Postnatal depression (PND), also called postpartum depression, is experienced by approximately 15%-25% of women after childbirth. Men can also experience this depression although much less frequently.
PND is not the ‘baby blues’. About half of all woman go through the baby blues, a milder depression that is normally resolved within ten days after the birth. There is also a more serious condition called postpartum psychosis (also known as puerperal psychosis) which affects approximately 0.2% and includes symptoms such as hallucinations, loss of contact with reality, thought disturbances and out of character behaviour.
If you get puerperal psychosis, you will need to go to hospital and see a psychiatrist. Ideally this would be in a specialised mother and baby unit where you can have your baby with you
Diagnostically, the DSM-IV does not recognize postnatal depression as a separate diagnosis; rather, patients with a diagnosis of postpartum depression must meet the criteria for both major depressive episode and the criteria for the postpartum onset specifier. The diagnosis must be made within four weeks of delivery.
The obvious signs are anxiety, inability to look forward to events, low mood and extreme tiredness. Often there is a lot of guilt and shame about not meeting a perception of being a good mother. Other symptoms of PND include:
- panic attacks
- extreme tiredness
- aches and pains
- feeling generally unwell
- memory loss or being unable to concentrate
- feelings of not being able to cope
- not being able to stop crying
- loss of appetite
- feelings of hopelessness
- not being able to enjoy anything
- loss of interest in the baby
- Afraid to be alone with the baby
- excessive anxiety about the baby *
Moreover, women with PMD frequently think they are “going crazy” and worry that if they share these thoughts with a health care professional, they will be “locked up” or someone will take their baby away from them*. These fears are about keeping themselves and their baby secure and come from a deep emotional bond. The mother will do anything to protect and be with her offspring and will internally fight to try and ensure nothing interferes with this relationship. The stress of PND often negatively affects the relationship with the spouse and other members of family and friendship networks.
Post natal depression develops in different ways, for some it is really sudden and for others it is very gradual. With the gradual kind the person is less likely to seek help, with sudden and severe onset professional help is likely sought. If left untreated PND can extend into a second year post delivery. It’s important that detection and treatment is timely as PND affects both the health of the mother and the offspring’s own mental health and development.
In terms of basic PND screening, the Edinburgh postnatal depression scale is used in primary care in Australia, the United Kingdom and Europe. You can complete the screening test on this site: The screening test for post natal depression. Do it now if you are concerned that you may have post natal depression. Remember to seek professional assistance if you think you have post natal depression. Getting immediate assistance and help is vital for a timely recovery.
It’s not about the relationship with the husband or the baby that is driving this depression; post natal depression is about chemical imbalance, and is more clearly documented than other types of depression such as major depression and seasonal affective disorder.
At least one third of the women who have had PND have a recurrence of symptoms after a subsequent delivery, and as many as 60% of women with bipolar disorder have a relapse after childbirth*. A history of depression or other mental health issues greatly increases your chances of developing PND.
Socioeconomic causes are also a factor in PND. The lower the socio-economic bracket the higher the chance of developing post-natal depression. The anxiety around providing for yourself and your offspring is likely to continue to fuel anxiety, tension and stress if money and other stable pillars are not there.
Let’s look at some stories about how two women beat post natal depression. The first story is Aimee’s.
With Aimee’s PND irritability was really infecting her life and her relationships. She went to the GP and got counselling.
It’s also noted how helpful the partner was in going through post natal depression. Aimee admitted suffering depression whilst pregnant, a predictive factor for the likelihood of PND forming. She then had the baby blues after the birth which developed into full blown post natal depression after the first year. In this video the problem of feeling guilty about your feelings when suffering PND is explored in that you should be feeling so good to have a baby and raise a newborn into the world but you feel so bad when going through PND. This incongruity is often deeply unsettling for the sufferer. She felt guilty about her feelings, which is very common for people with PND. This guilt becomes a driving force in the length and severity of depression unless treated and addressed. Aimee also experienced exhaustion, but it is encouraging that these resources can and do get replenished with the right care and support.
Jessica Rowe, an Australian TV journalist, also suffered from PND.
In her case the PND fuelled severe anxiety, panic and obsessive thoughts about the safety of her baby. In spite of being a mental health advocate for so long she still struggled with the crucial step of asking for help. Like Aimee’s case Jessica’s partner didn’t dismiss her concerns; he affirmed his love of her and assisted her in getting help. Jessica went on medication and sought professional help, making a strong recovery from PND.
How people beat post natal depression
Counselling or psychotherapy
Talking therapies are proven to be very effective against PND. Even discussing it with a GP is an excellent first step. Often CBT techniques will be taught during this process.
Exercise is crucial, especially if medication and talking therapies are not used when trying to beat PND. Listen to our podcast on why exercise is just so vital for depression.
Support and advice
Mutual support groups can share collective wisdom about implementing strategies to combat and beat PND. Keep reaching out to friends and family and ensure you have enough social contact to combat the impulses toward loneliness and isolation.
Keep a journal
My good friend Graeme Cowan created a support group a few years ago in which he suggested a great term, creating a mood-o-meter to track your mood every day. Keep a mood-o-meter along with a daily journal and document your mood and behaviour, start to map out relationships between thoughts, feelings and actions. Rate your mood for the day between 1-10. If the mood is four or below there are serious problems that need to be addressed. Remember when it comes to recovery most of the work remains with the person. Journalling helps cut through the fog of depression.
Sometimes antidepressants are necessary to treat more severe PND, but as they can pass through breast milk this needs to be carefully considered with relevant health professionals and family.
Don’t compare yourself with others
This is much easier said than done. It’s human nature to dwell and measure sense of worth and value against others. Comparing yourself against other mothers’ or worrying that you are not attaining super-mum status is only going to harm and worsen your mental health. In our articles on anger we looked at how certain types of personalities are more prone to depression, especially perfectionists and people pleasing personalities. This rings true for PND too, with the need to be seen as a good mother and the anxiety around doing everything perfectly to accomplish this aim.
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