Postnatal depression

You may find that the weeks and months after your baby is born are not the happy time you expected. If you are feeling tired, confused and unable to cope, you may be suffering from postnatal depression. Current medical opinion estimates that postnatal depression (PND) occurs in up to 15 per cent of new mothers, with different degrees of severity.

For some women it will be a brief time of needing extra support and help. For others it will involve some months of medication and possibly counselling. But women do recover from postnatal depression and go on to enjoy their lives and take pleasure in bringing up their babies.

• Feature: post traumatic stress disorder
• Is it baby blues?
• Recognising the signs
• Screening
• What causes postnatal depression?
• Getting professional help
• Puerperal psychosis
• Building social support
• Feeling down discussion forum
  

Is it baby blues?

Postnatal depression should not be confused with ‘baby blues’, a term used to describe the bouts of weepiness many women experience in the immediate postnatal period. This is mostly due to the enormous physical, hormonal and emotional changes your body goes through as you adapt to a non-pregnant state, and rarely lasts beyond a few days.

It is not surprising that after the ‘high’ of giving birth you may feel a little low. When this is combined with a lack of sleep, tender breasts and changing hormone levels as milk begins to be produced, and the physical discomforts of stitches and bruising, many women feel down and find themselves weeping on the third or fourth day after the baby is born. The treatment for these temporary blues is plenty of support and love, along with as much rest as you can get; then they should soon pass.

Recognising the signs

If after a few weeks your feelings of depression do not begin to stabilise but seem to get worse, you may be suffering from postnatal depression. True PND is indicated by a number of symptoms - the mix will vary between individuals, but usually includes some or all of the following. · A general feeling of lowness over a prolonged period of time; perhaps crying over the smallest things

• Lethargy and exhaustion
• Being unable to bond with your baby
• Feeling unmotivated and unable to perform everyday tasks; even looking after yourself and the baby may seem an impossible chore
• A sense of isolation from your partner, family and friends
• Anxiety and panic attacks
• Feeling that your life is drained of pleasure
• Thoughts of self-blame and insecurity
• Feeling at risk of harming yourself or your baby

Symptoms can appear up to a year after the birth, but more usually appear within the early months. Recognising the signs of postnatal depression is a crucial first step to dealing with it. However, you could be so deeply into the depression that you cannot see what is happening. Partners and family members should be alert to the possibility of postnatal depression and should seek professional help on your behalf if necessary.

Screening

Professional concern is sometimes triggered even before you realise that you could be ill. Parts of the UK are covered by a screening programme which aims to identify women who may be showing the first signs of postnatal depression.

Health visitors use questionnaires to assess all new mothers in their area, preferably at six weeks and also at six months after the birth, scoring their answers against a measure known as the Edinburgh Scale. A high score leads to gentle enquiry and intervention, usually by getting the mother to talk to her doctor.

What causes postnatal depression?

The causes are varied, depending on the individual woman and her background. In almost every case, there is no single factor, but there is instead a cocktail of elements which have combined to trigger the depression. For the majority of women affected by postnatal depression, the causes are largely psychological and social and may include:

• An unhappy or traumatic childhood, leading to an unsatisfactory relationship with your own parents
• The lack of a close and confiding relationship, especially with a mother figure in your own life
• Having no one to turn to for practical and emotional support
• You may have had mixed (and perhaps unexpressed) feelings about the baby, even during the pregnancy; the seeds of the depression can often be traced back to before the birth
• The birth may have been completely different from what you and your partner had originally wanted, leaving unanswered questions and unresolved emotions such as anger and confusion
• Early breastfeeding difficulties can sometimes prompt strong feelings of failure and guilt, which may then contribute to the onset of PND
• For some mothers, there may also be a tendency for depression in their genetic makeup. A general rule of thumb applied by psychiatrists is that the more severe the bout of postnatal depression, the more likely it is that the origins could be hereditary
• Common stress factors in other types of depression, such as the death of someone close, a change of job (or partner’s job), divorce or separation, or a house move, are also seen as potential causes
• Poor social conditions, such as unemployment and bad housing, are thought to have an effect

Getting professional help

Postnatal depression is an illness, and as with many illnesses, professional intervention is necessary if the sufferer is to regain her health and peace of mind. If you think that you may be suffering from PND, it is extremely important that you seek help as soon as possible. Talk first to your GP or health visitor.

Anti-depressants often form a part of the initial treatment. Some women feel unhappy at the prospect of taking pills, but these can play an essential role, helping to lift your mood while the causes of the depression are tackled. Contrary to popular belief, most anti-depressants are non-addictive, and some can even be taken safely if you are breastfeeding (advise your doctor if this is the case).

Your GP may also refer you for counselling sessions with a psychologist or psychiatrist. This treatment can help you to unravel the causes of the depression, allowing you to come to terms with your problems in a safe and controlled environment.

Puerperal psychosis

Puerperal psychosis is sometimes described as an extreme form of postnatal depression, but it should in fact be regarded as something completely separate. Unlike PND, the causes of puerperal psychosis are almost entirely chemical, rather than psychological or social. The condition, which occurs in approximately 1 in every 1000 new mothers, is usually linked to a heightened sensitivity to certain chemicals within the brain, and produces an extreme reaction to the sudden drop in oestrogen levels shortly after birth.

Puerperal psychosis has quite different symptoms to postnatal depression, with an earlier onset - often within the first few days after birth. The symptoms are similar to those of manic depression, with violent mood swings, irrational behaviour, hallucinations, delusions and lack of contact with reality. It requires prompt medical help and most women are admitted to hospital straight away.

Puerperal psychosis is best treated through residential mother and baby units, usually attached to psychiatric units and specifically geared to helping the affected mother maintain a bond with her baby. Places in these units are limited and some women with puerperal psychosis are treated in general psychiatric wards.

Building social support

Social support, and making contact with other people who have been through the same experience, can play an important part in your recovery from postnatal depression.

Your health visitor may be able to put you in touch with local support groups where you can talk frankly with other PND-affected mothers, listen to their accounts of living with postnatal depression and gain comfort from the knowledge that you’re not suffering alone. It can also be helpful to exchange practical ideas for coping with PND.

You could also seek social support by contacting the Association for Postnatal Illness, an organisation specifically run to help women with postnatal depression. As well as offering advice, sympathy and information covering all aspects of PND, it can also arrange one-to-one support from its network of volunteer counsellors across the UK.

Another useful organisation is SANE, which deals with depression and other mental health issues. SANE operates a national database of support services and may be able to put you in contact with PND-related groups in your area. Its helpline offers information on symptoms and treatment, as well as just a listening ear.

MIND (National Association for Mental Health) provides a means of building social contacts - the organisation has over 200 branches across England and Wales, most of which offer counselling services for individuals suffering from depression and other mental health problems. Some areas will also have specific support for postnatal depression. MIND’s helpline offers advice and information (including a booklet called Understanding Postnatal Depression). If you belong to the National Childbirth Trust (NCT), there may be a postnatal depression counsellor on your local branch committee. Or you could contact the NCT’s Special Experiences Register: this is a national database of NCT members who have gone through a range of problems (including postnatal depression), all of whom are willing talk to someone else in difficulties. This service is free and available to non-NCT members.

• To share your feelings with others and realise you are not alone, why not visit babyworld's feeling down discussion forum.