I think that before having children we all have preconceptions about what life will be like filled with tiny extra people. Usually the scenes we concoct in our mind are of blissful afternoons cuddling sweet-smelling newborns or soft-focused hours merrily spent playing with cheerful and chubby cheeked toddlers. As those of us who have crossed to the ‘other side’ (i.e. have children) well know, things rarely pan out as you expect.
Today is World Mental Health Day and in honour of this I wanted to write a few thoughts about Post-Natal Depression or PND. As a female GP with young children of my own, I see lots of similarly aged patients, so pre and postnatal care is inevitably something I am involved with a lot. I love this part of my job; seeing ladies arrive excitedly brandishing their pee’d on sticks, waddling in proud as punch with beautiful bumps and then of course meeting the tiny tot once it has arrived. However with all that happiness come many cases where things aren’t as straightforward or easy – from fertility issues, to miscarriage and all too often mental health issues. Post or even pre natal depression is something that seems to cut across the board, affecting women without warning and shattering what is perceived to be ‘the happiest time of your life’. I think, impart, that is what makes PND so exceedingly difficult, in that it fly’s in the face of all our preconceived notions of what motherhood and starting a family should bring.
Obviously PND is a huge area so here are just a few of my thoughts;
1) PND is common
It affects over 10% of all women and contrary to popular belief can occur soon after birth, several months later, or in a third of cases during pregnancy. Midwives and Doctors should be looking out for signs during both antenatal care and postnatally.
2) It can be difficult to distinguish PND from ‘normal’ emotions
Many people with PND initially experience symptoms of anxiety. Anxiety to one degree or another is a normal feeling those first few days and weeks after you’ve brought your new baby home. I greatly believe that our generation feels a huge pressure to do everything ‘perfectly’ when we embark on motherhood. Whether this is because we are having children later, because we don’t live surrounded by huge extended families or a general shift in society I don’t know – but I’m pretty sure my parents didn’t agonise about the safety features of this and that, or stress out over the precise temperature of the nursery…and I’d be fairly confident that they were happier for it. I blame this phenomenon for the anxiety and guilt so many new parents experience, but, very importantly, the vast majority of them are not suffering from PND. Similarly many ladies with PND will assume that how they are feeling is ‘normal for a new mum’ and not seek help. So how do you tell the difference?
It can be incredibly difficult – both for patients as well as their friends and family. My yardstick is that if anxiety has reached a point where it is actually stopping you doing something or getting in the way of you living your day-to-day life, then you should get help. Another factor that is a useful gauge is how Mum is sleeping. If once the baby has dropped off she is able to catch some kip, that’s quite reassuring. However if her sleep is poor between bouts of baby-led waking then I would regard that as very significant.
Fatigue is another symptom which can be difficult untangle. All new mums are tired, full stop. However there are differences between normal fatigue and tiredness due to depression. The fatigue with PND can become all-encompassing and start to interfere with daily life. Often with PND, mums not only feel exhausted, but also lose their interest in activities and other pursuits. If you are always feeling exhausted or repeatedly feel the effort of attending the usual toddler group is overwhelming, it may be time to wonder if things are as they should be.
Obviously there are many other symptoms of postnatal depression such as feeling low or tearful, and for a more comprehensive list see here.
3) Is it your hormones?
No one really knows what causes PND but there are some theories which suggest is may be due to the huge hormonal shifts your body goes through during pregnancy and the postnatal period. There are many other, so-called, risk factors that increase the chance of someone developing PND. If you have suffered with depression or mental illness previously or have a strong family history of mental health problems you may be at heightened risk. Having had a difficult pregnancy, fertility issues or traumatic labour are also thought to act as potential triggers for PND. By nature we are social creatures and a lack of social support or isolation is also well-known to be a risk factor.
Whatever the cause, one thing is for sure that PND is never ever the mothers’ fault. Many women place further pressure, stress and guilt on themselves for having PND. This is an illness like any other and not something anyone one would ‘choose’.
4) It doesn’t make you a ‘bad mother’
Many women fail to seek help, even if they realise something isn’t right, because of stigma and fear. Although things are slowly changing, even in this day and age mental health illness is much misunderstood. Patients themselves still often worry that Social Services will ‘take the baby away’ if they speak to someone about how they are feeling. Obviously this is not the case at all. Most mothers suffering with PND feel protective, loving and nurturing towards their baby and professionals involved will do all they can to support mothers in continuing to care for their little ones.
5) You will get better
Like most depressive illness, people do better. This is one of the first things I usually tell my patients, as I think when you are in the depths of despair it is impossible to imagine feeling differently. I’m sure most of them don’t believe me at the time, but I can only hope it causes a glimmer of hope to be sparked. Treatment should ideally be tailored to the individual but broadly for most women it compromises a mix of medication and psychological treatments. People, quite rightly, question the use of antidepressants in both pregnancy and breastfeeding. It is well-known that untreated PND can have a significant detrimental impact on, not only the mother, but baby too, so usually a balance of risk needs to be made. Two antidepressants that are commonly prescribed in breastfeeding are called Sertraline and Paroxetine. Neither of them cross into breast milk in any significant volumes and are widely regarded as being safe to take. My patients and I are very lucky that in our region that we have an excellent Perinatal Psychiatry Service – a branch of psychiatry specialising in pre and postnatal mental health. This can be an immensely useful service for ladies who are suffering with more severe symptoms of PND. However I am aware that not all counties are as fortunate.
Psychological support is also imperative to recovery from PND. Interpersonal therapy, cognitive behavioural therapy and psychotherapy have all been shown to be of immense help.
There are many other forms of support that can be of use to people, especially once they are starting to get better and it becomes easier to take some control of their own recovery. I’m a great fan of exercise in helping mental health as well as meditation, relaxation and strategies such as mindfulness.
For more information a great starting point is PANDAS. If you are concerned you may be experiencing symptoms of PND please talk to your midwife or GP.