Musubireyo nta mahwa! Nimwonkwe! Félicitations! Tuguhaye impundu! Congratulations! These are the warm and celebratory words traditionally spoken to new mothers in Rwanda after childbirth. They are expressions of joy, pride, and a shared sense of relief and accomplishment. In our culture, as in many cultures, the arrival of a baby is viewed as a profoundly joyful milestone that brings happiness to the entire family but especially to the mother who has carried and nurtured her baby for nine months.

ALSO READ: How mothers should cope with postpartum depression

For many women, this expectation holds true. However, for others, what is meant to be a joyful moment becomes overshadowed by persistent sadness, anxiety, irritability, insomnia, or episodes of weeping. This cluster of symptoms, commonly referred to as the "baby blues,” is considered normal and typically resolves within two weeks.

ALSO READ: Mother’s Day: Fighting postpartum depression

When these symptoms last longer, it is no longer just the baby blues—it may be postpartum depression. Unlike the brief emotional shifts of the baby blues, postpartum depression is more intense, longer lasting, and requires professional attention.

So then, what is postpartum depression (PPD)?

It is a serious mood disorder (a type of depression) that affects some mothers after giving birth. It is characterized by, according to Mayo Clinic, depressed mood or severe mood swings, crying too much, difficulty bonding with your baby, withdrawing from family and friends, loss of appetite or eating much more than usual, inability to sleep, called insomnia, or sleeping too much, and overwhelming tiredness or loss of energy.

Other signs and symptoms include less interest and pleasure in activities you used to enjoy, intense irritability and anger, fear that you're not a good mother, hopelessness, feelings of worthlessness, shame, guilt or inadequacy, reduced ability to think clearly, concentrate or make decisions, restlessness, severe anxiety and panic attacks, thoughts of harming yourself or your baby, and recurring thoughts of death or suicide.

In rare cases, about one to two in every 1,000 women develop a severe condition known as postpartum psychosis (PPP). This illness is life-threatening and requires immediate medical attention. Unlike postpartum depression, postpartum psychosis involves symptoms such as confusion and disorientation, obsessive or intrusive thoughts about the baby, hallucinations and delusions, severe sleep disturbances, paranoia, and in some cases attempts to harm oneself or the baby.

Understanding the distinction between normal baby blues and PPD or PPP is essential to supporting mothers and ensuring they receive the care they need during this vulnerable period.

Prevalence

Postpartum depression affects about one in seven women worldwide, and its prevalence can vary across the first three months, six months, and even later after childbirth. A meta-analysis spanning 56 countries reported a prevalence of 17.7%.

In Rwanda, research indicates that one in five women experience postpartum depression. Despite these figures, knowledge and awareness of the condition remain limited among mothers and the broader community. This lack of understanding may contribute to under-recognition, delayed help-seeking, and insufficient support for affected women.

Therefore, increasing awareness and education is essential to improving maternal mental health outcomes in the country.

Risk factors

According to Havard health publication, first-time mothers often face postpartum challenges as a novel experience, even when they have prepared through education on newborn care.

Uncertainty about emotional responses, combined with cultural expectations to prioritize the baby over themselves, can lead to neglect of their own physical and mental well-being. Single mothers may face heightened vulnerability, as the demands of caring for an infant alone can be physically and emotionally exhausting, increasing the risk of postpartum depression.

Additional risk factors include a previous history of depression, which predisposes mothers to neurochemical sensitivity and maladaptive coping strategies. Stressful life events and adverse environmental conditions such as lack of family support or unsafe surroundings, further elevate risk. Other contributing factors include the presence of a high-needs or difficult infant and limited financial or material resources, all of which can compound stress and make mothers more susceptible to developing postpartum depression.

Intervention or treatment

According to a 2022 research paper by Katharine Green and Maud Low, women experiencing postpartum depression can be supported and treated in several ways, including counselling, medication, and increased social support. Their research shows that counselling or psychotherapy is effective—with or without medication—in reducing depressive symptoms during the first 12 weeks, with cognitive behavioural therapy remaining effective for up to six months.

Psychotherapy is generally recommended as the first line of intervention for mild symptoms, while medication is advised for moderate to severe cases.

Additionally, social support plays a crucial role in recovery. Green and Low highlight that strong support systems help mothers cope more effectively with postpartum depression. In a news story, Life after birth: How mothers should cope with postpartum depression, a new mother, emphasized the importance of having someone available to help—whether by changing diapers, holding the baby so she can rest or even helping with feeding. Such support is essential for healing.

Role of Ketamine in the treatment of postpartum depression

Ketamine is another medication being investigated for the treatment of postpartum depression. Current evidence suggests that it may be effective for both treatment and prevention.

A systematic review and meta-analysis involving 4,389 pregnant women found that ketamine significantly reduced short-term postpartum depressive symptoms.

In another study of women undergoing caesarean delivery, researchers reported that a single dose of ketamine administered during the procedure reduced the risk of developing postpartum depression. Building on this growing body of evidence, King Faisal Hospital (KFH) in Rwanda is planning to incorporate postpartum-depression treatment into its ketamine clinic research, with the aim of evaluating ketamine’s potential benefits in postpartum populations.

The writer is a psychiatrist at King Faisal Hospital, Rwanda.