Are you crying more than your baby?

19:34, Nov 19 2012
depression stand
POSTNATAL DEPRESSION: The pressure on women to be ‘good mothers’ can discourage them from seeking help.

Postnatal depression, just like any form of depression, is a serious condition that can have a devastating effect on the whole family.

 "I was incredibly stressed and I knew something was very wrong but I thought, 'I am a mum, I should be able to cope'," says Sandy, a Melbourne mum of two who was diagnosed with postnatal depression when her first baby (now three) was three months old.

Sandy's bubble of pretence burst when, after a few days in a mother/baby unit, she was told it was time to go home. "I couldn't hide my feelings any longer. I bawled and bawled. I knew I couldn't manage at home. It wasn't about my baby not sleeping, which was the 'reason' I was in the mother/baby unit. I couldn't sleep, I was anxious and I had no support."

The pressure on women to be 'good mothers' can discourage them from seeking help, and women in the clutches of depression have been told to 'snap out of it' or 'pull yourself together' 

Mood disorders such as depression and anxiety can present during pregnancy or after birth, and may develop quite suddenly or more gradually over several months. The passing 'baby blues', where you are weepy for no apparent reason in the days following the birth (typically between the third and fifth day after delivery), affect up to 80 per cent of women. But about 15 per cent of women and 5 per cent of men develop moderate to severe postnatal depression, requiring medical treatment.

At the other end of the spectrum from the 'baby blues' is postpartum psychosis, a severe psychiatric disorder that affects only two or three in 1000 women; symptoms include delusions and manic behaviour, and help should be sought urgently. Although this is not common, women who do experience postpartum psychosis usually become ill within days of their baby's birth, so are likely to be either in hospital or at home with somebody who can get appropriate care very quickly (call your GP or the hospital where your baby was born for referrals). And, although it's frightening for family members to see a new mum 'unravelling', sufferers will recover with prompt and effective treatment.

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Symptoms of postnatal depression may include mood swings, anxiety or panic; sleep disturbances unrelated to the baby's needs (this seems like a cruel joke - baby is sleeping soundly and you're wide awake); changes in appetite; chronic exhaustion or hyperactivity (ironing at 3 am?); crying or feeling sad for no apparent reason; feeling like you want to cry but can't; irritability (your partner can't get anything right, no matter how hard they try); negative, obsessive thoughts; fear of being alone, or withdrawing from family and friends; loss of memory or concentration; unrealistic feelings of inadequacy or guilt; and a loss of confidence and self-esteem.

For men, symptoms can also include anger; loss of libido; engaging in risk-taking behaviour; increased hours at work as part of withdrawal from family; and increased use of drugs or alcohol instead of seeing treatment for depression.

Postnatal depression, just like any form of depression, is a serious condition that can have a devastating effect on the whole family (including partners, children and worried grandparents), as well as the person who is unwell. Yet the condition isn't widely acknowledged or understood in the community: the pressure on women to be 'good mothers' can discourage them from seeking help, and women in the clutches of depression have been told to 'snap out of it' or 'pull yourself together'. Their partners are often given well-meant but inappropriate advice, such as, 'take her out to dinner'.

For fathers, norms and attitudes around masculinity and being a dad can also play a part in the adjustment to fatherhood: according to Australian postnatal depression group PANDA, men are less likely to talk about how they feel, and maintaining that they are coping is very important.

Men can feel excluded from the parenting role or their relationship with their partner, as Richard, a father of a one-year-old, describes: "People would say, 'you must be so happy.' Part of me was saying, 'I should be happy, I am a father,' but our lives changed so dramatically that we were tired and stressed for weeks and months. There was a lot of getting used to the changes in the relationship with my partner. One day I was the centre of attention and the next day I wasn't. There were times when I was very tired and stressed and wondered what was going on. I would wonder, does this mean there's anything wrong with me, or with me as a father?"

Post and antenatal depression aren't biological (hormonal) conditions only; in fact, they're more likely to be the product of a range of interrelated biochemical, psychological and social factors, including a lack of social and emotional support; stress and changing relationships (particularly the couple relationship); social isolation; lack of sleep; a difficult pregnancy or birth experience; worries about extra responsibilities; and financial stress and managing the stress of work. A previous history of depression or a family history of mental or emotional illness can also be a risk factor for developing postnatal depression.

Dr Kathleen Kendall-Tackett, author of The Hidden Feelings of Motherhood, describes depression as "an illness that affects your mind and body, and both your mind and body contribute to depression." For instance, a chemical imbalance in our brains can influence our emotions; on the other hand, our thoughts, experiences and behaviour can affect the biochemistry of our brains.

The 'upside' of this is that we can make conscious choices to create and support a healthy biochemistry, such as making dietary changes and exercising daily - carbohydrates and exercise can increase levels of serotonin, a calming chemical. A US study at the University of Arizona Medical School (Freeman 2006), showed that increasing the intake of DHA (an essential fatty acid found abundantly in dark fleshed fish, such as salmon and tuna) reduced symptoms of postnatal depression in women who had already been diagnosed with the condition.

Because looking at events negatively can impact on the release of cortisol (a stress hormone), which can increase your susceptibility to depression, it can help to implement some stress management techniques, such as meditation, as well as trying to maintain a positive outlook.

The good news about PND is that it is treatable - and the sooner you get help, the more quickly you'll recover. There is a range of treatments, from psychological therapies to medication - and yes, there are safe medications for women who are breastfeeding.

As Sandy says, "If things don't feel right, don't try and be a superwoman - get help. It's a huge relief to know you have an illness, and it is easy to fix. Treating postnatal depression is a quality of life issue for your whole family."

Getting help

Let your family and friends know how you are feeling and accept help when it's offered. Talk to your doctor, midwife or Plunket nurse to see what treatment and help is available.

Plunket also has a 24 hour helpline 0800 933 922. Other helplines include the Ministry of Health's Healthline 0900 611 116 to talk to a registered nurse or the Depression helpline 0800 111 757.

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