It was hard for 28-year old Marie Ann Niyonizeye to carry and give her own child the love of a mother two months after delivery. She was always moody and never wanted to associate with anyone.

"I would lock myself in the room and cry, I avoided conversation with anybody, I was depressed but I couldn’t figure out what was wrong with me because I didn’t have any physical pain,” she says.

Niyonizeye says the situation got out of hand when she felt like killing her own child. Her husband was also considering walking out of their marriage.

Luckily, her older sister came to her rescue and took her to a psychological clinical officer, who was able to treat her condition.

Dr Francis Kazungu, a general practitioner at Clinic de Medicale, describes Niyonizeye’s situation as postpartum depression, a condition that affects mothers during and after delivery.

He explains that it’s hard for the affected person to understand what’s wrong with them, thus making the condition very risky and harmful to both mother and baby.

Dr Kazungu points out that although the condition mostly affects first time mothers, any mother is likely to get the condition after birth.

If left untreated, the mother can harm or even kill the baby, he warns.

What is postpartum depression?

Dr Kazungu defines postpartum depression (PPD) as an emotional disorder that affects the thoughts and feelings of women before and after delivery. This is due to the changes of the female reproductive hormones (increase of the level of estrogen and progesterone).

He says social and psychological anxiety of having the baby for the first time increases the risk of developing depression.

Signs and symptoms

According to Dr Kazungu, a mother suffering from PPD will always experience symptoms and signs which include, difficulty sleeping, appetite changes, frequent mood changes, getting overwhelmed with fear or sadness and crying a lot.

"The mother may also experience major depression, feelings of hopelessness, thoughts of committing suicide and wanting to hurt others. When one experiences such symptoms they should be given immediate help and support,” explains Kazungu.

Who’s at risk?

According to Dr Rachna Pandey, an internal medicine specialist at Ruhengeri Hospital, the risk factors for PPD are lack of physical, emotional support in childcare, anxiety about childcare, change in lifestyle after becoming a parent, changes in hormonal levels and depleting prolactin levels.

Previous history of depression, menstrual blues, previous abortion or still birth and cigarette smoking are the other risk factors, she adds, pointing out that PPD can affect both those who had normal delivery or C-section.

"There is no clear difference in PPD between those delivering naturally or by C-section. Although some studies suggest greater prevalence of PPD in women who undergo C-section, this could be related to difference in levels of oxytocin released during the two kinds of child birth and the difference is just for initial 2-3 weeks,” Dr Pande says.

On the other hand, Dr Kazungu says long labour or if one gets complications during delivery, there is increased risk of one suffering from PPD.

Managing the condition

Iba Mayale, a gynecologist at Doctors Plaza Clinic in Kimirinko, says the only treatment is going through good antenatal counseling so that the mother is prepared mentally for child birth. He also cites antidepressants as treatment for PPD.

"PPD is a reality and some mothers who go through it have no control over it. And anyone going through this should be able to get support from both husband and other family members in childcare, especially if they are first time mothers,” Mayele says.

He also advises that good physical and emotional support by clinical psychologists is helpful in preventing PPD, adding that during pregnancy, mothers should not only focus on antenatal visits, but also seek psychological help.

Dr Pande explains that such a mother should be kept involved in the care of their baby and supported to feel that she is not alone or it’s a burden on her.

She adds that family members should give due attention to the mother’s nutritional needs and other requirements.

Dr Pande says when PPD is treated, one recovers spontaneously over 4-8 weeks if it is a mild case, but for severe ones, one needs antidepressant drugs and psychotherapy.