Slowly developing postnatal depression (PND) can take two forms. One type occurs when a patch of postnatal 'blues' which started soon after the baby's birth becomes worse and more distressing as time passes. The second type develops more slowly and is not noticeable until several weeks after the birth of the baby. Visit Pandas Foundation - a charity set up to supply individuals and families with pre and postnatal depression
Symptoms of post-natal depression
DEPRESSION :
Many mothers begin to feel depressed, increasingly
despondent and hopeless soon after the baby is born. They
may feel terribly miserable and sad for no particular
reason and may find that they spend a large part of each
day in tears. Sometimes the mother may feel rejected by her
partner, family, friends, or even by the new baby; these
feelings usually have no foundation. The depressed mother
may feel permanently tired and lethargic, unable to cope
with household chores. She may give up bathing, dressing
properly or making-up.
Sometimes, the care of the baby is too much for the
mother whilst she is unwell and someone else must be found
to 'take over' until she has recovered. It is usually
inadvisable to separate the mother from her baby, as this
may serve to deepen the depression. If a relation or friend
cannot be found to keep the mother company and help look
after the baby, an advertisement may be placed in a local
newspaper for a lively pensioner who for a small fee will
help a convalescent mother with a young baby. This
arrangement enables the mother to stay in her own home and
keep her baby with her whilst she recovers.
ANXIETY :
A depressed mother may feel extremely anxious about a
variety of subjects and situations. She may be worried
about her health, possibly having felt unwell since the
birth of the baby. She may experience severe pain for which
the doctor can find no satisfactory explanation. This pain
is often in the head or neck. Other mothers suffer backache
and chest pains which they fear are due to heart trouble.
The mother may have a number of minor medical complaints
which can cause undue distress.
Pain and a general feeling of illness or constant
tiredness are very common symptoms of depression and can
become worse if the depression remains untreated.
Anxiety may take the form of unjustified worries about
the health and wellbeing of other members of the family,
especially the baby.
The mother may feel too tense and anxious to go out of
her home. She may not be able to bear to meet even her
closest friends, and may refuse to answer the door,
telephone or letters. In this situation, she will not
venture out to consult a doctor so a home visit may be
required.
PANIC :
A depressed mother is often very confused by everyday
situations and may experience feelings of panic. These
feelings are unpredictable and often very distressing. She
is unable to calm down and every effort should be made to
avoid the situations in which she becomes distressed.
TENSION :
Feelings of tension are often associated with
depression. The mother who experiences these feelings finds
them extremely distressing. She is quite unable to relax
however much she is encouraged to do so. She may feel as if
she is about to explode when the tension is at its worst.
This type of tension, when it is a symptom of depression,
may not be helped by taking tranquillisers. Women taking
these drugs should not despair if they do not work, as
there are other drugs; which run no risk of dependency;
that can be of more help.
OBSESSIONAL AND INAPPROPRIATE THOUGHTS :
A mother suffering from depression commonly has some
obsessional thoughts. These may be about a person, a
situation or about a certain activity. Some mothers become
very frightened and believe that they may harm a member of
their family especially the baby. These fears are very
common symptoms of depression and may or may not be
accompanied by feelings of guilt. Such fears are almost
entirely unjustified, but if a mother is afraid that she
may hurt the baby then she should tell her family and
doctor.
A distressed mother may find the companionship of a
suitable relative or friend reassuring. This phase of the
illness usually passes quickly once the treatment has
started to have its effect. the mother will benefit from
the company and moral support of a companion as she
recovers.
CONCENTRATION :
A depressed mother will probably find that she cannot
concentrate on books, television programmes or even
conversation. She will find, to her distress, that her
memory is very poor and she will often feel very
disorganised. She will find that she sits for long periods
of time doing nothing, but thinking about how awful she
feels.
SLEEPING :
Often a depressed mother will have some form of sleeping
difficulty. She may be awake until the early hours of the
morning, or get no sleep at all. Some find that they sleep
very fitfully and waken frequently, others that they wake
in the early hours of the mrning with nightmares, and then
cannot get back to sleep.
Many depressed mothers dread going to bed as their
symptoms trouble them more at night. Indeed some mothers
find insomnia one of the most distressing aspects of the
illness. Often mothers are prescribed sleeping pills by
their G.P. and find them ineffective even taken in large
doses. This situation can cause the mother to feel quite
desperate. If the depression is treated normal sleep will
be restored.
The feeding requirements of a young baby do not help a
mother who is having sleeping difficulties. It can be of
great benefit if someone else can feed the baby at
night.
SEX :
A common effect of depression is a complete loss of
interest in sex. This may last for some time, and is
helpful if partners realise that this is a symptom of the
illness and that sexual desire will return as soon as the
depression lifts. It should be stressed that a return of
sexual desire is often the last sign that a depression has
lifted, and great patience is necessary if a relationship
is to be kept intact whilst a mother recovers from
postnatal depression.
During the illness physical contact in the form of touching, hugging and cuddling can do much to reassure both partners and is very beneficial.
HELP FROM THE FAMILY :
Friends and family should make sure that the depressed
mother is receiving treatment for her depression from the
doctor. If the treatment she is prescribed does not suit
her, do encourage her to go back to the doctor and ask him
to change it. It can be helpful if someone accompanies the
mother when she sees the doctor. This person can then
assure the doctor that the mother is ill and not just being
'nervy'.
The family should understand that the illness is a
temporary one, and that with their help and support the
mother will recover. They should realise that it may take a
considerable period of time before she is completely
better.
Please do forget all ideas of 'chivvying' her out of it
and accept that she is unwell. Try to treat her as you
would if she had a simple physical illness.
When she is feeling unwell, take on as much of the
runnning of the household as she wants to give up. However
when she feels better let her do as much as she wants to.
You may find that she has patches of good and bad days,
this is very common with the illness.
Do remind her constantly that she will get better.
Remember that depression is not a sign of weakness. Often a
depressed mother will hate being left alone. If this is so,
then try to organise a rota so that there is always someone
who is close to her, and whom she trusts in attendance.
This is a passing phase of the illness but it is most
important that help be given until the mother is happy to
be left on her own.
Ultimately anything you can do to help the mother
throught the distressing stages of this illness will help
her towards recovery.
MEDICAL TREATMENT :
Any mother who thinks that she may be suffering from
postnatal depression should see her doctor as soon as
possible. If she cannot bear to visit the surgery a home
visit should be requested. In addition to this, Health
visitors can play a very important role in post natal
depression. They can help by raising mothers self morale,
help in introducing her to new mothers etc.
Try to tell the doctor all the symptoms which are
troubling you, as this will help him to correctly diagnose
the illness. If he prescribes some treatment, find out
whether you are being given tranquillisers or
anti-depressants. Many women feel that tranquillisers do
not help them and need to return to the doctor for the
treatment to be changed.
Though forms of drug treatment vary, they usually
involve the use of anti-depressant drugs. You cannot become
addicted to these. You may find that if you are taking a
tricyclic drug, your mouth becomes dry and you feel rather
drowsy but these feelings wear off as you continue to take
the drug.
If the drug you have been given unfortunately makes you
feel worse then you must tell your doctor and ask him to
change it. If you have taken your medication for several
weeks and it has not made you feel any better then consult
your doctor as you may need a stronger dose or an
alternative drug. These drugs do work gently and
improvement is gradual so try not to be impatient.
Many women find that their depression becomes much worse
just before, or during, a period. If this is so, you can
ask your doctor to consider progesterone therapy to help
prevent this severe form of pre-menstrual tension.
It is important to maintain a good diet, sometimes
Vitamin B6 or a general vitamin supplement may be
given.
It is very beneficial for a woman who has postnatal
depression to talk about her illness and its symptoms.
Close relations and friends should try to be sympathetic
even if they feel bored with these conversations. Often
just talking to the doctor (if he is sympathetic) can be a
great relief.
When you find a drug that helps you, do not try and
persuade your medical advisor to cut the length of the
treatment short. You may find when you take drugs that you
improve quickly but remember that depression is an illness
and give yourself plenty of time to make a full
recovery.
If your symptoms should return after you have stopped
taking your medication, do not despair, do tell your doctor
of your relapse. He will probably put you back onto your
previous medication. When you feel better again, ask your
doctor if you can cut down the pills down over a period of
time, as this often helps prevent a recurrence of
symptoms.
COUNSELLING :
Professional counselling can be very beneficial if you
are depressed. Some health visitors offer counselling on a
weekly basis, otherwise you may need to ask your G.P. to
arrange for you to see a counsellor. If your depression is
mild, counselling alone may help to lift it. If you are
given drug treatment for depression you can still ask for
counselling as well as the drugs. Whilst counselling is a
very valuable treatment for depressed mothers regrettably
in some places counsellors are not available.
Cognitive therapy is a very helpful form of therapy to
hasten a recovery from depression. It has the added
advantage that it teaches the mother coping skills which
may be of use after she has recovered. Cognitive therapy
helps mothers change many of the negative feelings that
they may have towards themselves and others.
SELF HELP :
The most important thing you can do for yourself is
believe that you will get better. You must have a great
deal of patience and realise that recovery will take
time.
Try to remember that the aches and pains which affect so
many mothers during postnatal depression are not the signs
of a serious or fatal illness. Many mothers think their
headaches signify brain tumours or the pain and tightness
in their chest is due to a heart condition. These pains are
very common symptoms of depression and worrying about them
makes the depression worse, so do try to relax and forget
about the pain and you will find that as the depression
lifts the pain quickly will fade away.
Take as much rest as you can. This is very important as
tiredness seems to make the depression worse. If you can,
try and get a rest on your bed, every day, and sleep if
possible. Avoid late nights if you can, and try to get
someone else to feed the baby at night. Some doctors
believe that rest, peace and quiet, after the birth can
help to prevent postnatal depression, so rest must play an
important part in your convalescence.
Do not go on a strict diet or go for long periods
without food. Hypoglycaemia - low blood sugar - can make
things worse for a depressed mother. If you need to diet,
cut down on sweet and starchy foods and eat plenty of fruit
and raw vegetables when you are hungry.
Most mothers benefit from taking a multi mineral
supplement tablet once a day.
Do not force yourself to do things which you do not really want to do or which upset you. Treat yourself with a little kindness, and be occupied doing things which do not cause you anxiety.
THE PILL :
Many mothers start to take the pill as soon as their
doctor will let them after birth. If a mother is at all
depressed she should stop taking the pill at the earliest
opportunity, even if she is loath to do so.
The pill can cause depression in some women and it is
seen as an aggravating factor where a woman is depressed
after birth. It is however, very important that the
depressed mother does not become pregnant because she will
probably need drug treatment which cannot be given in early
pregnancy. Also, a further birth can sometimes make the
mother more depressed and in this state she has two very
young babies to cope with.
For a woman who is suffering fromdepression several
methods of birth control can be used.
RECURRENCE :
Postnatal depression can occur again if the mother has
another baby but there are few accurate studies of
recurrence rates.
Most mothers are best advised to expect that they will
become ill after a subsequent birth, and plan accordingly.
They will them arrange plenty of support for the period
after the birth and provision will be made for help with
the care of older children.
If she expects to become ill the mother will feel more
able to seek treatment quickly should she notice depression
symptoms. If the mother does not become ill following the
birth, then nothing is lost and the support she has
arranged may have been helpful in preventing a further bout
of the illness.
Parents who want to add to their families can do so if
they accept the risk of a further bout of the illness and
feel that another child makes this risk worthwhile. Early
detection and early treatment are both factors which
previous sufferers have in their future.
PREVENTION :
There is evidence that extra psychological support
during a subsequent pregnancy reduces the likelihood of an
episode of postnatal depression. Your doctor or health
visitor may be able to arrange this for you.
Two other types of preventive treatment are currently
used. One method involves giving high doses of progesterone
after labour. The progesterone is given in decreasing doses
for eight days by injection. The mother then uses
progesterone pessaries until menstruation starts
again.
Women who are expecting babies and are interested in
this treatment should discuss it with their doctor. It
should be stressed that this treatment is as yet unproven
but early results indicate that it can be helpful in some
cases.
The other method involves the use of anti-depressants in
late pregnancy usually in the last three weeks. Many
doctors feel that exposing the baby to anti-depressants
even in late pregnancy is dangerous. However, some feel
that the benefit to the mother outweighs the risk to the
baby.
