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Today I thought I would create a bit of awareness around Post Natal Depression (PND) or Post Partum Depression. In a simple way, this is when a new mum becomes depressed for longer than 2 weeks after giving birth. This disorder has the same severe or prolonged symptoms of Clinical Depression that lasts more than a week or two and interferes with the ability to function on a daily basis.
PND can interfere with the relationship between mum and baby in terms of bonding and attachment. It can put relationship strains on the parents and PND can be extremely distressing for the new mum.
Baby Blues:
Getting the 'Baby Blues' is very common. 50-80% of women have this experience and it usually lasts a week or two after giving birth. Symptoms include mood swings, tearfulness, anxiety and difficulty sleeping aside from the baby. Baby Blues are thought to be linked with the stresses of pregnancy and hormonal changes. The treatment for this is usually rest and support.
Post Natal Depression:
There are 2 types of recognised forms of PND - Melancholic and Non- Melancholic.
Melancholic is rarer and has a distinct genetic or biological basis, thus unfortunately you are predisposed to PND and will most likely require medication in your treatment plan. It is characterised by slowed cognitive processes (thinking), poor concentration and psychomotor disturbances (agitation or slowing of movements); on top of the depression symptoms.
Non - Melancholic is more common and is linked with certain risk factors in your social environment. The depression can still be severe but this form of PND responds to psychological and therapeutic treatment and approaches. This is the PND I would like to chat about today.
There is a focus on fears and the concerns are often about the well - being of the baby or feelings of inadequacy as a parent.
Symptoms of PND can include:
Loss of enjoyment in usual activities
Loss of self - esteem and confidence
Loss of appetite and weight
Broken sleep (irrespective of baby)
Sense of helplessness and of being a failure
Wish not to be alive
Suicidal ideation (thoughts of suicide)
Panic attacks
Loss of libido (sex drive)
Fears of baby or partners' well-being or safety
Risk factors for developing PND can include anxiety during pregnancy, stressful life events during pregnancy, low levels of social support, low socio-economic status or obstetric complications. Risk factors mean that there is an increased risk of developing PND; it is NB to note not everyone with these risk factors will go on to develop PND.
The negative effects of PND can be frightening for people suffering from this disorder as well as for their families. Often the mum will struggle to bond with her baby and may not feel any gratification for her role as a mother. Tasks in her life may be too hard to manage at this time, particularly to do with the baby. Thus the new mum may feel isolated, guilty, helpless and hopeless and these feelings are constantly being reinforced by her inability to tend for and love her baby.
The risk for substance abuse increases with PND as does the suicide risk. Some mums start to have intrusive thoughts of accidental or intentional harm towards the baby. NB it is very rare for a non psychotic woman to commit infanticide but these thoughts can be extremely distressing nevertheless.
Depression will effect a mothers's ability to interact appropriately with her child. She may not respond to her baby's cues or she may be negative, hostile or disengaged. The outcome will be a lower cognitive function and emotional development in the child. In lay-mans' terms a child needs to learn about feelings, behaviours and feel validated and supported in order to develop and grow with confidence and stability. If the child is not being responded to or is receiving mixed messages about how to feel, the child will not feel secure in their own reactions and will not learn to understand their own emotions easily. This is bound to create problems later in life. Perhaps some of you are thinking that your own needs may have not been met as a child....
Breast feeding can be difficult for women suffering from PND.
Medication is not a popular choice for PND, particularly because women are breastfeeding and do not want to taint their breast milk. Side effects are not yet known in this regard and the argument lies between the side effects of medication and the negative effects of PND on the child's development. Something to think about.
Treatment:
The common form of treatment is psychotherapy using psychological approaches. The two approaches that are proven to be effective are Interpersonal Therapy and Cognitive Behavioural Therapy. In my personal opinion, it is important to find a person, group or approach that feels right for you. If you would like to treat this asap and are time limited, money limited or a person who does not like talking about their problems, a more manualised approach like Cognitive Behavioural Therapy (CBT) or Interpersonal Therapy (IPT) may suit you. Both approaches go for a number of weeks (12 - 20 on average, CBT can be less) and the skills you learn can be incorporated into your life outside of therapy. Other forms of therapy are less structured and more open ended, often with a person - centred base. My best advice would be to take into account what you would feel comfortable, talk to your GP about options and shop around for a therapist that works for you.
It is always important to feel comfortable and trusting of your therapist. You should work with them to find the best treatment for you. Your unique problems and commitments should be taken into account and you should feel comfortable enough to say when things are not working for you. Sometimes bringing your baby with you to the sessions may be helpful and the therapist can gain an idea of your interaction styles with your baby. You should NOT feel judged, this is important. If you are suffering from PND you are doing enough judging for yourself, you do not need to add to this.
It is important to understand Post Natal Depression so that we can be understanding of ourselves and of others, should we come across this disorder. We are only human after all and no person is immune to life's hardships in one way or the other. Lets support one another!
Hope this isn't too wordy and academic, hard to casually give the facts as we know them :)
Take care
XXXX
Paula
Reference:
Treatment of postpartum depression: clinical, psychological and pharmacological options
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039003/
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