Medically reviewed by PPD is a serious mental health condition that affects women within weeks to months after childbirth. Unlike the baby blues which affects up to 80% of new moms and typically fades within two weeks. PPD is deeper, more severe, and long lasting.
According to the World Health Organization (WHO), about 10–13% of women worldwide experience PPD. But in some low and middle income countries like Pakistan, the rate is significantly higher ranging between 28% and 63%, based on different studies conducted in urban and rural populations.
Causes of Postpartum Depression
Postpartum depression (PPD) is a clinical condition that affects many women after childbirth, causing persistent sadness, anxiety, and fatigue. It stems from a combination of biological, psychological, and social factors. Here’s a breakdown of the primary causes with why they happen.
Hormonal Changes
Why it happens
After childbirth, estrogen and progesterone levels plunge sharply, disrupting brain chemistry specifically neurotransmitters like serotonin and dopamine and the stress regulating HPA axis.
Prevalence
- Globally, PPD affects 10–20% of new mothers
- In Pakistan, hormonal shifts combined with stressors contribute to rates between 28% and 63%.
Emotional and Psychological Stress
Why it happens
New mothers often face sleep deprivation, anxiety, guilt, loss of identity, and pressure to bond. These stressors elevate cortisol and suppress mood regulating neurotransmitters, destabilizing emotional wellbeing.
Prevalence
- Women with prior mental health issues or low support are 3–5 times more likely to develop PPD.
- Pakistani studies report about 37% of new mothers with emotional distress experiencing clinical PPD.
Lifestyle & Sociocultural Factors (Especially in Pakistan)
Why it happens
In Pakistan, several factors amplify stress during the postpartum period:
- Limited paid maternity leave and domestic support,
- Societal/family pressure (especially from in-laws),
- Emphasis on male offspring,
- Low women’s autonomy,
- Stigma surrounding mental health
These create chronic psychosocial distress, a known trigger for depressive episodes.
Prevalence
- Regional studies in Pakistan show PPD rates like 19.3% (urban Sindh), 31% (Lahore), 41% (urban centers).
- National meta-analyses place prevalence between 28% and 63%.
Signs and Symptoms to Watch For
Emotional Indicators
- Constant sadness or emptiness
- Irritability or anger
- Crying spells without obvious reason
Physical and Behavioral Changes
- Difficulty sleeping or sleeping too much
- Fatigue
- Changes in eating habits
Risk Factors for Postpartum Depression
Previous Mental Illness
A history of depression, anxiety, or other psychiatric conditions significantly raises the risk of PPD.
- Pregnancy mood disturbances particularly increase vulnerability postpartum .
- Studies in Pakistan show that women with prior mental health issues are 3–5 times more likely to develop PPD.
Marital or Financial Problems
Marital conflict, financial stress, and lack of spousal support are well established stressors.
- The Family Stress Model explains how economic hardship leads to caregiver depression and relationship conflict.
- Low income and domestic disputes in Pakistan have been linked to higher PPD rates.
Low Education and Awareness
Lower educational attainment often leads to less knowledge about maternal mental health and available services.
- Pakistani studies show that women with limited education and awareness had significantly higher depressive symptoms during pregnancy and postpartum.
Cultural Pressure to Breastfeed or Return to Housework
Societal and familial expectations such as immediate postpartum return to domestic work and strict breastfeeding norms can overwhelm new mothers.
- These pressures contribute to guilt and stress, disrupting the mother’s emotional adjustment and increasing PPD risk.
Low Income, Unplanned Pregnancy & Domestic Conflict (JPMA Study)
A study in the Journal of Pakistan Medical Association (JPMA) identified these critical predictors:
- Low income: Limited resources -> increased stress and depression.
- Unplanned pregnancies: Mothers report higher psychological distress and lower control.
- Domestic conflicts: Including domestic violence, associated with up to 42% higher rate of depression in abused women.
How Postpartum Depression Affects the Baby?
1. Delayed Cognitive Development
- Infants of depressed mothers often score lower on early developmental tests (e.g., Bayley Scales, Griffiths Scale) and exhibit signs of stress during interactions—such as raised cortisol and avoidance behaviors—which disrupt normal brain and emotional growth.
- A 2025 study found that erratic temperaments and bonding issues linked to PPD can influence children’s school‑age behavior and emotional health.
2. Underweight & Malnourishment
- In Pakistan, a landmark cohort from Rawalpindi showed infants of depressed mothers had 4× higher risk of being underweight and 2.5–4.4× higher risk of stunting by 6–12 months, even after adjusting for socioeconomic factors.
- WHO and other studies confirm maternal depression is closely tied to infant undernutrition, illness (particularly diarrhea), and slowed growth in low-income countries.
3. Difficulty Forming Secure Attachments
- PPD impairs a mother’s emotional responsiveness less vocal modulation, lower sensitivity leading to infants being emotionally withdrawn or stressed during interactions.
- Disrupted early bonding raises the risk of attachment insecurity, which can cause long‑term psychosocial challenges.
4. Breastfeeding & Engagement
- Depressed mothers are more likely to stop breastfeeding early, report low milk supply, and have lower self efficacy.
- In Pakistan, insufficient breastfeeding, fewer health visits, and less responsive parenting all linked to PPD increase the risk of infant malnutrition and missed developmental opportunities.
Diagnosing PPD
Use of EPDS in Pakistan
EPDS questionnaires are used in Pakistani healthcare studies and clinics to identify PPD symptoms in new mothers. Routine implementation is very limited: a 2023 Lancet report stated that fewer than 20% of maternal health clinics in Pakistan conduct regular mental-health screenings, including EPDS.
Why Screening Is Critical?
PPD often goes unnoticed: Globally, up to 50% of cases may be missed without screening.
Early detection saves lives: The EPDS allows clinicians to promptly identify mothers scoring above the threshold (typically 10–13), enabling timely referral to mental health support.
Localized validation: Translated editions (like Urdu or regional languages) and culturally adapted cutoffs ensure EPDS remains accurate for Pakistani mothers.
Barriers in Pakistan
- Lack of regular screening protocols in most clinics, despite local research validating the EPDS tool.
- High prevalence (~30–50%) of PPD means missed opportunities for early intervention.
- Cultural stigma and limited resources restrict mental health access, leaving many women without support even if screened.
Treatments Available for PPD
1. Therapy and Counseling
Psychological therapies are considered first line treatment for mild to moderate PPD:
➤ Cognitive Behavioral Therapy (CBT)
- CBT helps mothers identify and challenge negative thought patterns and replace them with more balanced, realistic views.
- Numerous studies show CBT significantly reduces depressive symptoms and prevents relapse in postpartum women.
- It can be delivered in person or online, individually or in group settings.
➤ Interpersonal Therapy (IPT)
- IPT focuses on improving interpersonal relationships and communication, which are often strained during the postpartum period.
- Effective especially for women experiencing role transitions or lack of social support.
2. Medication
➤ Antidepressants
- Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed. Examples: sertraline (Zoloft), fluoxetine (Prozac).
- SSRIs are generally safe for breastfeeding, with very low levels found in breast milk.
- However, in Pakistan and similar regions, stigma around psychiatric drugs often discourages women from starting or continuing treatment.
➤ Important Considerations
- Medication is often combined with therapy for moderate to severe cases.
- Treatment decisions should be personalized based on symptom severity, mother’s preference, and breastfeeding status.
3. Holistic & Lifestyle Approaches
➤ Exercise
- Regular physical activity improves mood, reduces anxiety, and boosts self-esteem.
- A 2021 meta analysis found exercise reduced the risk of PPD by 30–40% when done 3+ times per week.
➤ Nutrition and Sleep
- Iron, omega-3 fatty acids, and vitamin D are often low in postpartum women and associated with depressive symptoms.
- Addressing sleep disturbances, especially through shared caregiving, is key to recovery.
➤ Social Support
- Emotional and practical support from family, friends, and peers can significantly reduce depressive symptoms.
- In Pakistan, traditional family setups can help but may also add cultural pressure.
- Online communities (e.g., Facebook groups for new mothers) are slowly emerging as valuable support networks.
4. The Role of Partners and Family
In Pakistani families, in-laws often live under the same roof. Educating families not just partners is key. Male partners involved in parenting are shown to reduce the likelihood of PPD by up to 25%, according to Harvard Health.
Myths and Misconceptions
Common myths still persist:
- “Only weak women suffer from depression”
- “It’ll go away on its own”
- “Good moms are always happy”
In many South Asian households, PPD is brushed off as “normal” or a “phase,” leading to chronic suffering and untreated illness.
When to Seek Professional Help
If symptoms last beyond two weeks or interfere with caring for the baby, don’t wait.
Emergency signs include:
- Suicidal thoughts
- Thoughts of harming the baby
- Complete emotional disconnection
FAQs
1. What’s the difference between baby blues and PPD?
Baby blues usually resolve in 1–2 weeks. PPD lasts longer and requires professional help.
2. Can dads experience postpartum depression?
Yes, studies show up to 10% of fathers worldwide experience PPD.
3. How long does PPD typically last?
It varies untreated, it can last a year or more. With help, many feel relief in a few months.
4. Is medication always necessary?
Not always. Some moms respond well to therapy and lifestyle changes, but medication may be essential in moderate to severe cases.
5. What can I do right now to feel better?
Talk to someone even if it’s just a friend or another mom. You don’t have to suffer in silence.