Kochi-based Abhilash K had been married to Anu for 7 years in 2012. The couple was based out of Dubai then and Anu was pregnant for the second time. They were overjoyed.
Soon after the pregnancy was confirmed, Anu moved to Kochi, closer to her in-laws, so that she could have help and care at hand. Abhilash was to join them after he fulfilled his work commitments in Dubai. The couple would speak every morning before Abhilash left for work.
But tragedy struck before the family could be reunited.
When their daughter was only 87 days old, Anu took her own life.
“My mother found Anu hanging in our first-floor house. Anu wasn’t responding to her calls and my mother could hear the baby crying from the ground floor. So, she had to go up and get people to knock the door down,” Abhilash recounts.
Abhilash was told that Anu had been in an accident and that he should rush back. When he found out about the suicide, he was left completely dumbfounded. “We spoke around 7 in the morning that day before I left for office. It was just like a regular conversation. She even went downstairs to visit my mother," he says.
In order to understand what led his otherwise cheerful and outgoing wife to take her life, Abhilash spoke to people close to her and to those from the medical fraternity. While there was nothing outright different about her behaviour, one of her colleagues, a paediatrician, told him that she seemed depressed two weeks before the ill-fated day.
Through the course of these conversations, Abhilash became aware of the term post-partum depression. “I had no idea that there was something like this. There could be no other reason why a person like her, who was always smiling, would do something like this,” he insists.
Abhilash has now started a Facebook page to raise awareness about the issue and insists that it must be mandatory for gynaecologists to give a brief to expecting parents about PPD.
What is PPD?
Most films and popular culture fill our minds with images of blissful motherhood, where the woman appears radiant and fulfilled when she holds her child in her arms. These images conveniently glaze over tougher physical and psychological effects that follow delivery.
Post-partum depression (PPD), also known as post-natal depression is one such condition, which while common, is rarely talked of.
Chennai-based gynaecologist V Madhini says that while most women go through post-partum blues, characterised by doubts about child-rearing and nurturing capability, and being emotional and overwhelmed, PPD is rarer.
Dr Jayanthini, a psychiatrist in Chennai, says that in cases where women suffer from PPD, it is likely that they have a family or personal history of depression or other mental illnesses.
However, Dr GK Kannan, a child and adolescent psychiatrist says that while having depression earlier in one's life can increase the risk of going through PPD, it is more important to recognise the groups that are vulnerable to the disorder.
"Those who have low social support, had difficulties in their pregnancy, had marital issues or if the child has medical or developmental problems, fall in the more vulnerable groups," he states.
As per American Psychiatric Association, PPD requires medical intervention and unlike blues, does not go away on its own. It is characterised by loss of interest in things you used to like, drastic change in appetite, anxiety (all or most of the time), feelings of guilt and worthlessness, fear of not being a good mother or disinterest in the baby, sadness, uncontrollable crying, inability to fall asleep or sleeping too much, among others.
PPD can even appear a few months after the delivery and can go on for weeks and months if left untreated.
How does it affect new mothers?
Sarita was 29 when she had Ankita in 2013. She decided to take a break from working as a Chartered Accountant and stay home for a while to take care of the baby. But her newly-attained motherhood was not defined by contentment or happiness. Instead, Sarita was weighed down by a feeling of worthlessness, which she believes came from not working.
Then, Ankita stopped breastfeeding at three months, when Sarita had wanted to breastfeed her for a year at least. Overwhelming feelings of guilt and inefficiency took hold of Sarita. It didn’t help that her in-laws, who lived separately from her husband and she, said in passing that they could now take Ankita to their place for a while because she wasn’t feeding.
Looking back now, she thinks this is when PPD really took hold of her. “I slept and woke up with scary, suicidal thoughts every day. My friends told me to consider therapy but I was too disinterested in my own well-being to care,” Sarita says. It was after two years that she finally went to a therapist and started taking anti-depressants in March this year.
For Ranjana*, who first gave birth in 1993, PPD was triggered by a complicated delivery where she incurred heavy blood loss. Too weak to move, she began having episodes of uncontrollable crying when she was still in the hospital after childbirth.
Once she was discharged, the feeling of worthlessness and hopelessness increased. “I’d cry for everything: being unable to take care of the baby, the housework, even when the child was unable to sleep,” she recounts.
She was diagnosed with PPD a few days later and seemed to have recovered, but it returned when the baby turned three months old. Her husband, while supportive, did not recognise it for what it was. Fortunately, Ranjana went to a doctor for a calcium deficiency and was told that she was suffering from mild depression. Ranjana recovered in a few weeks.
What can be done?
While PPD is treatable, Dr Jayanthini warns that caregivers must ensure that medication is properly administered. Because women suffering from PPD may have suicidal thoughts, the medication must be kept securely so that it is not misused by them to self-harm. Caregivers must also ensure that she takes the medication and does not hoard it.
“Moreover, families need to be educated that this is something biological. It is not in their control. Telling them to not create a fuss or that they’re worrying about nothing will only reinforce the stigma around mental illness, and prevent them from seeking the right help,” Dr Jayanthini warns.
She adds that while self-harming tendencies and neglect to the child are short-term effects, the long-term effects of PPD affect children in the long run.
Sarita for instance, admits that once Ankita was a toddler, Sarita’s frustration and anger would often come out on her in the form of yelling. “I knew she could understand what I was saying, yet she would not listen. I would yell at her a lot. I know it is wrong, but I just wasn’t strong enough,” she says.
Dr Kannan says that a child needs more than just nutritional support from the mother and that PPD can hamper his/her well-rounded growth: “If the mother doesn't give attention or affection to the child, he/she may also show high levels of irritability. In some cases, if the child’s health is neglected, he/she may also suffer from malnutrition. Depression can also lead to marital discord between the spouses which in turn will negatively affect the child. It's a vicious cycle.”
So, how must one know when to seek medical help? Dr Kannan outlines the signs and period:
“If the mother is increasingly crying, showing signs of high irritability, has thoughts of harming herself, shows a lack of interest in the baby but also feels guilty about it and if such symptoms persist for over two weeks, then it is time to see a professional.”
(The names of the women quoted in the story have been changed on request.)
With inputs from Monalisa Das.