We had a conversation with Dr. Muhammad Mujtuba who is an Associate Professor and Head Department of Psychiatry and Behavioral Science at Gulab Devi Hosiptal. He has done MSc in Biological Psychiatry from London and Diploma in Mental Health & Services from Portugal. He sees his patients at Hammed Latif Hospital
He informed and discussed various aspects of Postpartum Depression (PDD).
Q. What kind of disorder/s n mommy- to- be can expect in their pregnancy and why?
A.Mental disorders which are mostly encountered by moms to be are depression, anxiety, panic disorder, increased impulsivity, aggression, severe mood swings and suicidal ideation. And causes of these are either biological, psychological or social.So these may be hereditary, history of past mental disorder, due to young age of mother or current obstetric complications, not having friends in community, lower occupational status, living in a crowded household, unintended pregnancy, lacking intimate partner empathy and support, domestic violence and in some settings giving birth to a female.
Q. Do all the expecting mothers need to prepare themselves for prenatal mood disorders?
A. No. Although a few symptoms may occur especially during second trimester but these are usually self-remitting and may not effect social and occupational functioning of mother but if these symptoms persist for longer periods of time and effect social and occupational functioning of mother then they need to be addressed.
Q. What role does the genes of the expecting mother play when she gets some disorder during pregnancy and after having the baby?
A. Genes predispose a mother to a certain illness and because of various stressors or hormonal surge which happen during pregnancy and after delivery, they may manifest themselves.
Q. Are there any other reasons that instigate any kind of depression on moms (pre and post-delivery?
A. Factors that instigate depression in expecting mothers and after delivering the baby are either biological, psychological or social. Biological are hereditary and history of past psychiatric illness. Psychological are fear of labour, fear of becoming a mother, expectation of being a care giver, fear of extra burden, fear of sleepless nights, fear of raising a kid in the best way, fear of being compared to other moms of same age, living up to the expectations of others, decisions regarding the pregnancy, stress of handling other kids while continuing with pregnancy
Q. What are the symptoms of postpartum depression and what is the best way to deal with them?
A. Postpartum depression may be defined as a mixture of physical, emotional and behavioral changes that occur in mother after delivery. Symptoms are emotional, behavioral and cognition.Emotional are severe mood swings, aggression, restlessness, hopelessness, helplessness, worthlessness, guilt, persistent low mood, suicidal ideation and thoughts of hurting the baby.Behavioral are social withdrawal, appetite changes, insomnia, low libido, loss of interest in pleasure activities and also daily activities, poor self-care. Cognition are poor memory, inability to make decisions and lack of concentration.There should be immediate psychiatric, psychological and psychosocial interventions should be made. Psychiatric medication, psychotherapy and support from the family and friends is required for the speedy recovery.
Q. What is the difference between baby blues and postpartum depression?
A. Baby blues are the least severe form of PPD. Difference between postpartum depression and blues is that the symptoms of baby blues are less severe and they are self-remitting. Symptoms of baby blues start after two to five days of delivery and they remain for 2 weeks. If the symptoms become severe and don’t go after fourteen days, then we call it postpartum depression. Symptoms of baby blues are mood swings, irritability, restlessness, fatigue, crying for no apparent reason, insomnia and poor concentration.
Q. Can a mother get postpartum disorder much later after the birth of the child, for example if the baby is 10 months old, can the mother still get it?
A. No. The symptoms of postpartum depression will appear within 3 months.
Q. What do you have to say to the mothers who take Google as their doctor and try to treat themselves from thousands of treatments mentioned there?
A.Very interesting question. The situation which we frequently come across. Since Google has become very accessible and there is wealth of information available on Google so ladies before coming to a psychiatrist usually not only self-diagnose regarding the illness they have but also start so called treatments which are written on various web pages. Now we have to understand that a lot of these pages are written for general masses and not by professionals therefore most of the times they not only misdiagnose but also mistreat themselves. The yoga, relaxation exercises and various foods like olive oil or dates etc. although useful yet are not proven effective psychiatric treatment. Therefore, when they reach us not only illness has progressed much more but also the duration of treatment increase.
Q. A lot of educated mothers fail to identify depression, why is that?
A. Most important thing is a lot of people consider depression as a sign of weakness therefore they fail to acknowledge symptoms which they keep on having. Also there is a lot of stigma related to psychiatric illness and treatment and as a consequence a lot of misconception arise with it. New mother may be unwilling to reveal how she is feeling to her close family members and spouse because may be embarrassed by her symptoms or afraid that if she revealed her symptoms she will be institutionalized and will be separated from her new born. Childbirth education is therefore required also to help mommies to be.
Q. What is the ratio of prenatal and postnatal depression amongst Pakistani women?
A. Study conducted among females who had depression during pregnancy and it turned out 34% who were attending gynecological outdoors experience depression either throughout or for some part during pregnancy. We also conducted a study of females who had delivered a baby within 2 to 3 months and were visiting either gynecological outdoors or child outdoors and found that 22% of the females experienced or were experiencing depression after delivery.
Q. Do you think the role of society is negative when it comes to prenatal and postpartum depression?
A. Yes. It is very easy for people to see fractured leg and empathize with the person who is bed ridden as compared to a person who has fractured mind which isn’t visible by naked eye or test. Since most of the psychiatric illnesses are what the person feel so people around that person can’t understand the feelings and hence usual sentences are
“Allah pe yaqeen rakho”
“Apni soch theek karo ”
“Acha Socho gi acha hoga”
And the most bitter one is
“Shohar ki tawajjo lene k lye dramay karti he”
While in reality there are biochemical changes which make a person feel or behave in a certain way and these changes can’t be corrected until or unless proper professional help is given.