Postnatal Depression

Let's talk about postnatal depression. You have been looking forward to the arrival of your little one, but instead of feeling over the moon, you find yourself feeling teary, anxious and constantly worrying about everything. You feel like a failure, guilty about feeling the way you do and are not enjoying the new mum experience. It's really hard to admit to your partner, family, and friends that you are struggling, especially if they say things like 'you just need time to get used to the baby' or 'it is normal, just the baby blues.'

What is postnatal depression?

Postnatal depression (also known as postpartum or perinatal depression) is a major depressive disorder that can occur any time before birth and in the first year post childbirth. The onset is usually within four weeks of giving birth, but can also occur earlier or later. It can affect either parent but is more common in the birth mother.

How common is postnatal depression?

Postnatal depression is more common than you would think. One in ten women experience depression in pregnancy, and one in seven new mums experiences some form of postnatal depression in the year after delivery.

How do I know whether this is just the 'baby blues?'

Postnatal depression is not just the 'baby blues'. When you are pregnant, it is normal to worry about everything from getting a c-section to what colour to paint the nursery! And after the delivery most women will feel a little bit blue, maybe similar to hormonal changes that women feel when having PMS. BUT, these feelings are not severe and should not be all-consuming. Baby blues are a temporary feeling and usually pass within a few weeks while recovering from the delivery and adjusting to the responsibilities of caring for a baby.

What are the signs of postnatal depression?

On the other hand, symptoms of postnatal depression are similar to depression that can occur at other times in a person's life and include the following symptoms:

• feeling persistently sad, anxious, or empty;
• feeling hopeless and helpless;
• having little interest in activities that used to bring pleasure;
• feeling tired and drained all the time;
• withdrawing from family and friends;
• feeling guilty, worthless, or ashamed;
• experiencing significant changes in appetite or weight;
• having trouble sleeping or excessive sleeping;
• thoughts of death or suicide;
• feeling angry at your baby or even thoughts about harming the baby.

What are the causes of postnatal depression?

Postnatal depression is caused by a combination of genetic, biological, psychological, and social factors. Although these factors might put you at a higher risk of developing PND, it is impossible to predict who are more likely to be affected. It is important to remember that, similar to other mental illness, postnatal depression is a medical condition and not your fault. It can happen even to the most resilient amongst us.

But why are some people more at risk of developing depression?

Genetic factors:

Probably one of the biggest risk factors for postnatal depression are genetic susceptibility. Studies that looked at the risk of sisters showed that if one sister had postnatal depression, the other sister was almost four times as likely to develop postnatal depression herself.

Hormone changes:

Changes in hormone levels after giving birth can trigger postnatal depression. Postnatal depression may be caused by a combination of changes in hormone levels, including lower levels of estrogen and progesterone and fluctuating levels in other hormones and neurotransmitters.

Women who have a history of premenstrual dysphoric disorder are also more susceptible to the effect of hormone changes and more likely to develop postnatal depression.

Psychological and social factors:

Stressful life events (for example marital conflict, intimate partner violence or history of previous physical or sexual abuse,) other life or financial stressors, young age, single marital status or having and unwanted pregnancy also increases the risk of developing depression.

Previous depression:

Women who have a history of depression before they were pregnant are more than double as likely to develop depression in the postpartum period and women who have antenatal depression are more than five times as likely to develop postpartum depression.

Poor physical health:

Health problems or comorbid mental health difficulties such as body image dissatisfaction or eating disorders before or during pregnancy increases the risk of developing postnatal depression.

Adverse pregnancy or neonatal outcomes:

A difficult pregnancy, traumatic delivery, preterm or unwell baby. Difficulties breastfeeding or having to care for a difficult, crying or irritable baby also contributes to the risk of developing postnatal depression.

What are the consequences of untreated postnatal depression?

It is important to seek help if you suspect that you or someone you love have symptoms of postnatal depression, as the consequences can be quite serious.

Postnatal depression can lead to relationship problems with your partner and loved ones and can cause you to have difficulties bonding and caring for your baby. Untreated postnatal depression can also increase the risk of developmental delays, emotional and behavioural problems in your child. In severe cases, postnatal depression can even lead to suicidal thoughts or actions and thoughts about harming the baby.

Treating postpartum depression

If you are experiencing postnatal depression, it is important to seek treatment. Treatment options include counselling, education, seeing a doctor to exclude contributing medical conditions like iron deficiency anaemia and thyroid disease.

Lifestyle changes

It is often helpful to make lifestyle changes such as to improve sleep routines and quality (maybe ask your partner to take care of the baby for a few nights so that you can catch up on broken sleep), ensure a healthy diet, increase exercise and outside time and avoid harmful actions like alcohol, smoking or other substance use.

Family support is invaluable. Make time to catch up with family and friends, they will love it to catch up with you and your new baby. Sharing a coffee and a few laughs is a fun way to get much needed emotional support.

Counselling and psychological support

Health professionals are trained to provide support to mums in early parenthood. It can be very helpful to talk to a child health nurse about some of the worries that you might have about caring for your baby.

Several online services are available that provide emotional support for a variety of mental health problems, including support for antenatal and postnatal depression. See the list below for a few suggestions.

Psychologists can provide psychological interventions such as counselling or cognitive behavioural therapy to help you understand your feelings and develop strategies to manage them.

Medication

If depression symptoms are severe, then antidepressant, alternative medications such as St John's Wort (be mindful of medication interactions and use while breastfeeding - talk to your doctor before using this) or other medication may be prescribed to help manage the symptoms. 

Where to get help

Most midwives, child health nurses and doctors understand how common postnatal depression is and how to help you or how to access the help that you need.

• Your doctor, midwife, child health nurse, or other health care provider
• A mental health professional, such as a psychologist or counsellor
• A support group for mothers with postnatal depression

Online resources

Not everyone feels comfortable talking about their feelings with a health care provider and some people prefer the anonymity of the online environment. If this is you, there are a number of online support groups, forums and resources available, even chatbots that are designed to provide support for people with mental health difficulties.

• Beyond Blue Online forum: Online forums (beyondblue.org.au)
• Panda Online Support Forum: Mental Health Support Forum In Australia - Sane forums
• Suicide Call Back Service: Phone calls or online counselling
• Chatbots are a new and innovative way to provide support for people with mental health difficulties. Woebot is a chatbot, you can download the app or message on Facebook Messenger and it will provide you with support. Not quite the same as having a cuppa with a friend, but can certainly be helpful to provide cognitive reframing strategies...and available 24/7! Have a look at this person's experience on the Beyond Blue website "My experience with a robot counsellor (beyondblue.org.au)"

Need to talk to someone? - Phone support

If you are in crisis or just need someone to talk to.

• Beyond blue 1300 22 4636 (24/7)
• Lifeline 13 11 14 (24/7)
• Panda 1300 726 306 (9am-7:30pm)
• Suicide call back service 1300 659 467 (24/7)

Please ask for help if you need it!

If you are experiencing postnatal depression, there is no reason to feel ashamed, it is not your fault. It is important that you seek help because if left untreated could put your own life or that of your baby at risk.

Need more information?

• The Edinburgh Post Natal Depression Scale is a self-report questionnaire that is used to screen for perinatal depression. It is freely available online and also included in your baby's health record in Australian states. It can be a helpful discussion starter when talking to your doctor about postnatal depression.
• Beyond Blue is a national Australian organisation that provides information and support for those affected by depression and anxiety. They have a comprehensive website with fact sheets, videos and telephone support available. You can also join one of the online forums.
• PANDA - Perinatal Anxiety & Depression Australia is a national support organisation for women and their families who are experiencing anxiety or depression during pregnancy or after the birth of their baby. They have a telephone support line as well as a website with information and resources.
• COPE: Centre of Perinatal Excellence is an Australian organisation which provides clinical care and support for women who are struggling with the emotional challenges of being a parent. Their website includes a range of fact sheets and resources.
• Better Health Channel is an Australian government website that has a range of information and resources about health related topics.

 

Disclaimer

The healthcare information provided in this document is general in nature and not designed to replace personalised professional medical advice. Please consult your healthcare provider for advice if you are concerned about your health or the health of someone you know.