All expectant and new mums will have their good days and bad days, their ups and downs. But when a woman's bad days start to seriously outnumber the good she may be at risk of perinatal anxiety and depression.

What is perinatal anxiety and depression?
Most people are familiar with the term postnatal depression. However, with the growing recognition that depression can occur almost as frequently during pregnancy as afterwards, medical experts now prefer to talk about perinatal depression. This term covers both antenatal depression (depression during pregnancy) and postnatal depression.

How prevelant is perinatel anxiety and depression?
Studies have found that about 10 per cent of women will develop depression during pregnancy, with this rate rising to 16 per cent - about one in six women - in the first year after the birth.

But depression - a feeling of low mood and hopelessness - is only one side of the equation. About 4 out of every 10 women who develop postnatal depression will also develop an anxiety disorder. Anxiety may present as generalised anxiety or 'worry', phobias (fears) or panic attacks. Some mothers can even develop post-traumatic stress disorder, with distressing flashbacks and nightmares, in response to a bad birth experience or earlier life events.

Who is at risk of perinatal anxiety and depression?
Perinatal anxiety and depression can strike anyone: first-time mums, experienced mums, older mums, younger mums, and mothers from all socioeconomic backgrounds and cultures.  For some women it appears to be completely biological/hormonal on origin, for others a personal or family history of anxiety and depression, or social circumstances - financial problems, marital problems, social isolation or simply having a challenging baby - may contribute.

Whatever the cause, perinatal anxiety and depression is treatable, so if you suspect you or someone close to you, may be experiencing symptoms, it's important to seek help as soon as possible.

What are the signs of perinatal anxiety and depression?  

Women should consider seeking professional help if they:

• are unable to enjoy activities they used to enjoy prior to becoming pregnant or the baby's birth
• have trouble concentrating, making decisions or getting things done 
• have physical symptoms such as a racing heart, constant headaches, sweaty hands and loss of appetite 
• feel numb and remote from family and friends, even from the baby 
• feel out of control or continually on edge
• are unable to rest even when the baby is sleeping (or conversely feel exhausted and want to sleep all the time)
• feel angry and irritable with everyone and everything
• have constant feelings of guilt, worthlessness and shame, often about being a 'bad mum'
• have racing, anxious thoughts 
• feel trapped or in 'a dark place ' or 'tunnel' with no escape
• experience feelings of grief, loss and tearfulness 
• fear being alone with their baby (or conversely going out)
• have thoughts of harming themselves or their baby.
  

Is this just the 'baby blues'?
These symptoms should not be confused with the baby blues, a brief period of mood swings, tearfulness and anxiety that is very common among new mothers in the first week after giving birth. With the baby blues symptoms tend to appear 3–5 days after giving birth and usually resolve in a week or two.   

Perinatal anxiety and depression is different and potentially serious. If a woman experiences symptoms every day for more than two weeks, and these start affecting her ability to cope in daily life, she may be developing anxiety and depression and should seek help and advice.   

Can men have perinatal anxiety and depression?
Men are not immune from perinatal anxiety and depression, either; in fact about 10 per cent of men will experience symptoms around this time. Commonly, but certainly not always, this develops as reactive depression to a partner's illness - it's understandably difficult to be around a person who is 'down' all the time.

In fact, if the mother is depressed the whole family is affected: partner, baby and other children. That's why it's essential to get help straight away.

What should I do I have perinatal anxiety and depression?
Tell someone how you're feeling. This may be a supportive friend or relative in the first instance, or a health professional such as a: 

• general practitioner
• early childhood/family health nurse 
• midwife
• obstetrician
  

Sometimes it can be daunting to make the first approach to a professional. If that's the case, it's a good idea to get a friend or relative to make the call for you and, ideally, take them along to the first appointment.

These health professionals may refer you on to one of the following specialists if they feel you require further support such as counselling and/or medication:

• psychologist
• psychiatrist  
• social worker
  

How can they treat perinatal anxiety and depression?
There are many effective treatments for perinatal anxiety and depression. For women with milder symptoms, getting some practical (babysitting or housekeeping) and emotional support may be all that's needed.  'Talking therapies' - professional counselling and/or psychological treatments such as cognitive behaviour therapy - can also help a great deal. 

When symptoms are more serious, medication may be recommended in addition to (never instead of) talking therapies. In rare situations, for example if a mother has thoughts of harming herself or her baby, hospitalisation may be necessary. There are Mother and Baby Units in some public and private hospitals, where mothers can room with their baby while receiving treatment in a supportive environment.  

With the right treatment the vast majority of women will recover fully and go on the live happy lives with their baby and family.

Where can you go for more information?

PANDA - Post and Antenatal Depression Association or phone 1300 726 306, 9am to 7pm (AEST) Monday to Friday.
Gidget Foundation  
beyondblue 
Black Dog Institute
Suicide Call Back Service or phone 1300 659 467 for a 24 hours/7 days a week crisis counselling across Australia.