More than ‘just’ the baby blues – all about PND (Postnatal Depression)

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Depression or anxiety are quite common during pregnancy and early parenthood. Linda Drummond looks at the causes of PND, and how it affects women and men.

TABLE OF CONTENT

What is postnatal depression (PND)?

Postnatal depression (PND) is depression or anxiety that develops during pregnancy or after the birth of a baby. While PND used to refer only to postnatal depression, there is now a move to refer to antenatal depression as perinatal depression to include women who suffer from depression, mood disorders or anxiety during pregnancy under the blanket term of PND[1].

In Australia, PND affects one in seven new mothers, and one in 20 new fathers[2]. Approximately one in four Australians will suffer from some kind of anxiety disorder in their lifetime, but the postnatal period is a time of increased risk for women in particular. It’s important to note that mild to moderate cases are sometimes not even noticed by the individuals themselves[3].

Types of PND

With approximately one in 10 women developing PND, it’s important to understand how the condition is defined. There are three types of mood conditions a woman may develop during pregnancy or afterwards. These include[4]:

1. The baby blues. This  is very common and considered normal. The baby blues usually start on the third day after birth, and begin to abate by day 10. Symptoms include:

  • feeling weepy
  • feeling irritable
  • feeling anxious
  • feeling generally low.

2. Postnatal depression. This usually develops within the first four weeks after childbirth, but perinatal depression can also occur during pregnancy. Symptoms include:

  • a general low mood
  • not really enjoying anything
  • lack of motivation
  • feeling tearful quite often
  • general feeling of irritability
  • feelings of guilt, rejection or inadequacy
  • feeling unable to cope with anything.

3. Postnatal (puerperal) psychosis. This is an uncommon but severe form of PND. Around one in 1000 mothers will develop this condition. Symptoms include:

  • delusions or false beliefs
  • hallucinations
  • irrational thoughts
  • odd behaviour.

PND differs from regular depression as pregnancy is the trigger for the mood disorder. PND occurs either during pregnancy or in the 12 months following the birth of a child. But, like depression, it’s when a low mood becomes severe, lasts two weeks or more and interferes with how you function in daily life[5].

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What causes PND?

While the causes of depression during pregnancy and in the postnatal period are complex, there are a number of psychosocial factors you should be aware of. Research has shown that some of the main risk factors include[6]:

  • effects of illness – extreme nausea and vomiting during pregnancy can impact on the way our body functions
  • previous history – if you have a previous history of mood disorders requiring counselling or treatment
  • childhood history of being parented – we form our attitudes in childhood and this can impact us when we become parents
  • stressful life events – losing a family member or a job, or relationship problems can all have an impact
  • insufficient family or social support
  • childbirth related distress
  • a baby that’s difficult to settle, restless or unwell
  • self-criticism or perfectionism.

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Symptoms of PND

While the types of symptoms can vary depending on the type of depression, there are certain thoughts and feelings that women should look out for. These include[7]:

  • loss of self-esteem and confidence
  • unusual weight loss and loss of appetite
  • losing enjoyment in normal activities
  • sense of hopelessness or feeling like a failure
  • broken sleep (unrelated to baby)
  • feelings of wanting to not be alive
  • panic attacks
  • loss of libido
  • fear for baby’s wellbeing.

 

Types of treatment for PND

The first step in treating PND is a diagnosis to rule out any other causes for the symptoms. Once a diagnosis has been made, treatment options usually involve counselling, self-care, support or medication[8].

Counselling for PND

PANDA (Post and Antenatal Depression Association) advise that one of the most important aspects of treatment for PND is to have some kind of counselling or support. Counselling can help understand the causes of PND and also to help women adapt to the role of motherhood[9].

Self care for PND

After being diagnosed with PND it’s important for women to take care of themselves, and to ask for help or support from their partner, family or friends. Other actions include[10]:

  • telling someone how you feel
  • sleeping or resting whenever you have the chance
  • making sure you eat healthy food regularly, even if you don’t feel like eating
  • doing things that make you relax or that you enjoy
  • finding a local mother’s group or support group
  • letting others help with housework or the baby and asking for help if need be.

Exercise and PND

Going for a walk can help with PND. As little as a 10 minute walk with the baby in the pram can be a real help because exercise stimulates the brain’s pleasure centres, improving mood. Exercise can also decrease the chemicals that lead to stress[11]. Research indicates that exercise may help to alleviate symptoms of depression by[12]:

  • increasing energy levels
  • improving sleep
  • being a distraction from worries
  • providing social support
  • increasing self-esteem.

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Preventing PND

Prevention of PND involves early intervention. If you’ve experienced depression, mood swings or anxiety in the past, advise your caregiver at an early appointment so they can help you look out for any signs[13]. If a low mood or anxiety persists beyond a week or two, then it’s important to seek medical advice as soon as possible and not brush it off.

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Research on PND

BeyondBlue set up the Postnatal Depression Research Program to focus attention on improving women’s mental health before they give birth. The program uses a simple mental health screening tool, theEdinburgh Postnatal Depression Scale (EPDS), to identify women who may be at risk of postnatal or antenatal depression. More than 40,000 women were screened, and the project identified that up to 10 percent of Australian women experienced depression during pregnancy. This increased to 16 percent in the postnatal period[14].

Scientific opinion points to the need for ongoing research into postnatal depression. A working paper titledPostnatal depression and fertility: future research directions from St John’s College, Oxford and the Vienna Institute of Demography, says that although postnatal depression is a serious public health concern, about half of all cases of PND go unrecognised. It states that very little research has been done on the effect of PND toward future reproduction by sufferers or their friends or family[15].

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PND and dads

For men, pregnancy and the birth of a new baby can also be a stressful time as they adjust to new challenges. For some men, this can lead to anxiety or depression[16]. The signs of postpartum depression in men are similar to those in women – feeling irritable, stressed, anxious, sleepless and sad[17]. Men who are concerned about PND in themselves should seek advice from their GP.

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PND and your relationship

Relationship stress can be an enormous issue when couples are battling PND. However, most relationships will return to normal when the episode of depression lifts. In the meantime, couples should[18]:

  • find out as much as possible about PND
  • recognise that PND can cause relationship problems, not the other way around
  • talk often, and encourage the other person to talk about their feelings
  • look for stress management techniques such as exercise or meditation
  • organise a night out away from the baby every now and again
  • seek professional help.

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Where to get help

Contacting your GP or healthcare provider is the first step in identifying and treating postnatal depression. Psychiatrists, psychologists, social workers and occupational therapists can also offer treatment[19].

However, there are a range of other dedicated resources to help including:

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More from Kidspot on PND:

Read more about PND:

 

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