Dr Geetha Desai
Interview/ Dr Geetha Desai, professor, department of psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru
Q/ Given that mental health awareness is still quite low in our country, how can families recognise when someone is struggling with postpartum depression?
A/ I think there has definitely been an increased awareness, at least in urban areas, thanks to social media. But what happens is that many people normalise the changes that happen after childbirth.
Here’s what to watch for in a new mother: getting angry very easily, crying very often, is very distressed, gets worked up frequently, can't sleep, is not engaged, withdraws from other people, and is not actively participating in childcare. These are all signs. Sometimes new mothers become very anxious, and anxiety can be part of depression, too.
They might become extremely anxious about the baby's welfare or constantly have negative thoughts like, ‘I'm not a good mother’. You will notice them constantly seeking reassurance, asking family members whether they are doing things properly. They talk negatively about themselves or are overly self-critical about their mothering abilities.
These suggest they are probably going through a depressive episode.
Q/ Do you think that self criticism is fuelled by societal expectations that women should be natural caregivers and nurturers?
A/ I think so. The societal expectations of an ‘ideal mother’ definitely play a role. That's where normalising these feelings becomes problematic—when we say “Oh, feeling low and overwhelmed is just normal,” we might miss when someone actually needs help.
First-time mothers especially need our support. I think it is important that we call out and discuss these societal norms about ideal motherhood in public forums. But it is also very important how the mother internalises these ideas.
Q/ This must make bonding with the baby difficult. What kind of impact does this have on the child?
A/ We now have enough research evidence showing that when mothers are depressed, it affects bonding with the infant. It can also affect breastfeeding. The severity and duration of the mother's depression determine the extent of impact.
Difficulties in mother-infant interaction are likely to impact the child's emotional and cognitive development. There is enough evidence that maternal depression affects infant development, especially emotionally, and it can increase the risk of mental health problems as the child grows up.
But here’s something important: people focus so much on postpartum depression that they forget many can actually start experiencing depression during pregnancy itself. That's why it is better to call it ‘perinatal depression’—it includes both pregnancy and postpartum periods.
Q/ How would you rate current awareness levels, both among people and medical professionals?
A/ There have been campaigns about postpartum depression in communities. We are actively working to raise awareness about perinatal mental health problems through radio programmes and other initiatives.
Among obstetricians and gynaecologists, I have seen growing interest in the last couple of years. They are coming forward to discuss this more and asking how to screen women for depression. We have been conducting workshops and talks at medical conferences. We are definitely moving forward, though there is still work to be done.
Q/ What practical advice would you give family members who want to help?
A/ First and foremost, be open to listening to what the mother is going through. Don't normalise it or be overly critical. Sometimes it just helps to listen to what they are experiencing. Second, provide practical support—physical, instrumental support like taking care of the baby, allowing the mother to rest, providing adequate nutrition and discussing the worries that mothers have. Support them in seeking help for postpartum depression without stigmatising mothers who have mental health problems. Too often, families label them as ‘mentally unwell’. That stigma needs to be reduced—it is crucial.
Q/ Is there a genetic component to this condition?
A/ While there are genetic factors involved, it is not the only risk factor. It might increase risk, but there are protective factors as well. Not everybody with genetic risk factors will develop depression. It is important to screen mothers who have multiple risk factors—those experiencing violence, those without adequate support, those with complicated pregnancies, or those with a past history of depression. Screening during pregnancy helps us pick up early signs so mothers can get help sooner.
Q/ In overburdened government health care systems, how realistic is it to identify these cases?
A/ Some states are making progress through task-sharing approaches. Health care workers do first-level screening, and when they identify women at risk or going through depression, medical officers or obstetricians do a second-level assessment.
We are also training obstetricians on when to refer to psychiatrists or mental health professionals. This step-care approach is being practised in some states and districts. However, we still need a better Central policy on maternal mental health.
Q/ When should someone seek professional help?
A/ While two weeks is the guideline, if somebody is expressing suicidal ideas or behaviour, seek help immediately. Try to seek help earlier rather than later.
The longer mothers remain depressed, the longer it takes to recover, and the effects are much worse if treatment is delayed. Early intervention is crucial.
Q/ Who should be the first point of contact for help?
A/ It can be a general physician, an obstetrician, or a mental health professional. Maternal depression awareness should be universal. Everyone needs to know how to help and how to get help for mothers.
For pregnant women, obstetricians are ideal since they see them regularly. Many obstetricians can provide first-level treatment for depression.
Q/ Can postpartum depression become chronic?
A/ Only a subset of women develop chronic depression. Many get better with treatment.