This thread is Part 2 on the topic of Postnatal Depression. If you haven't yet read Part 1 it would be useful to have a look and read about what PND is, the effects it can have as well as factors that can contribute to it.
In Part 2 below you will find information below on the Symptoms and Treatment of PND.
Symptoms can begin anywhere from 24 hours to several months after delivery. Where the onset is abrupt and symptoms severe, women are more likely to seek help early. When the symptoms are harder to separate from normal adjustment to changes after having a baby treatment may be delayed, if it is ever sought, and PND can linger beyond the first year.
The following descriptions of PND symptoms come from women who have spoken to PANDA or attended PND support groups and can also apply to a man’s experience of postnatal depression.
- Sleep disturbance unrelated to baby’s sleep needs. Most women with a young baby fall asleep as soon as they are able to. Women with postnatal depression can lie awake for hours feeling anxious while their baby sleeps, or wake early in the morning. Others want to sleep all the time and have trouble getting up in the morning.
- Appetite disturbance. She may feel totally uninterested in food and say, “I force myself to eat because I am breastfeeding, but I don’t taste anything”. Some overeat in an attempt to control their anxiety, others feel sick at the thought of food.
- Crying. She may feel sad and cry without apparent reason. Tears come easily day and night. Others say, “I want to cry but can’t. I am crying on the inside.”
- Unable to cope. Daily chores, caring for the baby or self care may seem insurmountable to women with postnatal depression. Small demands she previously coped with may completely overwhelm her. She may feel like running away, overwhelmingly exhausted and very heavy physically and emotionally, or wish it would all go away.
- Irritability. She may snap at her partner or other children without cause. Partners often say, “I can’t do anything right. If I fold nappies she complains I do it the wrong way. If I don’t help, I’m being unsupportive.”
- Anxiety. She may feel a ‘knot in the tummy’ most of the time and panic without cause. Some experience heart palpitations so severe they fear they are having a heart attack. She may be anxious about her own or her baby’s health even after being reassured that nothing is wrong. Many women describe anxiety as their most obvious symptom and reject the term postnatal depression. They deny being depressed. The term ‘postnatal anxiety’ might more accurately describe the way some women feel.
- Negative obsessive thoughts. There can be little peace in the thought processes of women with postnatal depression. Small worries can consume thought processes, interfering with her ability to listen, concentrate or remember. She may experience unrealistic fears, afraid to let her partner go to work in case he has a car accident or fear something bad could happen to her baby. No amount of reassurance or distraction can hold her thinking at bay.
- Fear of being alone. Many women go out a lot or need their partner (or someone) at home with them at all times because they are afraid of being alone at home. The fear of something going wrong with the baby or her own perceived inability to cope with the baby on her own is overwhelming. Some feel incredibly lonely and go out to feel connected with other people - this takes an enormous amount of effort. Others feel they cannot be with other people and withdraw from family and friends, not answering the door or telephone.
- Memory difficulties and loss of concentration. A woman may forget what she wanted to say mid-sentence. She may not be able to concentrate on simple tasks or take in new information. Organising herself and her family can become too difficult. Sometimes she doesn’t know where to start or may start everything at once. She may be unable to think creatively about her problems or find solutions - like reaching out to services that will help her.
- Feeling guilty and inadequate. Feeling guilty can be a common feeling for all mothers but more so for the mother with postnatal depression. Her thoughts and feelings constantly reinforce in her own mind that she is inadequate and a bad mother. She may be unable to take encouragement from the good things she has done or to feel affirmed by her relationship with her baby. Reassurance will not dissuade her thinking and can discourage her from talking about how inadequate and guilty she feels.
- Loss of confidence and self-esteem. A woman who enjoyed her job may panic at the thought of returning to it, no longer sure she is able to do it. A woman who enjoyed having family and friends over may panic at the thought of visitors. She may feel unable to prepare a meal which she enjoyed doing before the baby was born. Most women with postnatal depression have very low self esteem regardless of how well they seem. Some describe their experience as a loss of sense of who they are, a loss of sense of self. (Factsheet: Postnatal Depression, PANDA)
The Edinburgh Postnatal Depression Scale (EPDS)
The EPDS (Cox, Holden and Sagovsky, British Journal of Psychiatry, 1987), used in many antenatal and postnatal clinics, is a set of questions to detect depression and anxiety at this time. It WILL NOT PROVIDE A DIAGNOSIS – only trained health professionals should do this. It will tell you whether you or someone you are close to has symptoms that are common in women with depression and anxiety during pregnancy and in the year following the birth of a child.
To complete this set of questions, the parent should circle the number next to the response which comes closest to how they have felt IN THE PAST SEVEN DAYS.
Please keep in mind that a person who does not score high on the Scale might still have depression. Likewise, a person who scores high on the scale does not necessarily have depression. The Scale only gives an indication.
Link here: http://www.testandcalc.com/etc/tests/edin.asp
All women with postnatal depression need emotional support from family and friends. Some women find psychological treatments helpful especially if they have experienced traumatic events in their childhood or more recently.
Antidepressant medication is a successful part of treatment for many women. There are many misconceptions about antidepressants and women who could benefit from them refuse them because they are afraid the medication is harmful. Antidepressants are not addictive and some can be safely taken while breastfeeding and pregnant.
It can be helpful to seek objective advice from a pharmacist or Drug Information Line.
This type of medication does not “change your personality”; it corrects the chemical imbalances in the brain that are thought to be responsible for symptoms of depression and anxiety.
It is important to understand that women cannot “snap out of” depression any more than they could “snap out of” diabetes. (Factsheet: Postnatal Depression, PANDA)
Where to go for help
If a woman does not feel the way she expected to feel after having a baby it is very important that she talk to her doctor or maternal and child health nurse. It could simply be that she is having trouble adjusting to the changes in lifestyle or the increased demand that occurs when a baby is born. If she is suffering postnatal depression it is important that she receive appropriate help as soon as possible. Postnatal depression is not something to be ashamed of. It should be seen as one of the many complications of pregnancy and delivery. With appropriate help women with postnatal depression do recover. (Factsheet: Postnatal Depression, PANDA)
Biopsychosocial postnatal depression and recovery
Postnatal depression should be viewed as a biopsychosocial condition that has an impact on the woman’s biological, psychological (spiritual) and social (cultural) wellbeing. Factors that contribute to postnatal depression come from all these areas and result in a variety of symptoms. A different combination of factors is responsible for each woman’s unique experience of postnatal depression. Strategies for managing postnatal depression towards recovery must address all biopsychosocial aspects of the woman’s life. This usually requires a combination of interventions.
Postnatal depression exists within family and communities, not with the woman alone. Assessment and intervention need to consider the significant other people in her family. (Factsheet: Postnatal Depression, PANDA)
For more information about treatment, please see separate thread/post on Resources and Further Reading.
For further information, please see separate thread/post on Resources and Further Reading.
- PND appears with mild, moderate, or severe symptoms. It can begin during pregnancy (antenatal depression), suddenly after birth or gradually in the weeks or months following delivery. Symptoms can emerge at any time during the first year after birth but most cases have their onset within the first four months.
- PND occurs in all cultures, religions, socio-economic and age groups.
- PND is not a modern condition. Each generation calls it something different. What we call postnatal depression today may have been called a ‘nervous breakdown’ fifty years ago.
- Some women are not identified with PND until well after the baby’s first birthday
- PND can happen after miscarriage, stillbirth, normal delivery, or caesarean delivery. Pregnancy is the common factor.
- PND is not something to be ashamed of; it should bee seen as one of the many complications of pregnancy and delivery.
- Most PND occurs after a first baby. It can also occur after any or recur with a subsequent pregnancy.
- A woman who has had PND has a 50% chance of recurrence with a subsequent pregnancy.
- If a woman becomes pregnant again before recovering from postnatal depression, the condition will continue through the pregnancy and may worsen. It is wise to wait at least a year after discontinuing medication before falling pregnant again.
- Early signs of PND are recognizable and with early identification and treatment most women make a full recovery. (Factsheet: Postnatal Depression, and Guide to Postnatal Depression Support Groups, PANDA)
With thanks and gratitude to MuminMind, our Ambassador for PND, for compiling this information.