Many mothers worry that they may have post natal depression (PND) but just aren’t sure if they do. One of the problems with depression is that it can be really difficult to be objective when you’re going through the experience.
Lots of times mothers are aware they aren’t happy or particularly well, but describing how they feel can be almost impossible. This is why check lists of symptoms can be very useful. What can also help is to listen to the people who love and care for you. If they feel that there’s something not right then it’s probably worth listening to them.
What is Post Natal Depression?
An acute depressive illness which can occur in the period between one and twelve months after having a baby.
What are the Odds of Having PND?
It is estimated that around 16% of mothers can be affected. Post Natal Depression is often described as being mild, moderate or severe. It’s common to feel better on some days than others and at different times of the day, mood can vary.
What’s the Difference Between having the Blues and PND?
The blues are a completely normal and common variation of mood which occurs between three and ten days after birth. Around 80% of new mothers will have the blues their post natal period. This is because of fluctuating hormone levels and once these have stabilised mood generally improves.
What Causes Post Natal Depression?
There’s no one cause for PND but there are risk factors. Hormonal, biological and emotional influence all contribute.
- There is an increased risk in women with a history of depression or mental health issues including anxiety.
- Women who experience ante-natal depression are more at risk of developing PND.
- Women who have experienced an exaggerated form of “the blues” which didn’t resolve within a couple of days after birth.
- Being in an unsupportive relationship, experiencing domestic violence or general relationship issues.
- Difficulty breastfeeding and needing to wean.
- Having an unplanned baby and feelings of guilt.
- A traumatic or disappointing delivery.
- Having a premature baby or one who is unwell, unplanned or a different gender to the one preferred.
- Having an unsettled baby who is reluctant to sleep and cries a lot.
- Having a stressful, complicated pregnancy.
- Difficulty in adjusting to parenthood, loss of identity, financial income and independence.
- Extreme exhaustion.
- Being a single parent without adequate social supports.
- Low income.
- Housing difficulties, disruption in the household or having to move house.
- Women who have had a miscarriage, stillbirth or caesarian section delivery can all experience PND.
Symptoms of Post Natal Depression
Post Natal Depression shares similar characteristics with other forms of depression. But the intensity of the depressive symptoms is often magnified because of being tired and caring for a baby.
- Overwhelming tiredness even if you’ve slept OK.
- Waking very early in the morning and not being able to go back to sleep.
- Low energy levels, poor motivation and lack of interest in socialising.
- Feeling overwhelmed and unable to cope with your own or the baby’s cares.
- Anxiety – often in anticipation of the baby waking.
- Appetite changes including comfort eating or loss of interest in eating. Loss of weight or sudden weight gain.
- Forgetfulness, confusion and mental “fog”.
- Panic attacks and feeling overwhelmed by fear.
- Unstable mood -mothers with PND often feel worse in the mornings and improvement in their mood as the day progresses.
- Thoughts of death, suicide, self harm, hurting the baby or wanting to “end it all”.
- Feelings of sadness, despair, disappointment, failure and occasionally, hopelessness.
- Feelings of being under a black cloud and intense loneliness.
- Lack of emotional connection to the baby, with feelings of ambivalence.
- Loss of libido.
- Fathers too, can also experience PND. Although they are not as frequently diagnosed as women.
Diagnosis of PND
- Can be made by the mother herself, her partner, friends or family.
- PND can be formally diagnosed by a health care professional following a physical examination and history.
- The Edinburgh Postnatal Depression Scale (EPDS) is commonly used; Depending on the total score a mother is diagnosed as having PND or being at risk.
- Blood tests are often ordered when a diagnosis of depression is made. It is important to ensure there is no underlying medical condition present such as hypothyroidism which could be mimicking depressive symptoms.
What is the Treatment?
Treatment options vary according to the severity of symptoms and the individual woman.
- Supportive psychotherapy. This can be with a psychologist, psychiatrist, social worker, doctor, or mental health nurse.
- Fish oil supplements and St. John’s Wart have been found to be effective in treating cases of mild to moderate depression.
- Cognitive Behaviour Therapy (CBT).
- Hypnotherapy, progressive muscular relaxation, yoga, exercise, massage and remedial therapies.
- Medications including anti-depressants, mood stabilisers and anti-anxiety medications.
What Can I Do to Help Myself?
- Ask for help. Be honest, don’t try and hide how you’re feeling.
- Write lists as reminders. Forgetfulness is a common symptom of depression.
- Exercise can be an effective strategy in managing depression.
- A healthy diet, adequate water intake and limiting caffeine all help.
- Don’t isolate yourself from others.
- Make a safety plan with a list of contact names and telephone numbers.
- Sleep, rest and look after yourself.
- Be realistic and avoid setting yourself up for feelings of failure. Plan for at least one enjoyable activity each day and be flexible.
Where can I go for Help?
- GP, Child Health Nurse or health care professional.
- An early parenting centre which specialises in PND and support for new mothers.
- Check http://www.beyondblue.org.au/the-facts/pregnancy-and-early-parenthood
- A PND support group – check http://www.panda.org.au
- From a psychologist – check www.psychology.org.au for location information.
- Friends, family, mothers and new parent’s groups.