- Describe the topic and case provided. Sets the scene clearly for essay.
- Provide description aetiology of Post Natal Depression (PND) and factors
associated with the development of PND. Clearly differentiates from “baby blues” and
identifies risk factors apparent for Sally.
- Provide an overview and explanation of common signs and symptoms associated
with PND. Relates clearly and succinctly to the case of Sally provided.
- Describes the criteria for assessment and diagnosis of Post Natal Depression.
Outlines screening tools used pre and postnatal for the identification of PND. Demonstrates
a clear understanding of why Sally was diagnosed with PND.
- Describes the psychological and physiological alterations that may accompany
PND. Provides an e overview of Pathophysiology associated with PND to required depth.
Relates clearly and succinctly to the case of Sally provided.
- Explains the main goal of management for Sally and treatment available.
(Pharmacological and non-pharmacological). Relates clearly and succinctly to the case of
- Provide an overview and explanation of short and long term complications
associated with PND. Relates clearly and succinctly to the case of Sally provided.
- Provides an excellent overview and explanation of 3 lifestyle modifications
relevant to Sally’s condition. Provides a correct overview of support services available for
Sally. Relates clearly and succinctly to the case of Sally provided .
Post Natal Depression
Why am I not happy after giving birth? What is wrong with me? These are some of the
questions that some women ask themselves a few days after giving birth. Instead of life with a
new baby being rewarding and thrilling, it becomes so hard and stressful. What such women do
not understand is that several emotional as well as physical changes occur to them when they are
pregnant and after they have given birth. These feelings can relapse quickly or they can persist
for quite a long period and even get worse a condition referred by physicians as postnatal
depression (PND). PND is a disorder characterized by a wide range of emotional and physical
alterations that many women experience after birth (O’hara & McCabe, 2013). Normally, PND
occurs a few days after a woman has given birth. It is not only experienced after the birth of the
POST NATAL DEPRESSION 2
first borne only but also with other children. A mother can have abrupt mood swings, sleeping
problems, sadness, restless, irritable, lonely, anxious, and a woman’s daily activities are also
affected. These symptoms are brought out clearly in the case study provided. For instance, Sally
says she feels tired and exhausted from looking after her children, she has lost her appetite, and
sleeps for only 4-5 hours a clear indication that she is having sleeping problems. Moreover, Sally
reports that she has difficulty concentrating in her accounting work and has recently become
forgetful with her daily chores, feels lonely, and does not cope with her situation.
PND is caused by several factors. According to O’Hara (2013), women experience
hormonal changes in their bodies that activate depression symptoms after pregnancy. During
pregnancy, the levels of progesterone and estrogen hormones increase substantially in a woman’s
body. However, the amounts of these hormones decrease drastically to their normal non-pregnant
levels within 24 hours of giving birth. This rapid drop in hormone levels has been implicated to
depression, the same way that hormonal changes in a woman before she gets her menstrual
period affects her moods.
At times, the levels of thyroid hormones may also decrease just after a woman has given
birth (DelRosario, Chang & Lee, 2013). The thyroid gland is an organ that is responsible for
regulating the body’s metabolism. However, when one has low levels of thyroid hormones,
he/she can experience symptoms of depression such as decreased interest in activities, fatigue,
irritability, difficult concentrating, sleep disorders, depressed mood as well as weight gain. These
symptoms are similar to those reported by Sally in her presentation. A simple blood test can be
conducted to determine if hypothyroidism is responsible for Sally’s depression. If so, Sally can
be put on some thyroid medicines such as thyroxine and levothryronine, which will aid in
increasing her hormone levels.
POST NATAL DEPRESSION 3
It is vital to note that there are some other factors that can contribute to development of
postnatal depression. These factors include;
- Broken sleep patterns, feeling tired after childbirth, and lack of adequate
rest can keep a mother from recovering her full strength for several weeks,
- The stress from variations of routines both at home and work whereby
some mothers feel they should be “super moms” to their kids which usually is not the
case and results in stress build up.
- The feeling of having less free time and less control over it. The mothers
feel depressed because they realize they will start staying indoors most of the time and
will spend less time with their loved ones and partners.
PND differs from baby blues in various ways. For instance, baby blues’ onset is
within 1-2 days after childbirth. It resolves without any intervention within 10 days after
birth. Some of the symptoms of baby blues include sadness, mood swings, crying spells,
anxiety, and loneliness (Gilbert, 2014). These symptoms are not severe and do not require
any medical attention to be taken. Some of the intervention that can be conducted include
taking a nap when a baby does, joining support groups, or talking to other moms. This is in
contrast with PND which affects the well-being of a woman. It also affects the functioning of
a woman for a long time. PND does not relapse easily. For management, PND is treated by a
qualified doctor. Support groups, counseling, and medicines can also help.
It is important for mothers to know the common signs and symptoms of PND so that
they can seek medical attention at the right time (O’Hara et al., 2009). Some of the sign and
POST NATAL DEPRESSION 4
- Irritability, where a mother sometimes feels angry for no valid reason,
- Panic attacks are also common with symptoms of nausea, sweating hands,
and a thumping heart.
- Sleeping problems; mothers find it a bit difficult to sleep even though the
baby is sound asleep.
- Tiredness; the women are lethargic, cannot cope house chores, taking care
of the baby or other tasks.
- The women have poor concentration, can be confused and distracted. They
also have trouble remembering or making decisions.
- Being worried excessively about the baby
- Feeling guilty and worthless
- No interest in certain activities such as sex
- Lack of appetite result in weight loss.
- Overeating and weight gain
- Tearfulness where a mother can cry often for reasons she understands very
- Obsessive behavior
- Having chest pains, headaches, heart palpitations, hyperventilation, and
PND assessment and diagnosis can be missed because the less severe symptoms are
usually common after childbirth. Majority of the mental illnesses especially depression have
POST NATAL DEPRESSION 5
similar symptoms as those of PND. During evaluation, a physician will ask about the patient’s
symptoms; what they are? How long they have lasted, and how bad they are. The patient will
also be asked on whether she has ever had similar symptoms before. Family or marital problems
will also be assessed as well as presence of any family member with mental illness or if the
patient has indulged in drug and alcohol abuse (Pearson et al., 2013). The patient’s medical
history will also be examined appropriately to determine whether the patient has any physical
cause that could be responsible for the manifested symptoms. Moreover, the physician can use
screening tools to conduct the diagnosis. Some of these screening tools include;
- Edinburgh Postnatal Depression Scale: This is a screening tool that
consists of ten questions which a patient answers (Cox, Holden & Henshaw, 2014). Upon
evaluation, the patient’s answers the probability of having PND. A score of 10 such as
the one that Sally had during her pregnancy is an indication that she could be depressed.
However, a score of above 10 indicates that the patient is at a high risk of developing
PND and therefore should seek quick medical attention. For instance, Sally had a score of
- This indicated that she had severe PND symptoms and she deserved urgent medical
interventions to be taken.
- Patient Health Questionnaire (PHQ-9) – This is a tool can be used pre or
postnatal for screening, diagnosis, evaluation, and determining the severity of depression
in an individual (O’Connor et al., 2016).
- Postpartum Depression Screening Scale (PDSS) and Center for
Epidemiologic Studies Depression Scale (CES-D) are other tools that can be used for
PND diagnosis and assessment.
POST NATAL DEPRESSION 6
PND has been linked with several psychological and physiological alterations. Some of
the psychological changes include the feeling of one wanting to stay indoors and not meeting
friends and other ones (Nanzer et al., 2012). A woman can become excessively obsessive
whereby a woman tidies her home meticulously and tries to maintain high standards. A mother
can also become distressed and may start avoiding scenarios where they experience them such as
public areas, social activities, and shopping. Women with PND also develop little interest in their
appearance, surroundings, and sex. In addition, one may develop overwhelming fears such as
dying while others may develop extreme thoughts about harming their babies. On the other hand,
the physiological changes include tearfulness, insomnia, and loss or gain of appetite which
results in either weight loss or gain respectively.
The pathophysiology of PND involves a decrease in the brain monoaminergic
neurotransmitters such as serotonin, norepinephrine, and dopamine (DelRosario, Chang & Lee,
2013). These transmitters are responsible for behavioral changes such as mood swings, fatigue,
agitation, vigilance, and motivation. These psychological changes arise due to abnormalities in
the synthesis, storage as well as release of these hormones. Other implicated causes include
abnormalities in neurotransmitter reuptake, and receptors which may result in low levels of the
hormones reaching the target site hence result in PND development.
The main goal of treating PND symptoms such as Sally is to manage the symptoms
associated with these disorders lest they progress and become severe. PND treatment can be both
pharmacological and non-pharmacological (Rudy Bowen & Kazi Rahman, 2012). The
pharmacological therapy for PND usually entails the use of antidepressant agents with the main
- selective serotonin inhibitors such as fluoxetine and fluvoxamine
POST NATAL DEPRESSION 7
- serotonin/dopamine/norepinephrine reuptake inhibitors such as bupropion
- monoamine oxidase inhibitors,
- Tricyclic antidepressants: These agents are normally prescribed to
patients with severe PND such as Sally who recorded an EPDS score of 22 during her
diagnosis. These agents include amitriptyline and imipramine.
Alternatively, non-pharmacological interventions can be also be used in PND treatment.
This is crucial especially to women such as Sally who would like to continue breastfeeding their
children at the same time manage their PND condition. Some drugs can traverse into breast milk
and may cause dire consequences especially in babies who do not have well developed systems
for breakdown of drugs. For instance, Sally can be advised by the physician to use essential oils
such as almond oil and grape seed oil for PND management. Lavender, roman chamomile, or
marjoram can also be used in a warm water bath before rest to aid in the creation of a sense of
more energy for fatigue management. Massage therapy for stress reduction, acupuncture
managing thyroid function imbalances, cranial sacral therapy for relaxation, proper diet, yoga,
and reiki can also be used (Dennis & Dowswell, 2013).
If PND is left untreated, it interferes with mother-child bonding and can cause severe
acute or chronic family complications (Milgrom et al., 2016). The acute complications include;
- PND having ripple effect which may generate emotional strain for
individuals close to the baby. For instance, Sally’s PND can increase the risk of
depression in Tim whenever he is at home. Her children and the neighbor who takes care
of Sally’s child at times can also be affected as well. The baby is also at risk of
POST NATAL DEPRESSION 8
developing behavioral and emotional complications such as eating and sleeping
difficulties, hyperactivity disorder/ attention-deficit, and excessive crying.
- Chronic complications include delays in language development among
babies (Schetter & Tanner, 2012). The mother also develops risks of developing major
depression problems in future which may deteriorate her health condition.
Sally can engage in several lifestyle modifications which will help her manage her
condition effectively. For instance, she can take part in daily exercises for about 90 minutes
every week. Yonkers, Vigod & Ross (2012), report that a 5-15 minute bursts are as effective as
longer stretches provided the overall exercise time is maintained. Therefore, Sally can pick her
baby and take a walk in the nearby park. She can also resume her social activities such as going
to the gym or attending church services. She can find supportive and understanding individuals
in these forums who she may share her thoughts, feelings, and experiences with. Besides, Sally
will also be to pray and meditate regularly in church; this is a healthy way for a mother to
integrate her motherhood. Finally, Sally can start eating meals that will promote her appetite and
work on it accordingly.
PND is a common disorder. There are several causes of PND the most common being
hormonal imbalance. The signs and symptoms of this disorder are quite distinct and women
should be educated properly on them so that they can seek medical intervention the immediately
they have such symptoms before it progresses into drastic complications that can affect the
family as a whole. PND can be treated easily through pharmacological and non-pharmacological
therapies. Lifestyle modifications are also a crucial step toward leading a PND-free life.
POST NATAL DEPRESSION 9
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Depression Scale (EPDS) Manual. RCPsych Publications.
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and treatment approaches. Journal of the American Academy of Physician Assistants, 26(2),
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psychological) for treating antenatal depression. Cochrane Database Syst Rev, 7.
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Gilbert, P. (2014). Depression: The evolution of powerlessness. Psychology Press.
Milgrom, J., Danaher, B. G., Gemmill, A. W., Holt, C., Holt, C. J., Seeley, J. R., & Ericksen, J.
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directions. Annual review of clinical psychology, 9, 379-407
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