💙 Men's Health

Postpartum Depression (Nigeria Guide)

Depression after childbirth — recognising, destigmatising, and treating postnatal mental illness in Nigeria

Postpartum depression (PPD) affects approximately 1 in 5 Nigerian mothers — yet it is dramatically underrecognised and undertreated. In Nigeria, cultural expectations of joy around childbirth mean many women feel shame about low mood after delivery, and families may attribute symptoms to spiritual attack or witchcraft. PPD is a medical illness — a neurobiological response to the dramatic hormonal, physical, and psychological changes of childbirth. Without treatment, it impairs mother-infant bonding, child development, and maternal wellbeing. It is very treatable.

Signs and Symptoms

✓ Persistent low mood, tearfulness, or feeling empty — beyond the normal 'baby blues' (which resolve by 2 weeks)

✓ Anxiety and excessive worry about the baby's health or your ability to cope

✓ Difficulty bonding with or feeling affection for the baby

✓ Sleep disturbance beyond what the newborn causes — inability to sleep even when the baby sleeps

✓ Feelings of worthlessness, failure, or guilt — 'I am a bad mother'

✓ Loss of appetite or overeating

✓ Difficulty concentrating or making decisions

✓ Thoughts of harming yourself or the baby — requires urgent assessment

Risk Factors

Previous history of depression or PPD
Antenatal depression or anxiety during pregnancy
Inadequate social support — lack of partner, family, or community support
Difficult delivery, birth trauma, or perinatal loss
Neonatal illness (baby in special care unit)
Financial stress
Relationship difficulties or domestic violence
Unwanted pregnancy
Breastfeeding difficulties and associated guilt

When to Seek Help

EmergencyThoughts of harming yourself or your baby — call a trusted person immediately, go to the nearest hospital, or call SURPIN crisis line (0800-800-2000)

Urgent — same daySevere agitation, confusion, hallucinations, or inability to care for yourself or the baby — may indicate postpartum psychosis, a psychiatric emergency

Within 1 weekLow mood, tearfulness, or anxiety persisting beyond 2 weeks after delivery — PPD assessment needed at postnatal check

Routine postnatal checkAll women should be screened for PPD at the 6-week postnatal visit using the Edinburgh Postnatal Depression Scale (EPDS)

Any timeTrusted family member or partner concerned about the mother's mental state — seek professional assessment

Tests & Diagnosis

🧪 Edinburgh Postnatal Depression Scale (EPDS)

A validated 10-question self-reported screening tool. Score ≥10 indicates probable PPD. Score ≥13 = depression likely. Question 10 screens for self-harm thoughts. Available in Yoruba, Igbo, Hausa translations. Used at postnatal check

🧪 PHQ-9 (Patient Health Questionnaire-9)

Standardised depression severity tool — useful for monitoring treatment response

🧪 Thyroid function tests

Postpartum thyroiditis can mimic PPD — fatigue, mood change. TSH, free T4

🧪 Full blood count

Postpartum anaemia worsens fatigue and low mood

🧪 Psychological assessment

By a psychiatrist, psychologist, or trained mental health nurse — for formal diagnosis and treatment planning

Treatment Options

Psychoeducation and destigmatisation

Explaining to the mother and family that PPD is a medical condition — not weakness, laziness, or spiritual failure. This is the essential first step in Nigerian settings where stigma prevents care-seeking

Social support and practical help

Partner and family involvement in baby care. Rest when possible. Connection with other mothers through mother-and-baby groups or online support communities

Psychological therapies

Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) are first-line for mild-moderate PPD. Available at psychiatric units of teaching hospitals (LUTH, UCH, LASUTH) and some private mental health clinics. Online therapy platforms are increasingly available

Antidepressant medication (moderate-severe PPD)

Sertraline (Zoloft) is first-line — minimal transfer into breast milk, well-tolerated, good evidence in PPD. 50 mg daily, increased to 100–200 mg if needed. Safe during breastfeeding. Takes 2–4 weeks to work — continue for at least 6 months

Other SSRIs

Paroxetine — also well-studied in breastfeeding (though more transfer than sertraline). Fluoxetine — effective but higher breast milk levels; prefer sertraline unless fluoxetine was previously effective

Do NOT stop medication when feeling better

PPD recurrence is high if antidepressants are stopped before 6 months. If this is a second episode, consider 12 months of treatment

Breastfeeding support

Breastfeeding difficulty contributes to PPD. Lactation support reduces this. SSRIs are compatible with breastfeeding — do not stop breastfeeding to take antidepressants

Postpartum psychosis (emergency)

A psychiatric emergency — rapid-onset confusion, hallucinations, extreme mood swings, and bizarre behaviour within 2 weeks of delivery. Requires urgent psychiatric admission. Treatment: antipsychotics (olanzapine, quetiapine), mood stabilisers, ECT in severe cases

Frequently Asked Questions

Is it normal to feel sad after having a baby?

'Baby blues' — tearfulness, mood swings, and anxiety — affect up to 80% of new mothers and typically peak at day 3–5, resolving by 2 weeks. This is normal hormonal adjustment. Postpartum depression is different: it persists beyond 2 weeks, is more severe, and significantly impairs functioning. Both are real — but PPD requires treatment.

Will antidepressants harm my baby if I'm breastfeeding?

Sertraline is the preferred antidepressant during breastfeeding. The amount transferred to breast milk is very small, and adverse effects in breastfed infants are rare. Untreated PPD harms mother-infant bonding and the baby's development far more than sertraline. Discuss with your psychiatrist or paediatrician.

My family says I should be happy — I just had a baby. Why am I sad?

Postpartum depression is a biological illness driven by the dramatic hormonal changes after delivery (particularly progesterone and oestrogen crash), combined with sleep deprivation, physical recovery, and psychological adjustment. It has nothing to do with being grateful or not. Just as a person can develop malaria even if they wanted to be well, PPD can occur even when a baby is wanted and loved.

Can postpartum depression affect the baby?

Yes. Untreated PPD impairs mother-infant interaction and bonding, which affects the baby's emotional development, cognitive development, and attachment. Children of mothers with untreated PPD have higher rates of behavioural problems and developmental delay. Treating the mother protects the baby.