Natal Depression

  1. Describe the topic and case provided. Sets the scene clearly for essay.
  2. 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.
  3. Provide an overview and explanation of common signs and symptoms associated
    with PND. Relates clearly and succinctly to the case of Sally provided.
  4. 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.
  5. 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.
  6. Explains the main goal of management for Sally and treatment available.
    (Pharmacological and non-pharmacological). Relates clearly and succinctly to the case of
    Sally provided.
  7. Provide an overview and explanation of short and long term complications
    associated with PND. Relates clearly and succinctly to the case of Sally provided.
  8. 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

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.

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
    symptoms include;


  • Irritability, where a mother sometimes feels angry for no valid reason,
  • Anxiety,
  • 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

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
  1. 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.

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
types being;

  • selective serotonin inhibitors such as fluoxetine and fluvoxamine


  • serotonin/dopamine/norepinephrine reuptake inhibitors such as bupropion
    and duloxetine
  • 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

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.



Cox, J., Holden, J., & Henshaw, C. (2014). Perinatal Mental Health: The Edinburgh Postnatal
Depression Scale (EPDS) Manual. RCPsych Publications.
DelRosario, G. A., Chang, A. C., & Lee, E. D. (2013). Postpartum depression: symptoms, diagnosis,
and treatment approaches. Journal of the American Academy of Physician Assistants, 26(2),
Dennis, C. L., & Dowswell, T. (2013). Interventions (other than pharmacological, psychosocial or
psychological) for treating antenatal depression. Cochrane Database Syst Rev, 7.

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.
(2016). Internet Cognitive Behavioral Therapy for Women with Postnatal Depression: A
Randomized Controlled Trial of MumMoodBooster. Journal of medical Internet
research, 18(3), e54.
Nanzer, N., Rossignol, A. S., Righetti-Veltema, M., Knauer, D., Manzano, J., & Espasa, F. P.
(2012). Effects of a brief psychoanalytic intervention for perinatal depression. Archives of
women’s mental health, 15(4), 259-268.
O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016). Primary care
screening for and treatment of depression in pregnant and postpartum women: evidence
report and systematic review for the US preventive services task force. JAMA, 315(4), 388-
O’Hara, M. W. (2013). Postpartum depression: Causes and consequences. Springer-Verlag.
O’hara, M. W., & McCabe, J. E. (2013). Postpartum depression: current status and future
directions. Annual review of clinical psychology, 9, 379-407
O’Hara, M. W., Schlechte, J. A., Lewis, D. A., & Varner, M. W. (2009). Controlled prospective
study of postpartum mood disorders: psychological, environmental, and hormonal
variables. Journal of abnormal psychology, 100(1), 63.
Pearson, R. M., Evans, J., Kounali, D., Lewis, G., Heron, J., Ramchandani, P. G., & Stein, A.
(2013). Maternal depression during pregnancy and the postnatal period: risks and possible
mechanisms for offspring depression at age 18 years. JAMA psychiatry, 70(12), 1312-1319.
Rudy Bowen, M. D., & Kazi Rahman, M. B. B. S. (2012). Patterns of depression and treatment in
pregnant and postpartum women. Canadian Journal of Psychiatry, 57(3), 161.

Schetter, C. D., & Tanner, L. (2012). Anxiety, depression and stress in pregnancy: implications for
mothers, children, research, and practice.Current opinion in psychiatry, 25(2), 141.
Yonkers, K. A., Vigod, S., & Ross, L. E. (2012). Diagnosis, pathophysiology, and management of
mood disorders in pregnant and postpartum women.FOCUS.