Postnatal disorders

Postpartum or postnatal depression (PND) is more severe than simply having “the baby blues”. The baby blues frequently occur among new mothers, starting a couple of days after the birth and normally disappearing after a few days. The symptoms are similar to those of general depression: you may have mood swings and feel weepy, miserable, tense, tired and on edge, and worried about your baby or yourself. The symptoms of baby blues may be caused by the huge changes in hormone levels that occur after birth.
It is generally thought that PND is experienced about 10 per cent of new mothers, although a 2006 survey for the Royal College of Midwives suggested that the number could be much higher, as 27% of women with children under the age of one said that they had received some form of treatment for postnatal depression.

What are the symptoms of postnatal depression?

Below is a list of the most common symptoms. If you only experience a few of them, from time-to-time, you're probably not suffering from postnatal depression. Becoming a mother is a physical and emotional roller coaster, so it’s normal to have highs and lows. But if you frequently experience a lot of the symptoms you may have postnatal disorders, and you should discuss your symptoms with your doctor or health visitor.

Common symptoms of PND include:

• Being unhappy most of the time, especially in mornings and/or evenings• Feeling that life is not worth living and there’s nothing to look forward to
• Feeling guilty, and keen to blame yourself
• Being irritable, and snapping at your partner or other children
• Being tearful
• Not being able to enjoy yourself
• Not being able to concentrate on anything
• Experiencing memory problems
• Struggling to make decisions
• Feeling that you have lost your sense of humour
• Letting things easily get on top of you, and feeling that you can't cope
• Having low energy levels
• Feeling constantly exhausted, but unable to sleep
• When you do sleep, sleeping badly and waking early
• Either lacking an appetite, or comfort-eating and piling on weight
• Feeling that your baby is a stranger, and not really yours
• Feeling very anxious about your baby, and constantly seeking reassurance from health professionals that she or he is all right
• Worrying about your own health, and perhaps frightened that you have a terrible illness
• Losing your sex drive

What causes postnatal depression

There are several recognised causes of PND.

Emotional causes

You may feel inadequate in your new role as a mother, causing you to feel anxious and guilty much of the time. Anxiety may escalate into panic attacks, and you may be afraid to be left alone with you baby. You may also become insecure because you feel unattractive, until you lose weight and get back into shape.

Physical causes

Low energy, fatigue, loss of appetite and lack of sleep are common physical symptoms following childbirth, and can contribute to depression. It’s never easy to get adequate rest with a newborn baby in the house. Other physical factors may include inadequate thyroid hormone levels, or a difficult or premature delivery. Physical trauma or abuse during pregnancy can also cause depression after the birth.

Previous history of depression

If you have a past history of depression, the stress of having a baby may trigger PND, and it may take several months before you begin to feel better. One in a thousand women (especially those with bipolar disorder or schizophrenia) may experience postpartum psychosis, with symptoms such as hallucinations, delirium, extreme agitation, or thoughts of hurting the baby or of suicide. But in most cases, the condition can be treated successfully.

Loneliness

PND may be triggered by a sense of loneliness caused by relationship problems, or a recent death in the family. It is not unusual to feel isolated and lonely after giving birth, especially during the first weeks, but it becomes a problem when the feelings continue or intensify. However, treatment is available.

Loss of control

A baby demands major lifestyle adjustments. The resultant loss of control may contribute to depression, especially if you have perfectionist tendencies.

Inability to cope

For many women, becoming a new parent may be a frightening challenge, and that can lead to depression. It’s important to keep things in perspective. You will cope better if you enlist help with childcare and household tasks from family and friends. And find someone you can talk with openly whenever you feel overwhelmed. You and your baby will be much more relaxed if you accept that neither you nor your baby is perfect. Being a mother takes practice.  

What treatments are there for postnatal depression? 

If you think your depression is more than simply post-birth blues, talk to someone who understands, such as your health visitor or doctor. There are many ways to overcome depression, such as the following examples.

Medication

Your doctor may carry out basic medical tests to rule out conditions other than depression, and may then prescribe antidepressant or anti-anxiety medication. Antidepressant medication is usually a very effective treatment for postnatal depression, especially in conjunction with support and counselling. Although antidepressants don’t necessarily deal with the cause of the depression they can help to speed up recovery. Unfortunately, there are many misconceptions about antidepressants and many women who would benefit refuse to take them because they are afraid that the medication is harmful, particularly if they are breastfeeding. In fact, antidepressants do not change your personality; they simply act on the brain chemicals thought to affect depression and anxiety. They are not addictive and there are some that can safely be taken when breastfeeding.

Counselling

Counselling can help you to understand the reasons for your PND and help you develop strategies to adapt to motherhood and overcome your depression. There may be contributing factors such as unrealistic expectations of motherhood or a past history of child abuse.

Lifestyle changes

Although it’s difficult to vary your routine when you are anxious or depressed, small changes can be helpful. For example, taking an invigorating shower every morning and resting when your baby is sleeping rather than doing housework. Exercise is an effective treatment for depression, even if all you can manage is a walk in the fresh air. Take baby in a sling or stroller if no one is available to look after him or her. Relaxation and meditation can also be very effective. And good nutrition is important – ideally a balanced diet low in saturated fats, refined sugar and caffeine and high in fruit, vegetables and whole grains. Alcohol is best avoided.

Support

Patience, understanding and emotional support from your family and friends are perhaps the most crucial factors in your recovery. And joining a mother’s support group can be highly beneficial.