The four-stage process to regain control of Postpartum Depression

Postpartum depression (PPD) is characterized by a major depressive episode that begins within four to six weeks following delivery, as per international diagnostic criteria. Recurrence rates for PPD are high, with 40% of affected women experiencing depression again in their lifetime and nearly 50% facing another episode in subsequent pregnancies. Symptoms of PPD encompass fatigue, irritability, anxiety, lack of pleasure, feelings of helplessness, sleep and appetite disturbances, indifference towards life events, low self-esteem, and feelings of incompetence as a parent, among others. PPD is considered a multifactorial condition influenced by both environmental and genetic risk factors for depression.

Risk factors for PPD  include:

• Previous depression.
• Adverse life events.
• Lack of social support.
• Socioeconomic position.
• Personal and family psychiatry history.
• Stressful experiences (such as trauma).
• Specific pregnancy-related factors.
• Intimate partner violence (IPV) occurring close to or during pregnancy also elevates the risk of postpartum depression.

The impacts of PPD are significant and extend beyond the affected individual. They include poor attachment between the mother and newborn, potential stunted growth and low weight in the child, disrupted breastfeeding, and adverse effects on the infant’s cognitive, emotional, and social development. There is also an increased risk for psychiatric disorders in the child during infancy, childhood, adolescence, and adulthood. Women of color and those with lower incomes are more likely to suffer from postpartum depression and may face barriers to accessing treatment (Gopalan et al., 202).

The four-stage process to regain control of Postpartum Depression

Women experiencing PPD often undergo a four-stage process in an attempt to regain control:

1. In the initial stage, mothers grapple with intense worries, persistent obsessive thoughts, and difficulties focusing.
2. In the second stage, women feel a sense of loss of their “regular selves,” describing a robotic feeling while caring for their infants. Withdrawal may occur, and thoughts of self-harm or suicide may surface.
3. The third stage involves women planning strategies to overcome PPD, such as seeking help from healthcare providers, engaging in prayer, or finding comfort in support groups.
4. In the final stage, women regain control of their thoughts and feelings as despair lifts.
   Should we throw away our medicines after the ‘Best Before’ or Expiry date?

   Introduction

   One of man’s best inventions is drugs, especially disease-specific ones. Drugs are substances other than food, which can prevent, relieve the symptoms, or cure an abnormality or disease. Globally, the cost of drugs has soared over the years, resulting in a situation whereby low-income earners are unable to buy branded medications. In underdeveloped and developing countries where food and drug agencies have poor capacity to perform their regulatory functions optimally, we tend to see the proliferation of substandard or fake drugs. So many times, this ugly trend is energized by not just greed but by the market demands for affordable medications.

   Why Medication exceeds expiry date

    To mitigate the challenge of not being able to buy drugs, when necessary, people from resource-limited settings stack up some essential medications in their homes, which eventually exceed the best before or expiry dates on them. Sometimes, doctors could change a patient’s prescription because of reactions, allergies, or inability to purchase the drug, which could result in leftover drugs that eventually exceed the expiration date. Also, big pharmacies and patent-drug stores cannot sell all their stock, leading to the expiration of some drugs. This situation has raised many questions about the safety of these drugs after their expiration or beyond the “best before” date. Because of the importance of drugs and the health risks involved when taken wrongly, people have always consciously discarded unused drugs when it’s past the expiration date, even one day.

   How Safe is a drug after the expiry date?

   The debate about drugs being safe after their expiration date has persisted over the years, as many people still hold the opinion that pharmaceutical companies deliberately label their drugs with short shelf lives to guarantee steady patronage. Eventually, most of these unused drugs are discarded. The context that drugs can still be safe for a long time after expiration has gained several affirmations. In a recent study by Benjamin Davido and others titled ‘Efficacy of Expired Antibiotics: A Real Debate in the Context of Repeated Drug Shortages’ published in MDPI Journal “Antibiotics”, it was reported that when appropriately stored in line with the expected conditions, no expired antibiotics tested failed to be potent after one year of expiration. In another study by Sushil Sharma and others, titled ‘A study to investigate the chemical potency, physical stability, and efficacy of analgesic agents over a period of two years post their expiry date’ published in the “Medical Journal Armed Forces India”, it was seen that drugs such as Diclofenac, Piroxicam, and Ibuprofen retained their stability, analgesic efficacy, chemical active ingredients and by implication their potency up to a duration of two years after expiration.

   Important factors to consider

   However, the issues of proper storage and handling can play a big role, especially in the tropical climate of West Africa and other geographical regions. Hence, people in the tropics may have to rely on their capacity to store their drugs in the required condition in deciding whether to use a drug past the expiration date or not.

   Conclusion

   This article doesn’t advocate for the use of expired medication but to reduce anxiety about accidental use. It is essential to understand factors that impact drug stability.

   (Written by Ebenezer Dic-Ijiewere PhD.)

   NB: Always consult your healthcare professionals regarding expired medications to ensure medication safety and effectiveness.

   Key Strategies to Cope with Stress

   Stress has a significant impact on overall health, playing a crucial role in the development of various diseases and placing a substantial strain on the healthcare system (Shchaslyvyi et al., 2024). It is closely linked to numerous long-term health problems, especially cardiovascular conditions, which are often worsened by daily psychosocial pressures like job-related stress (Shchaslyvyi et al.,2024) It is essential to understand the healthy ways to cope with or manage stress.

   Various strategies recommended according to the CDC (2025)

   1. Take Care of Your Mind

   Limit news and social media exposure: Excessive exposure to harmful or distressing news can exacerbate stress.

   Make time to unwind: Incorporate relaxation practices such as deep breathing, stretching, or meditation.

   Keep a journal: Writing can help you process emotions, reflect on your thoughts, and release tension.

   Spend time outdoors: Whether you are being active (walking, hiking) or just relaxing outside, nature can be a calming presence.

   Practice gratitude: Regularly noting things you are grateful for helps improve emotional well-being.

   Connect with others: Talking to trusted friends, family, or community/faith-based groups provides support.

   2. Take Care of Your Body

   Get enough sleep: The CDC recommends 7 hours or more per night for adults and suggests maintaining a consistent sleep schedule.

   Move more: Physical activity is one of the most effective ways to reduce stress; even small amounts can help.

   Eat well: A balanced diet (fruits, vegetables, lean proteins, whole grains, low-fat dairy) supports both physical and mental health.

   Limit alcohol and avoid substance misuse: Moderating alcohol intake, avoiding illegal drugs, and not misusing prescription medication are essential.

   Avoid tobacco: Smoking, vaping, and the use of other tobacco products can worsen stress or its effects.

   Stay up to date with healthcare: Regular check-ups, screenings, and vaccinations help you maintain your physical health — which can help buffer stress.

   3. Integrate Physical and Mental Health

   The CDC emphasizes that mental well-being and physical health are closely linked. Regular physical activity is not only good for the body but also supports emotional resilience.

   It encourages finding a “right combination” of coping techniques that work for you — not everyone copes the same way.

   4. Know When to Seek Extra Support

   The CDC notes that while stress is everyday, chronic stress (long-term) can lead to serious health problems.

   If you’re struggling to cope or stress is affecting your daily life, it’s okay to reach out for help. They list resources, including crisis lines.

   Sources

   CDC. (2025)

    International Journal of Environmental Research and Public Health, 21(8), 1077–1077. https://doi.org/10.3390/ijerph21081077

   The Health Effects of Stress

   Overview of Stress: Stress significantly affects health, contributing to disease development and burdening healthcare systems considerably. It is a significant factor in various ongoing health issues, particularly cardiovascular diseases, which are often impaired by everyday psychosocial pressures, such as work-related stress.

   The following are the roles of stress in disease development.

   Gender Differences in Stress Responses: Gender plays a vital role in how individuals experience and manage stress. Research reports that women are more likely to develop mood disorders and autoimmune. At the same time, men tend to have higher rates of early substance abuse, infectious disease, mortality, and antisocial behavior. Unsuccessful stress management can lead to severe physical and mental health consequences for both individuals and communities.

   Physiological Responses to Stress: The study reports that stressful events can trigger emotional responses such as anxiety and worry, impacting the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal-medullary (SAM) system, which may lead to unhealthy lifestyle choices, comprising poor sleep, alcohol consumption, decreased physical activity and increased smoking thereby increase the risk of diseases.

   Chronic Stress in Specific Environments: Chronic stress in educational settings and workplaces impacts mental and physical health noticeably. Also, it indicates that occupational stress significantly affects mental well-being.

   Traumatic Events as a Stress Source: Traumatic events are a prevalent source of stress that affects a large portion of the population. The study reports that In North America, about 60% to 75% of individuals will experience a traumatic event in their lifetime, including serious accidents, exposure to war, sexual assault, chronic childhood abuse, or neglect.

   Risk Factors for Uterine Fibroids Among Black Women

   Uterine fibroids (UFs) represent the most prevalent non-cancerous tumors among women of reproductive age. Symptomatic fibroids can lead to significant health issues and are the primary reason for hysterectomies in the United States and globally, contributing to substantial socioeconomic impacts and affecting over 70% of women of reproductive age (Langton et al., 2024). African American women tend to develop fibroids approximately 10 years earlier than White women in the US and bear a disproportionate health burden from these tumors

   Black women experience UFs at higher rates, with an earlier onset, more severe symptoms, and faster disease progression compared to other groups.

   According to Sithembinkosi Ndebele (2024), 85% of participants were non-Hispanic Blacks. Black participants had a higher likelihood of a UF diagnosis, and the following risk factors were reported contributing to the high prevalence of UFs in Black individuals:

   1. Socioeconomic Status: Lower socioeconomic status is reported to increase the rates of UFs.
   2. Adverse Environmental Exposures: Increased exposure to environmental pollutants is associated with a higher prevalence of UFs.
   3. Chronic Stress: Experiences that increase chronic stress are significant contributors.

   Lifestyle and socioeconomic factors, closely tied to neighborhood characteristics, further influence UF prevalence. These factors include:

   1. Body Mass Index (BMI): A higher BMI correlates with a higher risk of UFs.
   2. Alcohol Use: Regular alcohol consumption is positively correlated with UF diagnosis.
   3. Income and Occupation: These factors influence access to healthy food and healthcare.

   Strategies for Improving Sleep Quality

   Sleep is essential for the health and well-being of children, adolescents, and adults. Quality sleep supports emotional well-being, metabolic health, cognitive function, mental health, and cardiovascular and cerebrovascular health. Additionally, getting sufficient, high-quality sleep helps reduce the risk of fatigue-related accidents and injuries, such as motor vehicle accidents and workplace incidents.

   Recommended Sleep Duration

   The American Academy of Sleep Medicine (AASM) and the Sleep Research Society (SRS) recommend that adults aim for at least 7 hours of sleep each night to promote optimal health. Similarly, the National Sleep Foundation (NSF) advises adults to get 7 to 9 hours of sleep per night, with older adults requiring 7 to 8 hours.

   Prevalence of Sleep Disorders and Mental Health Impacts

   About one-third of the population experiences insomnia symptoms, such as difficulty falling or staying asleep. Additionally, 4% to 26% of individuals report excessive sleepiness, and 2% to 4% have obstructive sleep apnea. Insomnia is associated with a significantly increased likelihood of mental health issues; individuals with insomnia are 10 times more likely to experience clinically significant depression and 17 times more likely to experience anxiety compared to those without insomnia. Poor sleep is also linked to post-traumatic stress, eating disorders, and psychosis spectrum experiences, such as delusions and hallucinations.

   Improving sleep Quality

   Improving sleep quality benefits mental health, and research reports that sleep plays a causal role in mental health challenges. Better sleep positively affects future mental health, even those without clinical symptoms.

   Strategies for Improving Sleep Quality

   • Creating a relaxing sleep environment
   • Limiting daytime naps
   • Managing stress and worries
   • Being mindful of food and drink choices
   • Sticking to a consistent sleep schedule
   • Incorporating physical activity into daily routines.

   Successful interventions for managing or reducing effects of Postpartum depression (PPD)

   Postpartum depression (PPD) presents a significant public health concern, affecting not only the physical and mental well-being of mothers but also that of their infants. Research suggests that approximately 13 million women worldwide are diagnosed with PPD annually (Xu et al., 2023). Mild depressive symptoms are experienced by around 50% to 75% of mothers, with 10% to 15% developing postpartum depression within the first week after childbirth (Xu et al., 2023).

   Understanding preventive measures to reduce its prevalence is very crucial.

    1. Exercise intervention has proven effective in preventing PPD disorders. In a 12-week exercise intervention study, aerobic exercise was found to relieve postpartum depression symptoms in PPD patients. Engaging in suitable aerobic exercise during pregnancy has been reported to promote pelvic mobility and improve birth canal space to relieve maternal labor pain. However, it also aids in preventing pregnancy complications. Studies suggest that PPD symptoms may manifest during pregnancy, with a similar 12% occurrence rate of depression reported, which indicates that preventive measures during pregnancy may have a significant impact on reducing PPD (Xu et al., 2023).

   Moreover, research indicates that the antidepressant effects of exercise can persist beyond the cessation of physical activity. Therefore, research suggested that incorporating aerobic exercise into prenatal care may substantially prevent PPD more than exercise as a postpartum treatment strategy.

   Engaging in moderate exercise during pregnancy can reduce the likelihood of developing postpartum depression (PPD) among expectant mothers. Partaking in at least 150 minutes of moderate-intensity aerobic exercise per week significantly enhances the efficacy of physical activity in preventing and treating PPD (Xu et al., 2023). Moderate aerobic exercise prompts the release of endorphins, which uplift mood and alleviate symptoms of anxiety and depression. Additionally, it helps regulate hormone levels, improve sleep quality, and enhance self-awareness and self-esteem, thereby positively influencing the mitigation of postpartum depression (Xu et al., 2023).

   Also, social support plays a vital role in maintaining the mental well-being of pregnant and postpartum women, with supervised exercise and team-based exercise serving as effective avenues for providing such support. For instance,

   • Team exercise fosters a positive environment for maternal emotional communication, and sharing maternal emotions enhances mothers’ childbirth knowledge and skills, reduces fear of labor pains, alleviates negative emotions, improves interpersonal communication, and enhances self-efficacy (Xu et al., 2023).

   • Supervised exercise, which involves physical activities piloted and supervised by healthcare professionals or fitness trainers, ensuring that exercises are safe and suitable for individual pregnant and postpartum women. Participating in supervised exercise classes or programs also offers opportunities for social interaction, which is critical for mental well-being and can lighten feelings of isolation by connecting with other new mothers and professionals in a supportive setting (Xu et al., 2023).

   2. Music therapy, when used as an adjunct to conventional psychotherapies, has been shown to improve physiological symptoms and effectively reduce negative emotions without any adverse side effects. It can positively impact and alleviate symptoms of PPD, offering a safe and affordable substitute to standard treatments. Music therapy is considered to reduce the need for pharmacological interventions during PPD treatment. Research has indicated that music therapy interventions such as music listening, improvisation, songwriting, singing, relaxation and meditation, and lyric analysis effectively reduce the risk of prolonged PPD and it can encourage strengths, empower individuals, and foster connections with themselves and others (Patch & Short, 2022).

   References

   Xu, H., Liu, R., Wang, X., & Yang, J. (2023). Effectiveness of aerobic exercise in the prevention and treatment of postpartum depression: Meta-analysis and network meta-analysis. PLOS ONE, 18(11), e0287650–e0287650. https://doi.org/10.1371/journal.pone.0287650

   Patch, M. C., & Short, A. E. (2022). Addressing the “Baby Blues”: Developing a Music Therapy Model for Prevention and Treatment of Postpartum Depression. Australian Journal of Music Therapy, 33(2), 82–90. https://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=10&sid=e5bc3ad9-8160-4ed8-bb4f-752141ecd9c5%40redis

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