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Post-Natal Depression – Spot the Signs…

There is no denying that having a baby is an incredibly stressful and emotion-filled time for nearly every new parent.  While the arrival of a new baby is undoubtedly nerve-racking for the father of the child, it is predominantly the mother who undergoes the most intense psychological turmoil, fuelled by pregnancy hormones and thoughts of her impending new job of “mother” with all the responsibilities which that role encompasses.  It is very common for new mums to feel a bit low, emotional and tearful in the first couple of weeks after childbirth – often referred to as the “baby blues”.  This depressed mood usually starts to disappear very quickly as you get the hang of your new duties and start to feel more in control of your life.  But for many new mothers the negative feelings they have initially continue to fill their minds for a longer than usual period and this could indicate the onset of a more serious mental health condition called Post-Natal Depression (PND). 

Statistics show that about one in ten mums in the UK develop PND in the few weeks following the birth of their baby – although occasionally PND will only begin a few months later.  While it is ordinarily the mother who is affected by PND, it should be noted that fathers can also develop PND through negative thoughts about their own inadequacy at supporting their partner and coping with the emotional changes of becoming a dad.

There are many different types of depression according to psychological theory.  PND is a specific type of depression which follows the birth of a child.  Psychologists consider the following criteria when making a clinical diagnosis of depression [1] :

• Difficulties in sleeping e.g. trouble falling asleep; not returning to sleep after awakening during the night; waking too early; or too much sleep
• Poor appetite or weight loss; or increased appetite and weight gain
• Loss of energy
• Feelings of worthlessness
• Difficulty concentrating, thinking or making decisions
• Recurrent thoughts of death or suicide

If you are not gaining any pleasure in your daily activities and feel like you are stuck in a permanent sad mood, and you are experiencing at least four of the symptoms above each day for at least two weeks, then there is a strong chance you could be assessed as suffering from depression. 

Additional symptoms for PND could include:
• Feeling irritable for a lot of the time
• Tearfulness
• Panic attacks or feeling trapped in your life
• Lack of motivation or interest in yourself and your new baby
• Feeling lonely, guilty, rejected, or inadequate
• Feeling overwhelmed or unable to cope
• Physical signs of tension, such as headaches, stomach pains, or blurred vision

You might scoff at the point above about sleep difficulties – obviously you are going to have difficulty sleeping when you have a demanding newborn to look after.  You may also find you are eating more if you are breastfeeding to increase your calorie intake.  The thing to remember is that if those symptoms occur in addition to feeling uncharacteristically sad, detached from reality, and generally seeing each new experience in a negative way for a prolonged period, then you could be in need of some form of medicinal or counselling intervention to treat your PND.

If you do think you may be experiencing symptoms of PND, you should not be afraid to talk to your GP or health visitor, close friends or family about the way you are feeling because it is not something to be ashamed of.  I know there is a lot of pressure to a behave like a “Supermum” from the moment your baby is first put in your arms, but hopefully the stats will show you that PND is fairly common (about 10% of new mums affected) so you are not alone.  PND can be caused by any number of factors, including depression during your pregnancy and anxiety about your upcoming new responsibilities, a traumatic birth experience, relationship or financial problems, and a lack of support from your friends or family during the daunting initial period of motherhood. 

PND will not disappear by itself.  The most positive aspect of a PND diagnosis is that it is fully treatable through a variety of measures.  You should also discuss your feelings with your partner or close family members as their support will be very beneficial to your recovery.  You will probably be prescribed medication (antidepressants) to be taken for a fixed period to help lift your mood.  You can discuss any concerns you have over combining medication and breast-feeding with your GP.  Counselling (also called talking therapy) has been found to be very effective in treating many forms of depression, including PND.  There are several different types of counselling methods used to treat PND, the availability of which may depend on your local NHS Trust’s resources (if you have private medical insurance that will cover your treatment then you can afford to be a bit more picky about the type of counselling you want to receive).  Cognitive-Behavioural Therapy (CBT) is often used when treating depression because it can be successful in a very short time period.  In essence it works by changing the negative thought processes and feelings you have into more realistic ones by challenging their validity.

You should be aware that there is another, more severe, form of depression which can occur after the birth of a baby, referred to as Postnatal Psychosis.  This may be similar in some ways to PND, but is also characterised by delusions (seeing things that aren’t there) and hallucinations (hearing voices which don’t exist in reality).  Other irrational and suicidal thoughts are symptomatic in this serious mental health condition and, if you suspect that you or a partner may be suffering from this condition, you should seek immediate medical help.

Media reporting on PND has often not been helpful in encouraging new mothers to admit they are suffering from the condition.  For example, stories suggesting that depression during pregnancy or PND can have a detrimental effect on their child’s early development is not likely to make someone want to hold up their hand immediately and acknowledge they have a condition which could be harming their child!  But, as ever, if you read articles which seem like they are reporting the latest new medical discovery, be sure to look for more academic reports on the outcomes of whatever study is being reported.  Often the findings will have been misinterpreted and sensationalised to get a more interesting story out of it.  For example, an article in the Daily Mail in June 2008 [2] reported that ante-natal and post-natal depression were found to increase the risk of poor mental and physical health development in children.  However, in a rebuttal article on the NHS Choices website [3] we are told that, although this study did highlight the possibility of an association between depression during pregnancy and delayed child development, the study cannot prove that there is a link as there are several mitigating factors which could have affected the findings in this experiment.

If you would like to know more about PND, please look at the information available on the NHS Choices website [4].  Not only will you find a lot more detailed accounts of the symptoms, causes, diagnosis, and treatments available, but there is also a video of mums talking about their experience of PND and a section with “Real Stories” where other mums who have had PND have written about their experiences.

References
[1] Kring, A. M., Davison, G. C., Neale, J. M. & Johnson, S. L. (2007).  Abnormal Psychology (10th Edition).  John Wiley & Sons. USA.
[2] http://www.dailymail.co.uk/health/article-1029814/Depressed-mothers-hold-children.html
[3] http://www.nhs.uk/news/2008/06June/Pages/Depressionduringpregnancy.aspx
[4] http://www.nhs.uk/Conditions/Postnataldepression/Pages/Introduction.aspx?url=Pages/what-is-it.aspx

Author: Claire for Kidz Things
April 2009