Postpartum depression ( also called PPD) affects a very large number of women across the world and can have some detrimental consequences for not only the mother who suffers, but for her children as well. It is a subject in which is hard to study because in recent years, we have only been able to study the behavioral and psychological side of this type of depression. The objective of this research paper is to not only explain what postpartum depression is, but also dive deeper and explain what exactly causes this depression in new mothers to form both from a biological side and psychological side of things. Within our studies we will find that postpartum depression is linked to hair cortisol levels found throughout the three different trimesters of pregnancy but also by perturbed methionine–homocysteine metabolism. One of the studies concluded that psychopathological symptoms, stress during pregnancy, and hair cortisol levels can forecast PPD symptoms at all different times throughout a full term pregnancy. The other concluded PPD in the mother is also related to a low APGAR (Appearance, Pulse, Grimace Activity, Respiration) score in infants born to these specific mothers in the the study.
What Causes Some Women to Have Postpartum Depression
Postpartum depression is depression suffered by a mother following childbirth, typically arising from the combination of hormonal changes, psychological adjustment to motherhood, and fatigue (Google Dictionary 2017). For a lot of women, symptoms of depression are fairly common within the first five to seven days of childbirth but can also occur at other times including after a miscarriage or during breastfed weaning. Approximately seventy to eighty percent of women who give birth experience “baby blues”; which is what many people confuse PPD with being. Baby blues have the same type of symptoms which include anxiety, mood swings, and being restless and irritable. Fortunately with baby blues, these symptoms normally go away within two weeks after giving birth. What is most important when distinguishing between PPD and baby blues is asking the question, “Is the mother still able to care of the child and also herself”? Postpartum depression as stated have the same type of symptoms but they are much more severe and longer lasting. Symptoms include frequent outbursts of crying, decrease in energy levels, loss of motivation, and questioning of self-worth.When diagnosing PPD, doctors see if the mother or family members have been treated for bipolar disorder or any other mental illnesses in the past. Other factors that can contribute to these feelings are an unplanned or wanted pregnancy, lack of social support by friends and family, or issues with fetal development throughout pregnancy. According to the American Psychological Association, one in seven women who have given birth experience postpartum depression (Magill’s Medical Guide, 2013).
Postpartum depression results from many things from both a psychological and biological standpoint. One change biologically comes from the change in body hormones caused by childbirth. These can affect a mother’s mood tremendously. One of the hormones is homocysteine. Homocysteine is an amino acid that occurs in the body as an intermediate in the metabolism of methionine and cysteine. When there is a high elevation of homocysteine, it is called hyperhomocysteinemia. This affects neurotransmitter pathways which are involved with behavior and mood changes. A study done by researchers in India decided to compare the levels of homocysteine and its vitamin determinants in depressed and nondepressed women during the twenty four to forty eight hours after given birth and at six weeks postpartum to evaluate whether these factors can predict the development of postpartum depression and to see if serotonin levels correlate positively or negatively with said amino acid and vitamins. The study took place from December 2010 until November 2011 and included 103 women. Out of the 103 women tested, fifty eight of the women were concluded to have PPD. Test results showed that there were other contributing factors such as age, education, and employment status which were positively correlated with women being diagnosed with postpartum depression. The study had inconclusive results on whether homocysteine levels actually contributed to women having PPD or not.
The second study deals with hair cortisol levels relating to postpartum depression. It is a risk factor because the dysregulation of the hypothalamic-pituitary-adrenal axis which results in an increased exposure of pregnant women to cortisol ( “Hair Cortisol”, 2017). Our hypothalamus synthesizes CRH as part of a stress response. It stimulates the release of cortisol to help prepare a human for anything stressful happening upon their body. The hypothalamic pituitary adrenal axis is changed during pregnancy because of the existence of the placenta. The placenta assists in a surged release of cortisol the dysregulation of the hypothalamic-pituitary-adrenal axis which results in an increased exposure of pregnant women to cortisol (“Hair Cortisol”, 2017). Levels of cortisol can be sampled in many different places of the body such as the urine, blood, or amniotic fluid of a pregnant woman; but testing from hair strands is a lot less invasive. During this study, a total of forty four women were assessed in all three trimesters. Their assessments were taking during their prenatal appointments and then again two weeks after giving birth. They were divided into two groups after the assessments; one group scored below ten on the Edinburgh Postnatal Depression scale and the other higher than ten. This scale is a ten question assessment that was developed to assess woman showing possible symptoms of postpartum depression after giving birth. Out of the forty four women, only sixteen scored above a ten . When examining the correlation between a diagnosis of PPD and cortisol levels in hair strands, the research showed that cortisol levels were higher in women with postpartum depression than without. The study was able to dig even deeper and show that these symptoms increases dramatically from between trimester one and two to trimester two and three (the levels decreased from trimester one to trimester two and then increased into the third trimester). This doesn’t exactly mean that hair cortisol levels substantially predicts that a woman will be diagnosed with PPD unfortunately. The linear regression of this test showed that hair cortisol levels could predict 21.7% of the variance of postpartum depression symptoms (“Hair Cortisol”, 2017). And to give even more detail to their findings, the hair cortisol in the first and third trimesters remarkably anticipated the Edinburgh Postpartum Depression Scale scores. In summary to this test, high levels of maternal stress during all three trimesters are linked to having symptoms of postpartum depression.
Although both of these studies have been helpful to women all across the world, there still is a lot to be found out about postpartum depression. These studies only have a prediction rate of 21.7% and it’s only because women possessed underlying symptoms. With leading technologies, I feel as if sometime in the near future we will be able to narrow down what it is that exactly causes postpartum depression. This is such an undermined topic that really needs more research so that women who suffer from this can get the help that they need. This information provides psychologists with stepping stones in the right direction of where to begin on getting women help. Even now in hospitals after giving birth (whether it be twenty four hours after or four days), nurses and doctors just have you skim through a pamphlet about postpartum depression but don’t go into detail about how serious it actually is. This isn’t enough and many of times this pamphlet just gets thrown away. How many women suffer without getting help before it’s too late? Do the antidepressants prescribed by doctors help or hurt the situation even more? The adaptation to becoming a mother is very trying as you learn to change into your new role; taking care of both yourself and a baby who is dependent upon you to care for their every need. This is one challenging, draining, and overwhelming job title. Being a new mom who has depressed feelings or bouts of anxiety about caring for a child, know that you are not alone and that there is help out there. You may even be made to feel guilty about the way you do things with your child from other family members. Just know this: having postpartum depression is not in any way your fault. Postpartum depression is a medical condition that can be treated by medications and/or therapies. By explaining your feelings with a professional who knows how to assess you and talk you through your new role, you will be able to make a positive change in your life that will allow you to care for yourself and your child in a way that you wouldn’t have thought possible before.