Postnatal Depression (PND) is a mood disorder which ranges from mild to severe, and symptoms may begin suddenly or appear gradually during the first year after birth. It can occur after the birth of any child, and women who have previously experienced depression are at greater risk of developing PND.

It is important to distinguish PND from the 'baby blues' and postnatal psychosis.

The 'baby blues' affects up to 80% of women, usually between the 3rd and 10th day after giving birth. Women may feel more tearful and moody and may at times be overwhelmed. This usually passes within a few days.

Postnatal psychosis is a mood disorder that affects about one in 500 women in the first week or so after childbirth. It is characterised by severe thought disturbances, abnormal behaviour, hallucinations, confusion, and loss of contact with reality. This is a medical emergency and a doctor should be consulted immediately.

                                          Symptoms of Postnatal Depression

Each woman will experience PND differently and not all women will have the same symptoms. Usually PND is indicated when symptoms are excessive or when they last for two weeks or more, and most women will find that the severity of their symptoms remain fairly constant.

Physical signs

• Fatigue
• Significant changes in appetite and sleep patterns
• Lack of interest in sex
• Having no pleasure or interest in usual activities
• Irritability
• Lack of concentration or focus

Behaviour

• Lack of motivation
• Obsessive behaviour such as cleaning, walking, or pacing all the time
• Substance abuse
• Inability to cope with day to day routines
• No interest in your appearance, or taking care of yourself
• Cutting yourself off from others
• Uncontrollable crying

Thoughts

• Irrational thoughts
• Fear of being rejected or unwanted by partner
• Blaming yourself for the things that seem wrong in your life
• Wanting to run away
• Fear of harm coming to your partner or your baby
• Fear of being alone, or going out
• Negative, obsessive or morbid thoughts
• Thoughts of suicide

Feelings

• Guilt, shame or worthlessness
• Extended periods of feeling sad
• Feeling pessimistic and bleak about the future
• High levels of anxiety or panic
• Feeling unusually irritable and impatient
• Mood swings
• Feeling "low" or "flat"
• Feeling pressured by others to experience the so called joys of motherhood
• Helpless, hopeless or out of control
• Feelings of anger and resentment toward your self and/or your baby which won't go away
• Feeling inadequate, having no confidence or self-esteem
• Feeling numb, empty and despondent

Some symptoms may be caused by such things as anaemia, sleep deprivation, thyroid dysfunction or bereavement and need to be considered before diagnosing depression. However, if you experience a combination of these symptoms for more than two weeks, you should talk to your doctor or family care nurse.

Contributing factors

Bio-chemistry/physiology. Hormones, stress, complications during pregnancy and birth, feelings of a lack of control in labour and during birth.

Demography. Extremes of age and education being younger, being older, lacking educational opportunities or being a university graduate.

Psychology/psychiatry. Perfectionist personality, past psychiatric history, family psychiatric history, drug and alcohol problems, significant life events such as death in the family.

Sociology. Poor social supports [social isolation], poor relationships with partner, parents or others.

What next?

No matter how severe the depression is, reaching out for help is the start of the healing process. Often because the feelings women have are very scary or seem "wrong", they are reluctant to tell others for fear of being criticised or judged. These feelings are not a reflection of how you are as a person but a normal part of psychological illness. Being able to share what you are going through with someone you can trust is often the first step on the road to recovery.

If after reading the symptoms you believe you may be experiencing PND, then there are a number of professionals who may be able to help you, such as:

• General Practitioner
• Baby Clinic Nurse
• Psychologist
• Early Childhood Nurse
• Social Worker
• Obstetrician
• Psychiatrist.

Sometimes you might find that your health care professional may be dismissive of your concerns and say things like: "You have a beautiful baby, what are you worrying about," "Get over it," or "It's just a normal first-time mother experience." If this is the case, make sure you find someone else who will help you. Trust yourself to know that what you are feeling is very real. Often it can be helpful to tell a close friend or family member who can go along with you to offer support.

Postnatal depression can be treated successfully with the right help. The types of treatments may vary, depending on the severity of the depression or your personal choices and may include:

Cognitive behavioural therapy. A short term structured therapy which seeks to help the depressed person acquire positive thoughts and attitudes which give a more realistic view of themselves and the world about them.

Interpersonal psychotherapy. This therapy examines and adapts the individual's current functioning by focusing on how past and present relationships affect them.

Trauma therapy. An effective therapy with those who have had trauma in their life (e.g. miscarriage, previous stillbirth or birthing trauma, or sexual abuse).

Talking

Attending support groups

Having the opportunity to simply talk about your experiences may often alleviate much of your anxiety and stress around PND. It also helps to know that you aren't the only one to experience it.

Medication

Sometimes, it may be necessary to prescribe antidepressants and it is important to balance the potential risk posed by that medication to the baby against the risk that mental illness may pose for both the mother and the baby. As all medications cross to the baby through breast milk, caution should always be taken, and you have the right to not only know how these medications may interact with your body or affect your baby, but also the right to refuse this method of treatment.

Hospital admission

Hospital admission to a specialised mother and baby unit.

Hormonal therapy

Alternative therapies [such as acupuncture or aromatherapy]

Individual treatment may vary and will probably include a combination of things, depending on the severity of your PND or your preferences for treatment.

Other things that can help

• Regular exercise
• Yoga or relaxation
• Eating well-balanced meals and avoiding caffeine
• Asking friends and family for help
• Having time alone by yourself, and also as a couple to nurture yourself and your couple relationship.

Linking in with a support group

Please view our calendar to find out more information on where and when the group meets.

Telephone support

Telephone support can be organised through PANDSI for those who do not wish to, or cannot attend support groups. People who are isolated may benefit from this service. Please contact us on 02 6288 5293 if you feel this kind of support would be suitable for you.