Postnatal depression

by Dr. Jon Rampono, Consultant Psychiatrist

About 14% of women in Australia who deliver a baby will develop a clinically significant  depressive disorder in the first 12 months after birth.

The great majority of women will start having symptoms within 3 months of delivery. However, a smaller percentage will first experience the symptoms some time later within that first year.

In addition, a further 12% will experience some symptoms of depressive disorder not enough to warrant a diagnosis of clinical depression but serious enough to have a significant impact on themselves and possibly their relationship with their baby and/or partner.

Therefore, around 1 in 4 women having a baby in Australia will experience the negative impact of a depressive disorder in the first 12 months after the birth of their baby.

Risk Factors

A number of factors increase the risk for postnatal depression however, it is important to note that none of these are absolute causes in their own right. These include:

• A past history of depressive disorder
• A family history of depressive disorder
• Major changes in personal circumstances e.g. moving home, renovating a house
• Problems in the relationship with the father of the baby
• Perceived lack of support in the pregnancy and the postnatal period, significant disparity between expectations of motherhood and the reality of motherhood
• Unexpected and major medical complications around the time of delivery
• A baby who is perceived as “difficult” in relation to sleeping problems, feeding and/or reflux.

Symptoms

Postnatal depression is not simply about feeling down or not coping. Postnatal depression involves a wide range of clinical symptoms that are present for at least 2 weeks. These include:

• Low mood
• Feeling particularly worse on waking in the morning or in the evening
• Changes in sleep pattern, difficulty going off to sleep in the evening, difficulty returning to sleep if you wake in the middle of the night, waking too early in the morning or hypersomnia, sleeping excessively
• Reduction in appetite and/or increase in comfort eating
• Reduction in interest in household chores, looking after the baby and/or leisure
• Low libido
• Tearfulness
• Irritability
• Despair
• Fleeting thoughts of either escaping from it, feeling that a fatal, unintentional accident would not be such a bad thing or, in some cases, actively thinking about ending your own life
• More impairment in memory, concentration and/or decision-making more than what usually occurs for many women in the postnatal period
• Reduction in the quality of enjoyment of the day
• Reduced energy
• Feelings of guilt lack of self-worth and failure as a mother.
• In many women these feelings of depression are accompanied by varying degrees of anxiety. In some people there are physical symptoms of anxiety including chest tightness, palpitations, difficulty in breathing, headaches, tremor and/or irritable bowel and bladder.

In more severe cases, panic attacks, feeling unable to cope with crowds and/or feeling dissociated from oneself or the environment may occur.

The above symptoms may occur at different times in all normal people. However, if there are any concerns about ongoing symptoms and/or the number of symptoms present, it is very important to be assessed.

Where to get help

Many people find it valuable to talk to a trusted friend to get an outside perspective.

Child Health Clinic Nurses are an extremely valuable resource and support in this area.

Many GP's have a specific interest in women’s health and in some cases, postnatal depression in particular. The names of these GP's are often known to Child Health Nurses or local PND Support Groups.

Some Psychologists and Psychiatrists have a special interest in postnatal depression. In most cases, a GP or Child Health Nurse can direct you to these individuals.  Please do not feel embarrassed or uncomfortable about seeing a specialist in this regard. Very few people would be embarrassed about seeing a Neurologist about a persistent headache, migraine or double vision.

Postnatal depression is a treatable recognised disorder and not a personal failure.

Management of postnatal depression is best done with the support and involvement of a partner. Most men are troubled, bewildered and/or exasperated by the changes that have unravelled in front of their eyes. Information and a clear management strategy are very valuable.

Steps in Management:

• A full medical assessment
• Explanation and information
• Outlining treatment strategies

Management Options:

Personal and Environmental Changes

In many cases, an understanding of the matter and the implementation of personal and environmental changes are all it takes to reverse the course of postnatal depression.

These options would include things such as:

• The partner doing the feeds and looking after the baby until around midnight enabling the mother to get some sleep before being woken for the first feed at night.
• Practical assistance with household chores,
• Time out from baby,
• Return to previous activities such as exercise, leisure or manageable parts of a previous job.

Medication

as well as Counselling, Cognitive Behavioural Therapy and/or Psychotherapy should be considered in cases of moderate to severe postnatal depression.

Usually, medication consists of one of the newer antidepressants.

There is now extensive information about the use of antidepressants in breastfeeding. Your GP or Specialist can access this information for you.

Antidepressants are not addictive. Antidepressants will not make you happy. They simply reverse the medical symptoms of depression and enable a woman to be the mother she wishes to be.

In Summary

Postnatal depression can have a profoundly negative effect on a woman and her baby at this important stage of her life that should be a time of great fulfilment and joy.

Postnatal depression is potentially dangerous.

Postnatal depression is an eminently treatable and manageable disorder.

The first step is acknowledgement that this may be occurring followed by an appropriate and thorough assessment leading to a logical plan and pathway out of the shadows of a Mood Disorder into mothering in its fullness.

In Australia, the post and Antenatal Depression Association (PANDA) is a non profit organisation for women and their families affected by Antenatal and Postnatal Mood Disorders.

See http://home.vicnet.net.au/~panda/

If you are concerned you have postnatal depression, please try to get help as soon as possible.  

  
  Maternal Child Health Line Ph: (03) 9853 0844 and for country callers Ph: 1800 134 883 
  Parentline Ph:132 298
  Caring Ph: 136 169