Postnatal depression

Living through postnatal depression can be one of the most overwhelming, frightening and debilitating experiences a woman can have.

She may feel her world has fallen apart, that everything is black or that nothing makes sense. For some, it can even start during pregnancy, and if left untreated can get worse after the baby is born.

There are three types of childbirth-related depression that are talked about:

• Postnatal or maternity blues are very common. A new mother feels down and tearful in the week after her baby is born. This feeling passes after a few days.
• Postnatal depression, a more serious condition, is also common. The mother becomes seriously depressed in the first months following the baby's birth. It can occur any time during the baby’s first year. 
• Postnatal psychosis (sometimes called post partum psychosis) is rare and involves symptoms of psychosis (being out of touch with reality) as well as changes in mood – either a depressed or an extremely high mood. It usually begins in the first two weeks after the child is born.

Here we focus on postnatal depression. This can happen to women who have never been mentally unwell before. Others may have had depression or a psychotic illness in the past. Regardless of what has happened before, the symptoms and treatment are similar.

The major difference between this form of depression compared to others is that it involves a newborn baby as well as the mother therefore it is really important to seek help early. Because postnatal depression can affect how you feel about, and care for, your baby and other children it is important not to ignore any signs. Talk to your midwife or doctor immediately.

If you fear you might harm or kill yourself it is vital that you seek help immediately.

The good news is that postnatal depression can be treated and you will get better over time.

Myths about postnatal depression

Postnatal or any depression is a sign of a weak character.

NOT TRUE Postnatal depression can strike any woman after the birth of a baby. While some particular personality types may be more likely to develop depression, the vast majority of women who develop the condition have been previously healthy and led normal lives.

Women with postnatal depression can 'snap out of it' or just choose to 'pull their socks up'.

NOT TRUE One of the most disabling symptoms of depression is the fact that it saps the will and makes doing anything an enormous effort. Depression is an extremely unpleasant experience, and most women with this condition would (and do) do anything to get well. ‘Snapping out of it’ is not an option.

What causes postnatal depression?

While anyone who gives birth is vulnerable, there are certain factors that increase the chances of developing postnatal depression.

Risk factors before pregnancy and birth:

• Past history of depression or other mental health problem.
• Relationship difficulties, especially with the father of the baby or with own mother.
• Having little social support.
• Onset of depression during pregnancy.
• Hormonal problems.
• Life stresses or difficulties such as money or housing problems.

Risk factors related to the birth:

• Birth complications, such as caesarean delivery.
• The birth did not live up to expectations, eg, birth in hospital or with medical intervention when the woman wanted a home or natural birth.
• Birth of a brain-damaged or ill baby.

Risk factors after birth:

• Ongoing postnatal blues.
• Not wanting to hold the baby or having negative or no thoughts about the baby.
• The mother experiences sleep problems.
• The baby is fussy, has problems feeding, or has colic or reflux.

Signs to look for (symptoms)

The signs of postnatal depression are the same as for depression, which can occur at any other time. These may vary between women and over time in any one woman.

• Feeling low, sad or depressed. This is described in a variety of ways by people, especially if they are from non-European cultures. The woman may describe feeling sad, empty, having no feelings, or may complain of pain that is hard to locate. She may cry for no apparent reason. Some women may feel sad or low in mood all of the time, others have periods where their mood is more normal but the periods of feeling good do not last more than a day or two.
• Losing interest and pleasure in usual activities. This means you don’t enjoy things that you would usually find pleasurable. 
• Feeling irritable or angry for no reason. This may be the main mood change for some women. If it continues, it can make dealing with the frustrations of caring for a baby very difficult, and may also be very damaging to other relationships.
• Change in sleeping patterns. The most common change is reduced sleep, with difficulty getting to sleep, disturbed sleep, and/or waking early and being unable to return to sleep. While it is usual for mothers to have their sleep interrupted by a waking baby, women with postnatal depression often find they cannot sleep even when the baby is settled. For example, they may lie awake worrying about the next feed or the next day.
• Change in appetite, often not feeling like eating and, as a result, losing weight. Some women will have increased appetite, often without taking any pleasure in eating. 
• Decreased energy, tiredness and fatigue may be so severe that even the smallest task seems too difficult to complete, causing great difficulty in caring for the baby. 
• Physical slowing or agitation often comes with severe depression. The person may sit in one place for periods and move, respond and talk very slowly; or they may be unable to sit still, pace and wring their hands.
• Feeling worthless or guilty involves loss of self-confidence. As a result of feeling bad about themselves, you may withdraw from doing things and from contact with others. You may also feel that they are a bad mother.
• Having thoughts of hopelessness and death and feeling that there is no hope in life. 
• Finding it difficult to thinking clearly. You may have difficulty in concentrating. You may also have great difficulty making even simple everyday decisions.
• Being anxious – there are various kinds of anxiety that people suffer from but as the depression decreases these symptoms stop. They may include:
• Excessive worry or fear, with associated physical symptoms such as muscle tension, pounding heart or dry mouth. The focus of worry will often be the baby.
• Panic attacks, with sudden episodes of extreme anxiety and panic and physical symptoms of fear. Again the focus is often to do with the baby.
• Phobias. Specific fears about situations, fear of open spaces, confined spaces, heights, objects, animals or creatures such as spiders.
• Excessive concern about physical health. You may worry that you are physically ill in some way, or that your baby is ill or has something terribly wrong with him/her.

How to decide if you have a problem

If you are concerned, or suspect you (or a loved one) has postnatal depression it is important to talk to your midwife, doctor or Plunket nurse. Remember, depression is a serious illness and you do need to see your doctor if you suspect you may be suffering from it.

Treatment options

Treatment of postnatal depression can involve a number of aspects, each of which can be tailored to your individual needs.

Your doctor will recommend a mix of treatment options which best suits you. Talk to them if you are considering stopping treatment and work together with them to find some compromise that will ensure continuing wellness but address your concerns about the treatment. If you are on medication, it is very important that the decision to stop taking it is made with the input of your doctor and anyone else involved in your treatment. With some medications stopping suddenly can make you feel worse.

Therapy, such as counselling

Supportive counselling is a treatment for milder forms of postnatal depression, where it is as effective as antidepressant medication. More specific therapies such as cognitive behaviour therapy, (CBT) are very effective. People learn how to use their own skills and resources to cope with worries and problems.

Psycho-Education (providing education)

Education about postnatal depression can be extremely important to help the new mother, their family/whānau and supporters to understand and help in their recovery. Your doctor will give you information about postnatal depression, suggests different ways to handle it, and discusses any complications which could occur.

Talking about it with friends and family/whānau will help.

Medication

Your doctor may prescribe antidepressants for depression. Finding the right medication can be a matter of trial and error – there is no way to predict which medication will be effective and tolerated (have fewer troublesome side effects) by any one person.

If you are prescribed medication you are entitled to know:

• the names of the medicines
• what symptoms they are supposed to treat
• how long it will be before they take effect
• how long you will have to take them for and what their side effects (short and long-term) are. 

If you are breast feeding no medication is entirely safe. Before making any decisions about taking medication at this time you should talk with your doctor about the potential benefits and problems. As noted before, it is important not to stop taking antidepressants suddenly without medical advice.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress. When considering taking any supplement, herbal or medicinal preparation you should consult your doctor to make sure it is safe and will not harm your health, for example, by interacting with any other medications you are taking. 

Physical health

It's also really important to look after your physical wellbeing. Make sure you get an annual check up with your doctor. Being in good physical health will also help your mental health.

Thanks to Janet Peters, registered psychologist for reviewing this content. Date last reviewed:  September, 2014.