Times of India
27 November 2010
Mumbai, India

It is one of the least diagnosed health problems in the country. Post–partum depression, which allegedly drove Dahisar resident Deepika Parmar to throw her infant daughter out of KEM Hospital’s toilet, affects 15% of all pregnant women and new mothers but it is rarely identified, say psychiatrists and psychologists.

"Post–partum blues affect 80% of all mothers due to the hormonal changes that occur in their body but they get alright within a month," said Dr Shamsah Soonawala from Jaslok Hospital’s psychiatry department.

This is obviously a benign condition but around 15% of these women plunge deeper into depression as the hormonal changes are accompanied by biochemical changes as well. "These women need both medication and counselling," she said. Worse, roughly 2% of them suffer from postpartum psychosis–a la Texas resident Andrea Yates who over eight years ago killed five of her children within one hour after "hearing voices".

According to Dr Harish Shetty, "Doctors have hospitalised depressed women during and after pregnancy in a bid to protect the infant and to treat the mothers. Wanting to harm one’s infant is an important symptom of depression. A mother who wants to or harms her infant is mentally ill unless proved otherwise."

In the case of Deepika Parmar, the police arrested her a couple of days ago after she was declared stable by KEM Hospital doctors. "She was stable after medication and counselling," said Dr Shubhangi Parker, head of psychiatry department at KEM Hospital.

In fact, the metropolitan court of Bhoiwada, remanding Parmar to judicial custody till December 8, has directed the jail authorities to facilitate her psychiatric evaluation and treatment. "We will apply for bail on Monday," said her lawyer Devendra Yadav.

Little research has been done in India on post–partum depression. A study done by Dr Prathap Tharyan of Christian Medical College in Vellore that was published in the British Journal of Psychiatry in 2002 said that "low income, birth of a daughter when a son was desired, relationship difficulties with mother–in–law and parents, adverse life events during pregnancy and lack of physical help were risk factors for the onset of PPD".

Shetty and Soonawalla felt there was a need for active screening of pregnant women for signs of depression.

Signs to Look Out for What: Post–partum depression is characterised by depression. It could begin as lack of interest, mood swings and, in extreme cases, with ambivalent and hostile feelings to the newborn

Why?
When a baby is born, the focus is entirely on the new entrant. No thought is spared for the mother's emotional needs. Her depression is missed.

Family members also miss other predictors: History of previous depression, if she has suddenly stopped taking medication. Also, if there are many children in family, if there is medical or socio–economic stress in family.
PPD is common but it is preventable and is treatable with medication and counselling.