Postnatal depression is depression that is lasting, as opposed to the baby blues, which are typically short lived. It usually occurs shortly after the birth, although it may go unrecognised for quite some time. Postnatal depression affects more than 15% of women and 10% of men. PND can develop between one month and up to one year after the birth of a baby.

There are three recognised mood disorders in the postpartum period.

Baby Blues

The baby blues usually occur between three and 10 days after giving birth. The baby blues are common and affect around 80% of women. Women with the baby blues may feel tearful and overwhelmed, due to changes in hormone levels following childbirth. The baby blues is common and to be expected following the birth of a baby. The baby blues usually disappear within a few days without treatment, other than support.

Postnatal Depression (PND)

PND is treatable illness that can cause fatigue, sadness, loss of enjoyment in activities, irritability, and anger.

PND can occur also occur during pregnancy (antenatal depression).

It can occur in all cultures, equally common in Maori and Europeans, all socio-economic classes and at all ages.

It happens mostly after the first baby but can occur after any other pregnancy. If you do develop postnatal depression there is a 50% chance that you will be affected in subsequent pregnancies.

Postnatal Psychosis

Affects one in 500 women in the first week or so after childbirth. It involves having difficulties thinking clearly (thought disturbance), seeing or hearing things that are not there (hallucinations), feeling everyone is against you (paranoia) and powerful delusions. This is a medical emergency and a doctor should be contacted immediately.

There is a risk to the life of both mother and baby if the problem is not recognised and treated. Postnatal psychosis requires a hospital stay. With appropriate treatment women suffering from postnatal psychosis fully recover.

Signs and Symptoms of PND

Postpartum depression can affect mothers in several different ways. Generally these symptoms are felt regularly over a period of approximately three to four weeks.

Below are some common signs and symptoms:

• A feeling of being overwhelmed

• A feeling of being trapped

• A feeling that it is impossible to cope

• A low mood that lasts for longer than a week

• A sensation of being rejected

• Crying a lot

• Feeling guilty

• Frequent irritability

• Headaches, stomachaches, blurred vision – signs of tension

• Lack of appetite

• Loss of libido

• Panic attacks

• Persistent fatigue

• Problems concentrating or focusing on things

• Reduced motivation

• Sleeping problems

• The mother lacks interest in herself

• A feeling of inadequacy

• Unexplained lack of interest in the new baby

• Lack of desire to meet up or stay in touch with friends.

What Causes PND?

Like depression, postnatal depression doesn’t have one definite cause, but it is more likely when a number of factors are combined:

• A past history of depression and/or anxiety

• A stressful pregnancy

• Depression during the current pregnancy

• Sexual abuse

• A prolonged labour and/or delivery complications

• Problems with the baby’s health

• Difficult breastfeeding

• Sleep deprivation

• Being a single parent

• Having an unsettled baby

• Having unrealistic expectations about motherhood

• Isolation and/or lack of support

• Hormonal changes from childbirth

• Family history of mental disorders.

Treatment for PND

The type of treatment that is best for you can depend on various things including:

• How severe your depression is and what symptoms you have

• The impact of your symptoms on your ability to function (to look after yourself and your baby)

• Whether you have had depression or other mental health problems in the past

• Your current situation.

There are many therapies for PND however the most important factor is recognising that it exists. As many depressed mothers don’t know what is wrong with them, it is up to GPs, midwives, partners or family to help spot behavioural changes. All women with postnatal depression need emotional support from family and friends.

It is important that you visit your GP for a full medical assessment.

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Pregnancy can be a time of emotional highs and lows. For some women, however, the lows are persistent and interfere with daily life. Depression during pregnancy (or antenatal depression) is an under-recognised condition experienced by approximately 9% of women at any given time during pregnancy. The symptoms of antenatal depression are no different to the symptoms of depression at other times during one’s life, but can be compounded by the fact that women may also be experiencing other physical symptoms as a result of being pregnant.

Depression can start at any time during pregnancy and can come on suddenly or develop gradually. It may persist for many months.

Depression during pregnancy does not mean that a woman will have postnatal depression, however about 50% of women suffering from severe depression during pregnancy go on to develop postnatal depression. Therapy during pregnancy can reduce the chances of developing postnatal depression dramatically.

SYMPTOMS OF ANTENATAL DEPRESSION

A woman may be suffering from antenatal depression if she feels some of the following symptoms during her pregnancy, usually daily over a period of three to four weeks:

• Inability to concentrate and difficulty remembering

• Difficulty making decisions

• Anxiety about the pregnancy or becoming parents

• Feeling emotionally numb

• Extreme irritability

• Sleep problems not related to the pregnancy

• Extreme or unending fatigue

• A desire to eat all the time or not wanting to eat at all

• Weight loss or weight gain not related to pregnancy

• Loss of interest in sex

• A sense that nothing feels enjoyable or fun anymore, including the pregnancy

• Feeling like a failure, feelings of guilt

• Persistent sadness

• Thoughts of death or suicide.

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Self-Help for Postpartum Depression

Sometimes the best thing you can do if you have PND is to take care of yourself. The more you care for your mental and physical well-being, the better you’ll feel. Lifestyle changes can help you feel like yourself again.

• Get some sleep. A full 8 hours may be impossible when dealing with a newborn, but lack of sleep often makes depression worse.Ask for help from your partner, family members and friends to help you fit in naps when you can.

• Be kind to yourself. Find small ways to pamper yourself, like taking a bubble bath, having a hot cup of tea, or have a massage, read a book.

• Eat well. When you’re depressed, nutrition often suffers. What you eat has an impact on mood, as well as the quality of your breast milk, so do your best to establish healthy eating habits.

• Aim for a balanced diet of protein, complex carbohydrates, fruits and vegetables.

• Get out in the sunshine. Sunlight lifts your mood, so try to get at least 10 to 15 minutes of sun per day.

• Ease back into exercise. Exercise is an effective method for treating depression. Don’t overdo it; a 10-minute walk can improve your mood for two hours.

• Practice relaxation techniques. A daily relaxation practice can help relieve symptoms of depression, reduce stress, and boost feelings of joy and well-being. Try yoga, deep breathing, progressive muscle relaxation, or meditation.

And remember:

• Accept help when it is offered! Find people who can help you with child care, housework, and errands so you can get some much needed rest.

• Give yourself credit for the things you’re able to accomplish, even if you only get one thing done in a day. If you aren’t able to get anything done, don’t be hard on yourself.

• Give yourself permission to feel overwhelmed.

• Remember that no one expects you to be super mum.

• AND…care less about the housework!

Anti-Depressant Medication

Anti-depressant medication can be prescribed for PND, especially if the depression is moderate or severe. The medication can help improve symptoms such as low mood, poor concentration, irritability or poor sleep. This can help to assist you bring back some balance to life which can help you cope better with everyday life and your baby.

MOST MEDICATION CAN TAKE TWO TO FOUR WEEKS BEFORE THEIR EFFECT CAN BUILD UP, SO YOU DO NEED TO GIVE IT TIME.

Anti-depressants are not addictive and some can be safely taken while breastfeeding and pregnant.

It can be helpful to seek objective advice from a doctor, pharmacist or drug information line.

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Post Traumatic Stress Disorder (PTSD) is the psychological term for a set of reactions anyone may experience when something traumatic or scary happens. PTSD for mothers can come from events before, during, after or throughout the entire birth experience. Only recently has it been recognized that PTSD may be suffered as a result of a traumatic birth experience.

These symptoms should alert you to possible PTSD:

• Experienced an event perceived by the person experiencing it as traumatic.

• Flashbacks of the event, vivid and sudden memories.

• Nightmares of the event.

• Inability to recall an important aspect of the event – psychogenic amnesia.

• Exaggerated startle response, constantly living on edge.

• Hyper-arousal, always on guard.

• Hyper-vigilant, constantly looking around for trouble or stressors.

• Avoidance of all reminders of the traumatic event.

• Intense psychological stress at exposure to events that resemble the traumatic event.

• Physiological reactivity on exposure to events resembling the traumatic event – panic attacks, sweating, palpitations.

• Fantasies of retaliation.

• Cynicism and distrust of authority figures and public institutions.

• Hypersensitivity to injustice.

See www.tabs.org.nz for more information on PTSD.

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Anxiety is a feeling of uneasiness, apprehension or dread and is a normal reaction to stress and can actually help us respond appropriately to real danger helping to motivate us in some situations.

However anxiety can be irrational, with no specific event, object or situation prompting it, and it can be overwhelming. When anxiety interferes with a person’s ability to cope with everyday life, professional help is needed.

Anxiety is a common symptom of PND. For some women with PND, anxiety is their main symptom. Because these women often don’t feel ‘sad’ or ‘depressed’, they can find a diagnosis of PND hard to accept.

Anxiety often goes hand in hand with depression and is more common than depression. Up to 20 to 30% of women experience anxiety in pregnancy and after delivery.

Most new mothers worry about their babies’ health. If you have PND, the anxiety can be overwhelming. You may worry that:

• Your baby is very ill.

• Your baby is not putting on enough weight.

• Your baby is crying too much and you can’t settle him/her.

• Your baby is too quiet and might have stopped breathing.

• You might harm your baby.

• You have a physical illness.

• Your pnd will never get better.

You may be so worried that you are afraid to be left alone with your baby. You may need reassurance from your partner, health visitor or GP.

Forms of Anxiety

There are different types of anxiety disorders:

• Generalised Anxiety Disorder (GAD)

• Panic Disorder

• Obsessive Compulsive Disorder (OCD)

• Social Phobia

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Women may feel anxious, but are unable to pinpoint what they are anxious about. Some women with PND feel irrational concern about their own health, or the health of their baby for example is the baby gaining enough weight, getting enough sleep, is the baby unwell.

Some women will continue to feel that way even after repeated assurances that all is well.

Women in pregnancy might worry about the health of the baby, childbirth, or whether they will be a good mother. Of course, many of these worries are a normal part of becoming a mother however when the amount and the intensity of worrying is excessive, help should be sought.

Physical Symptoms of Anxiety

• Restlessness

• Easily fatigued

• Difficulty concentrating

• Muscle tension

• Disturbed sleep

• Headaches

• Muscle aches

• Trouble falling asleep or staying asleep.

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A panic attack is episodes of acute fear or discomfort that can last for up to fifteen minutes.

During a panic attack, women may experience:

• Feeling like you can’t breathe

• Chest pressure or chest pain

• Pounding heart

• Racing pulse

• Dizziness or light-headedness

• Tightness in the throat

• Sweating

• Trembling or shaking

• Nausea

• Tingling or numbness in the hands or feet

• Hot flushes or chills

• Sense of unreality or dreamlike sensations

• Extreme fear of losing control, doing something embarrassing, going ‘crazy’ or dying.

People having panic attacks sometimes believe they are having heart attacks, losing their minds, or on the verge of death.

They sometimes can’t predict when or where an attack will occur, and between episodes many worry intensely and dread the next attack.

When people have repeated panic attacks, or become very fearful of having further panic attacks, this is called Panic Disorder.

People who have full-blown, repeated panic attacks can become very disabled as they start to avoid places or situations where panic attacks have occurred. For example, if a panic attack happened while driving they may develop a fear of driving and avoid it completely.

Some people become housebound or are able to confront a feared situation only when accompanied by a spouse or other trusted person. When the condition progresses this far, it is called agoraphobia.

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People with obsessive compulsive disorder (OCD) have persistent distressing thoughts, images or impulses (obsessions) and may use rituals (compulsions) to control the anxiety that these thoughts produce.

People with OCD may feel compelled to engage in certain rituals such as hand-washing, counting, checking, or cleaning. They may be obsessed with germs or dirt, and wash their hands over and over. They may be filled with doubt and feel the need to check things repeatedly.

Many people have rituals, such as checking to see if the stove is off several times before leaving the house. This is often a normal response. The difference in people with OCD is the degree of time spent in doing this. Usually this takes more than an hour a day or causes marked distress or impairment and it is this which differentiates it from normal.

If OCD occurs in the postnatal period, it can interfere with the mothers ability to take care of her baby. For example, they may not attend straight away to the crying baby, as they feel compelled to complete a ritual such as cleaning or checking.

Some mothers with OCD become obsessive about germs contaminating their baby and may go to great lengths to ensure the baby does not come into contact with anything considered dirty (e.g. changing their clothes many times a day, not allowing the baby on the floor, repeatedly washing the baby’s ears and nose).

Often women feel embarrassed or ashamed about their thoughts and compulsions and it can be very hard to tell someone. However, it is important to tell your doctor as OCD as can be treated.

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People with social phobia have marked and persistent fear of social or performance situations in which the person feels she is being exposed to scrutiny by others. She would usually feel that she would act in a way, or show anxiety symptoms, that will be humiliating or embarrassing.

This fear interferes with work and other ordinary activities. Physical symptoms often accompany the anxiety of social phobia and include:

• Blushing

• Sweating

• Trembling

• Nausea

• Difficulty talking.

Social phobia can be limited to only one type of situation – such as a fear of speaking in formal or informal situations, eating or drinking in front of others or, in its most severe form, a person may experience symptoms almost anytime they are around other people

People with social phobia may have lived with it for a long time. For new mothers their role as a parent may provide an opportunity to overcome this or it may make things more difficult.

New mothers have to face many situations in which they or their baby are the focus of attention e.g. family get-togethers, Plunket or mothers groups. These situations may be very uncomfortable for someone with social phobia. However having a baby may encourage some women to feel less anxious as the focus may be on the baby. For some mothers there is extra motivation to overcome their social phobia for the benefit of their child.

Another concern for some mothers can be feeling that their parenting skills are being judged. This may discourage them from going out.

Breastfeeding in front of other people is something that any mother can be self conscious about initially. Breastfeeding in public or in front of others can be particularly anxiety provoking for mothers with social phobia. They often avoid it completely which can cause considerable inconvenience. They may give up breastfeeding completely due to their anxiety.

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PND is generally perceived as a condition that affects women in those first few months after having a baby, but research suggests that up to 10% of new fathers are suffering a similar form of depression after the birth of their child. Men find it harder to recognise and accept that they might be depressed. The symptoms can be similar to those described for women but men may be particularly irritable, angry or uncommunicative. Men are likely to see these feelings as a weakness (which it is not). Fathers can feel excluded from the relationship between the mother and the baby. Two thirds of fathers may experience their own version of the ‘blues’. They can feel inadequate for the task in hand, less in control of their own lives and “on the outer” in their relationship with their partner. Fathers may feel that the birth of the baby has brought about the loss of the familiar partner that he has known. It also brings the loss of the relationship that they once shared. There is the loss of control, loss of intimacy and the loss of how things used to be.

Being a father may not come naturally to all men. How they cope depends on many factors:

• Their own experience of being fathered.

• Whether they find relationships easy or challenging.

• Whether they have had contact with babies and children before.

It is important to remember that pregnancy is a challenging time for fathers as well. They may worry about:

• Will his partner and baby be healthy?

• Will he be able to provide for the family?

• How will he protect his family?

• How will his relationship with his partner change?

• Does he feel an important part of his baby’s growth and development?

Fathers adjust best if they are included in the process of pregnancy, childbirth, and caring for the baby. Fathers need to spend time developing their relationship with the baby. This will also help their mood.

Reasons Why Men May Develop PND

• A history of depression themselves and/or in their family.

• Financial worries.

• Marriage or relationship problems.

• Thoughts and feelings of inadequacy.

• A feeling of isolation and/or no family, friends to help out.

• Physical health problems.

• Inevitable changes to lifestyle and routines.

• Coming to terms with fatherhood and all the emotional, physical changes and a sense of responsibility that it brings with it.

• The strain of coping with their partners PND.

There are hundreds of reasons why depression might occur and many have nothing to do with becoming a father.

Support Men with PND

A GP is a good point of contact and can help offer advice on ways to cope with the PND.

Mothers can help support their partners who are experiencing PND. Although it’s difficult to provide adequate support when you have a new baby to care for, there are some simple measures mums can take to help their partner feel better and more positive about life. Just being there for him when he wants a chat, being sensitive to his needs and finding at least an hour or two each week to be together can make all the difference to his recovery – if you work through it together your relationship may also become stronger too.

The very worst thing that can happen is if he’s left to battle the blues by himself.

Other helpful methods:

• Keep physically active – a brisk walk can do wonders for the soul and make you feel better about things.

• Meet up with friends. Socialising outside of the family unit can be a great remedy for depressed dads – it reminds them that they are an individual, that there are other things going on in the world, other people to make them laugh etc.

• Chatting to other dads going through a similar experience can help.

• Invest time in hobbies or take up a new interest such as fishing, art or photography.

• Watch your alcohol and drug intake, it is very easy at this stressful time to find refuge in alcohol and drugs which can lead onto other problems.

If you find that the depression isn’t easing, counselling may help. Some men might find the thought of revealing their thoughts to a complete stranger horrifying, but statistics show that it can be surprisingly effective at easing the symptoms of depression and helping people to think more positively.

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If someone you love is experiencing PND, the best thing you can do is to offer support. Give her a break from her childcare duties, provide a listening ear, and be patient and understanding. You also need to take care of yourself. Dealing with the needs of a new baby is hard for fathers as well as mothers.

How to help your wife/partner/family member:

• Encourage her to talk about her feelings. Listen to her without judging her or offering solutions. Instead of trying to fix things, simply be there for her to lean on.

• Offer help around the house. Help with the housework and childcare responsibilities. Don’t wait for her to ask!

• Make sure she takes time for herself. Rest and relaxation are important. Encourage her to take breaks, hire a babysitter, or schedule some date nights.

• Be patient if she’s not ready for sex. Depression affects sex drive, so it may be awhile before she’s in the mood. Offer her physical affection, but don’t push is she’s not up for sex.

• Go for a walk with her. Getting exercise can make a big dent in depression, but it’s hard to get motivated when you’re feeling low. Help her by making walks a daily ritual for the two of you.

It is important to understand that people cannot “snap out of” depression any more than they can “snap out of” diabetes.

Support Groups

The type of treatment that is best for you can depend on various things including:

Support groups are an enormously valuable form of support and treatment as they provide an opportunity for women to come together in a safe and supportive environment for mutual support. Often it is comforting to be with other mothers who feel like you do and are experiencing similar symptoms. Often being in a non-judgmental environment can help mothers to feel that they are not alone.

There are different types of support groups, some are facilitated by health care professionals while others such as Well Women Franklin are peer support groups.

A Peer Support Group is conducted by facilitators with a degree of expert knowledge, often who have experienced PND themselves. The mothers that attend such groups are experiencing PND and can offer parenting and emotional skills as well as support through the recovery process together.

Support groups do not suit all women with postnatal depression as not everyone is comfortable in a group setting.

Counselling

Visiting a Counsellor or Psychotherapist can be beneficial, especially if a mother does not feel that they can benefit from a support group environment. A counsellor can provide an important part of recovery from antenatal and postnatal depression with the regular appointments allowing the mother time to focus on her, how she has been feeling and what is important to her recovery.

It is important to find someone who the mother feels comfortable with and who has the type of skills needed to help her. Counselling can help develop strategies for coping and managing anxiety.

There are many different counselling approaches including Cognitive Behavioural Therapy or CBT, family therapy, solution focused therapy, and psychoanalysis.

There are different types of counsellors including psychologists, counsellors, social workers, family therapists, psychotherapists, psychiatrists and general practitioners with counselling qualifications.

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