Motherhood was an isolating and bewildering experience for Shinie Antony, a short story writer based in Bengaluru.
She developed postpartum depression, characterised by "a sense of anti-climax". "Like, this is it, there's no going back. Nothing will ever be normal again. Goodbye, everyone," says Shinie, adding that she felt "trapped" as a young mother.
"No one said a thing about the attack of hormones," she rues. "I felt vaguely cheated but held myself responsible for my mood. My parents were there round the clock, taking on a lot of the practical chores of caring for a newborn. What ran in short supply was humour; everyone was tense," says Shinie, who is popularly known as Chetan Bhagat's editor.
As her kids grew, Shinie was swamped by mom guilt. "To this day, I feel I shortchanged them and bend over backwards to indulge them. But when they were babies, I just ran out whenever I could."
According to a study published in the Journal of American Medical Association last year, millennial mothers are 51 per cent more likely to experience prenatal depression than women 25 years ago. One in five new mothers in India experiences depression after childbirth. Many of them live in denial. They have trouble bonding with their babies. Some may not want to breastfeed.
What is more worrisome is that there is very little awareness about postpartum depression among people in India, and hence, the condition often goes underdiagnosed. Left untreated, it could increase the risk of suicides, anxiety disorders and other psychiatric conditions.
The National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru offers hope for women suffering from depression during pregnancy or the months after childbirth. A team of mental health experts in NIMHANS has come up with a tool to detect mental health problems in expectant and postpartum mothers. "It is a simple tool that will help in detecting depression and anxiety, which are risk factors both in pregnancy and postpartum. Even obstetric clinics and antenatal centres as well as health workers in the community who see women in their homes, can use this tool which is in the form of a questionnaire and identify perinatal and postpartum depression," says Dr. Prabha S. Chandra, professor, department of psychiatry, NIMHANS. ''Depression and anxiety can lead to preterm births and low birth weight. Violence and poor support are risk factors for anxiety and depression both in pregnancy and postpartum, '' adds Chandra.
NIMHANS has partnered with AIIMS Bhubaneshwar, Fernandez Hospital, Hyderabad and People Tree Hospitals, Yeswanthpur to develop and test this tool.
NIMHANS has also tied up with state governments for implementing programmes to help moms in need. "We have already started work in Kerala and Chhattisgarh. In these states, the governments have started integrating mental health into routine maternal care programmes like Reproductive and Child Health (RCH)," says Dr. Chandra, adding that Karnataka will soon follow their footsteps. "We are training obstetricians and psychiatrists at district health centres in these states in phase one. In phase two, we will train the primary health centre and community health centre doctors in maternal mental health. PHC doctors will train auxiliary nurse midwives in phase three," she explains.
NIMHANS has outpatient and inpatient wings to provide support and treatment for women having mental health problems related to pregnancy or childbirth.
Depression during pregnancy (prenatal depression) is increasingly present among new age mothers. 25-year-old Meena Venkat from Bengaluru, who was pregnant with her first baby, feared she might not survive on the labour room table. "She was petrified of the possible pain and would spend all her time watching YouTube videos on childbirth. Her anxiety was so severe that she even considered terminating her pregnancy," says Dr. Chandra.
It is not uncommon for pregnant women to feel weepy or depressed. However, conditioned by society to be happy, regardless of their state of mind, they tend to shrug off the blues. Depression during pregnancy may also cause guilt in women. They blame themselves for feeling depressed and do not seek medical help. This could put them at risk and hamper pregnancy outcomes.
Depression has an impact on the biochemistry of the uterus and what the baby is exposed to during pregnancy, explains Dr. Shari I. Lusskin of Mount Sinai Hospital in New York City. "It is not like the baby is in a bubble, completely protected. The mother's hypothalamic pituitary adrenal axis is affected when she is under stress, and that affects the stress management system of the baby. If the mother is depressed during pregnancy, it can induce long term changes in the baby's response to stress," says Dr. Lusskin, a clinical professor of Psychiatry, Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai.
Why are women more prone to depression during pregnancy and the weeks and months after childbirth? There is a growing body of research linking maternal depression with genetics. "It runs in families with a history of major depression and bipolar disorder," says Dr. Jennifer L. Payne, director of the Women's Mood Disorders Center at the Johns Hopkins School of Medicine in Baltimore. A personal or family history of postpartum depression can raise one's odds of developing it, she adds.
Environmental factors can also contribute to postpartum depression. Traumatic delivery, lack of sleep and poor social support can sometimes trigger this condition. "Another possible cause of postpartum depression is the dramatic hormonal change that occurs at the time of delivery when estrogen and progesterone rapidly decrease. There is no evidence that women who develop postpartum depression have different levels of ovarian hormones, but there is evidence that their brains are "mood sensitive" to changes in levels of ovarian hormones," says Payne.
What kind of help is available for women with postpartum depression? "The treatment is basically broken into two approaches—medication and psychotherapy. Talk therapy triggers chemical changes in the brain, which lead to changes in emotion and behaviour. The combination of the two treatments often leads to the best outcomes," adds Dr. Lusskin.
A comprehensive support system should be in place before the baby arrives, suggests Shinie. "New moms should not be made to feel ashamed of wanting some me-time. In fact, it should be made available to them. Date nights with partners would be lovely too."
A new mom should feel integrated into humankind, baby in hand, not out in the cold, she says.