just returned to work? That could possibly contribute to a source of your stress given that you've to juggle home commitments and adjust to your work place again. 

I think you should speak to your husband about some of the challenges you're facing right now and try to get more help, especially at night. Sometimes, a good night's sleep can do wonders. :) Furthermore, I would also urge you to speak to your obstetrician/ psychiatrist for a thorough assessment and find out how we can help you cope better with these stressors. It is important to get help as postpartum psychiatric disorders can adversely affect mother-child bonding.

Good luck, and do keep us updated on your progress. :)


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967 views 22 May 2018
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