I got a call a few days ago to go see a friend I have known for some years.
The wife (let’s call her Mercy), who had delivered their second born without complications a few months ago, had been admitted to hospital as a result of post partum depression. This news got me a bit off guard as Mercy seemed to have had such a wonderful, energetic pregnancy.
I remember doing a group baby visit and making ‘baby blues’ jokes on the unusual detachment and sadness she was feeling at that time. “Being a mom is no joke. You’ll feel better when Lil Teddy learns to change diapers.” We laughed, she didn’t. When she got back to work after her three month maternity leave, she constantly complained that her lower back throbbed; shoulders—even wrists—hurt. She didn’t have an appetite and was extremely short-tempered with people. She couldn’t figure out why she was so unhappy, blamed it on being tired and possibly growing out of her job.
Before this phone call, I had never, ever had one person say to me: “I have postpartum depression.” I associated postpartum depression with a woman I once saw on national TV serving life in prison for killing two sons; her lawyer argued that she suffered from a long history of depression, with people who didn’t like their babies or felt like they had to harm their children. My friend didn’t have anything remotely close to those feelings. The day we visited her, she looked at her baby with tenderness, agitated at anyone speaking too loudly and potentially waking her up. So I didn’t think Mercy had any such condition.
But then, again, I am not a doctor.
I got in touch with Dr. Kimaru at the Nairobi West Hospital, which has dedicated three days a week for a psychiatry clinic. Amongst cases handled here are related to depression, substance use disorders (which the doctor advised is no longer termed substance abuse), bipolar mood disorders, suicidal tendencies, neuro degenerative disorders as well as a rehab facility for mental health patients.
“Post-Partum depression is a form of psychotic dis-order(major depression) not otherwise specified with an onset in the first 1-4weeks after child, with an overt presentation of bipolar disorder that is timed to coincide with tremendous hormonal shifts after delivery. It is fundamentally a disorder of women, but in some rare cases, affect the father. In those rare instances, the husband may feel displaced by the child and it may become competitive for the mother’s love and attention. However, the father probably has a coexisting major mental disorder that has been exacerbated by stress and fatherhood.” said Dr Kimaru of Nairobi West Hospital.
“Baby blues and post partum depression are different conditions but they are related. Baby blues are normal, with half to two thirds of women who deliver normal babies experiencing them. Peak onset is on the third to fourth day, and disappears by end of week two. Women developing blues have often experienced depressive symptoms in the last trimester of pregnancy. Both of these conditions’ frequency of the emotional changes and their timing suggest that they are related to readjustments in hormones after delivery. Progesterone and oestrogen increase greatly during late pregnancy and fall after birth.”
Dr Kimaru further noted that in post partum depression, the new mother presents symptoms like sudden mood swings, sadness, loss of appetite, sleeping problems, feels irritable, restless, anxious and lonely. The condition further has the liability of mood alterations between euphoria and misery, episodes of crying, and patients may complain of feelings of confusion.
“The major difference between baby blues and post partum depression is that of severity of symptoms. Baby blues symptoms are not severe and pharmacotherapy (treatment) is not needed. In puerperal psychosis the symptoms are severe, considered an emergency and treatment is required. Worsening baby blue in terms of duration and severity is considered as postpartum depression (puerperal psychosis)” noted the doctor.
I thought of how much my friend suffered as we made jokes of the situation, and it hit me that postpartum does not discriminate. Mercy couldn’t control it. And that’s part of the reason it took her months seek help.
“If a loved one gets these symptoms, get a diagnosis and treatment started urgently,” Dr. Kimaru says. “Tend to her baby to allow her time to sleep, encourage the mother to exercise and talk about her feelings. Proper nutrition for the new mother is key, as well as a warm environment with friends and family.”