Let's talk about post-natal depression
31 January 2010By Dr RAMINDER KAUR
HAVING a baby is an important event in a woman’s life. For what can seem like forever, her body has been undergoing major changes and she may have experienced considerable discomfort or even ill-health while pregnant. When the baby is born, the woman becomes responsible for the well-being of a small, vulnerable person, who has very immediate needs for care and attention.
We tend to assume that motherhood is joyful and rewarding, and that it will be easy enough to adjust to the arrival of a new baby. However, no matter how wanted the baby is, he or she will bring changes to the mother’s life, changes which can be disturbing or distressing.
Many women find they go through a low patch shortly after they give birth, feeling tired and weepy. But these “baby blues” generally only last a few days before women feel more themselves again.
Women are affected to varying degrees by postnatal depression. With a great deal of effort, some may struggle on with their lives, although everything may seem flat and dull. – AFP
For others, having a baby has a more serious and longer lasting effect. These women become depressed, confused, or very anxious, and can’t just “snap out of it”. This reaction is known as postnatal depression, and can be very painful and upsetting for the woman herself, her partner, and her children.
This information is written for mothers who are going through this experience, and for their families and friends. It aims to provide some basic information about postnatal depression, what it feels like. and the possible causes.
What is postnatal depression?
We tend to have high expectations of motherhood. So if you find yourself in turmoil and begin to doubt if you can manage, or even want to manage, it can be very distressing.
Many mothers find they become tearful and despondent, anxious, or tense and angry, and don’t know what to do about it. If you feel like this, there may be no clear reason for it, which can make things worse since you may then feel guilty and inadequate. Even though the baby was planned, and your pregnancy and birth went well, it is as if a great black cloud has arisen out of nowhere and settled over you. You probably never thought that having a baby would make you feel like this.
Postnatal depression is more common than you realise – between 10 and 20% of women are affected. It can occur straight after the baby is born, or months later. It can start very suddenly or slowly take hold. Women of all ages and backgrounds are affected: both first-time mothers and those with other children.
It is possible to feel alright with your first child, but become depressed with the next. The chances of developing postnatal depression (PND) are higher, however, if a woman has had PND before.
Each woman is affected in her own particular way. These are some of the feelings and experiences women often report:
·Depressed and tearful. Everything can seem a struggle. You feel bad about yourself and about everything around you.
·Anxious and worried about your own health, the baby’s, or the rest of the family’s. You may feel genuinely frightened of being alone at home, or of going out.
·Irritable and frustrated. You may snap at your children and get angry with your partner or friends.
·Exhausted, both physically and emotionally
You may also notice changes in the way your body functions and the way you behave:
·Concentrating on even the simplest task can be difficult.
·Your usual sleep patterns may be disrupted. You may feel you want to sleep all the time, or it may be hard to fall asleep or sleep long enough.
·Your appetite can be affected.
·Your body may seem to slow down. Making decisions of any sort, even about what to wear, can seem impossible.
·Or you may feel full of nervous energy and keep constantly busy, but not really achieve much.
·You may lose interest in sex.
Women are affected to varying degrees by postnatal depression. With a great deal of effort, some may struggle on with their lives, although everything may seem flat and dull. Others will be overwhelmed by powerful, frightening feelings they can’t control. In despair, you may even believe that life has nothing to offer and the only way out is to kill yourself.
It can become a vicious circle that traps you. You become more tired through lack of sleep and this makes you more irritable. You then feel guilty about how you’re treating your family, and more and more useless. It seems to go on and on.
But postnatal depression does not last. You will not always feel like this. It can be an enormous relief to realise that although there is a problem, something can be done about it.
It is important, also, to find that you are not the only one to have these experiences. Other women have been through them too and recovered.
Understanding postnatal depression
Once a woman recognises she is experiencing postnatal depression, she’s likely to look for reasons. There are various possible causes, and a number of things may work together to trigger it off. The cause can differ from one woman to another, and sometimes there may be no clear reason. At particular points in your life, you may just be more vulnerable. Or difficult events in your past may make you more likely to experience postnatal depression.
Here are some of the suggested explanations:
·The birth itself may have been distressing or seriously disappointing. This can leave you with a sense of violation or loss, which may bring on postnatal depression.
·Your baby may be very demanding, or perhaps he or she was born prematurely or has a health problem or disability. All these can put unbearable stress on you as the mother.
·You may be under a lot of pressure generally. Perhaps there are money or housing problems. Maybe you get little support from your partner, or don’t have one. Possibly you’re isolated and lonely with no one to provide support or help.
·Our own experiences of being mothered can influence how we cope as mothers. Painful memories of events in our childhood, the loss of loved ones, or separation from them, physical or sexual abuse, may return when we face motherhood ourselves.
·Society has a very mixed view of motherhood. On the one hand, mothers are regarded in a rosy light as selfless sources of love and caring. On the other hand, society makes little attempt to meet the needs of mothers and young children. Taking a baby out anywhere can be an enormous effort.
·Being a mother is regarded as instinctive, as something women all know how to do. Yet, very often, women have had little or no experience of caring for small children before their own baby comes along, and no chance to prepare themselves or learn the skills needed
·We can easily end up feeling isolated and ignored. If we’ve given up work, we may well feel resentful at being cut off from the adult world and at losing our income.
·Some doctors support the view that changes in hormone levels after giving birth lead to postnatal depression, although not all doctors agree on this.
Very rarely, a woman may develop a serious condition called post-puerperal psychosis. This can lead her to behave in highly excitable and uncontrollable ways. She may have strange or bizarre beliefs or may hear voices, and will need medical help and support.
How can I deal with postnatal depression?
Postnatal depression is exhausting and frightening. But there are steps you can take to break free. More will be said below about getting help from other people, but there are things you can do to help yourself recover. What helps may be different for each of us, but here are some of the things other women found useful.
Begin to take care of yourself. Have a treat, or indulge yourself by doing something you really enjoy. Meet a friend for lunch, have a leisurely soak in a bubble bath, buy yourself a bunch of flowers.
Get a break from the baby and the other children. This can be hard to arrange, but worth it, even for a short time.
As far as possible, get enough rest. When the baby’s asleep, ignore the housework and put your feet up for a while. If getting to sleep is difficult, try to develop a bed-time routine to unwind – have a bath or read for a while.
Exercise can help you relax. It need not be anything strenuous. Going for a walk gets you out and gives you a break from the baby’s demands.
Try to eat regular meals. Lack of food or too much junk food may only make you feel worse. If you have no appetite, try to view food as medicine. Gradually, your appetite will return.
Find ways of expressing your feelings. If you don’t feel able to talk to your partner or a close friend, use other outlets, write down what you feel. Let yourself cry. Close the bathroom door and scream if you want to. If you feel anxious or tense all the time, you may want to find out about relaxation techniques from your doctor. Your local library may be able to supply some books on this.
Don’t keep pushing yourself to live up to other people’s expectations. Be good to yourself. Pay attention to the good feelings and the good times, rare as they may seem just now.
They will become more frequent.
Recovery won’t be easy and it won’t necessarily happen quickly.
Getting help from others
Sometimes it is useful to talk things over with someone outside your immediate circle of family and friends. It can be a big step to seek out such help, but you shouldn’t feel ashamed of needing it.
Getting help early, as soon as you recognise you have a problem, can save you and those close to you a lot of anguish. There are various sources of help available, each offering different kinds of support.
Counselling and therapy. These are sometimes called “talking treatments” because they give people a chance to talk through their difficulties.
Such therapy, of which there are many types, tends to be longer-term and concentrates more on explaining and coming to terms with past events.
Counseling tends to be more practical and focuses on present day feelings and difficulties.
In either, it is important to find a counselor or therapist you can relate to and trust.
Counselors and therapists use a range of different approaches and you may need to discuss what is best for you.
Psychotherapy tries to help you understand your current feelings in the context of past events and experiences. Cognitive therapy sets out to help someone feel better about herself.
You may not necessarily feel you have to find out what caused you to develop postnatal depression, but want to use counseling or therapy to help you overcome the pain of depression.
Your family doctor may have access to the services of a counselor for his/her patients and may be able to help, or put you in touch with someone who could. While your baby is small, you are likely to have regular contact with your doctor. Try and explain to him/her how you are feeling.
You may feel it is important that you see a counselor or therapist on your own. If you have a partner, you may want him to be involved, to some extent at least, so you can both move forward together. It is important, though, that you work out what you want.
Self-help. Many women have found that talking with others who’ve been through similar experiences is very helpful. It can be a great relief to find you’re not alone.
Members of a self-help group can provide each other with the support and encouragement needed to get through the bad times, and practical advice on how best to cope.
Self-help groups provide an opportunity to be honest about your feelings, in a setting where others understand but don’t blame you.
Some groups offer both mutual support and counseling, with input from an experienced counsellor.
Medical treatment. Many women may be nervous about going to their family doctor to discuss their feelings of depression because they feel frightened or ashamed. But a sympathetic doctor can be a great source of support and reassurance. Your doctor may choose to treat you himself, or may refer you to a psychiatrist for specialist help.
A course of anti-depressants may be prescribed for you. These are not addictive. They do not in themselves cure depression, but can lift your mood sufficiently to enable you to cope more effectively and to take advantage of other help, such as counseling. These drugs work for a lot of people, but not all. They can have unpleasant side effects, such as drowsiness, or giving you a dry mouth, or constipation.
Most anti-depressants take two to four weeks to have any effect, so it is important not to give up too quickly if you don’t feel better straight away. Your doctor may suggest you keep taking them for a few more weeks after you do feel better, as this can prevent the depression from returning.
If you are breastfeeding, your doctor should be able to prescribe a drug which will not affect your baby. It is important that you get your doctor to explain the treatment offered. You’re entitled to information about the likely benefits and disadvantages of each drug prescribed for you.
You may also want to talk about alternatives to drug treatment, such as counseling or self-help. Your doctor may be able to put you in touch with other sources of help.
Friends and relatives. As a relative or friend, you can help by being patient and understanding. You can show your concern by listening sympathetically, and being prepared to spend time with the depressed mother. Try to prompt her to talk about how she’s feeling. Let her know you still care for her, and can help and accept her, even though you don’t understand why she feels like this.
It’s unlikely to do any good to tell her to pull herself together, or to say she’s got nothing to be depressed about. Praise and realistic encouragement are likely to be more effective.
On a practical level, you can help by giving her time to herself, away from the baby and the other children. She may well be finding it difficult to cope with everyday chores. Try not to get frustrated or angry. Do what you can to help out. As she recovers, let her regain control of things. If you take over completely, she will only feel even more useless and despondent.
Someone who is experiencing postnatal depression often sees everything in a negative light, and becomes preoccupied with her problems. You can help by challenging this negative way of thinking and pointing out situations or tasks which she has handled well.
You may also need to encourage her to seek help. Your support can prompt her to take that step. Perhaps you could accompany her to a self-help group or a counselor, even if you do not take part. Above all, try to be patient. It will take time for her to re-establish herself, and for you both to re-build your relationship.
It is not easy to see a woman you care about go through postnatal depression. To see someone appear to change so much and become almost unreachable can be deeply distressing. You may worry that in some way you have contributed to the depression.
You will often feel helpless and not know how to react. You may feel bewildered and resentful that this has happened to someone close to you. You may feel angry at the effect on you and on the rest of the family, particularly the baby.
It can be very wearing to live with, or be in close contact with someone with postnatal depression. No matter how hard you look, there may be no apparent reason for this to have happened. You may find yourself becoming depressed or agitated – it is now known that many new fathers as well as mothers experience depression.
Perhaps you have had to take on tasks and responsibilities because your partner or friend is not able to cope. This can be especially exhausting when a young baby is involved. And at the back of your mind is a nagging anxiety about what will happen to the children in the longer-term.
All this is a great deal to bear on your own. It is therefore important that you get advice and support too. If possible, get others to help you. Talk to your family doctor about your concerns.
Discuss your own feelings with family and friends. Try to find time to do things which you enjoy. Remember that you count too.
The future
The most important thing I’d want to tell other women is that you can leave postnatal depression behind you. It may take a while to get over postnatal depression, but it will happen. You will probably find you begin to have more and more good days, but try not to be too let down when a bad one comes along again.
Don’t expect too much of yourself too soon. Remember that all women go through spells of feeling low, sometimes with no obvious cause, and don’t be misled into thinking you’re not making progress.
I used to warn people off when I was having a bad day so that they’d give me space and let me be.
If you’re considering having another baby, the thought of experiencing postnatal depression again may make you very wary.
But it is possible to take steps to prevent it. This time, you and those around you have experience and foresight on your side, and can watch out for the warning signs.
If possible, plan in advance of the baby’s arrival how you can get help and support, and allow time for yourself. It’s a good idea to avoid putting yourself under undue stress, for example by moving house, although obviously it’s not always possible.
Perhaps most importantly, find someone you can confide in and trust – a friend or relative, a doctor, health visitor, counselor, or someone in your self-help group.
Some doctors will advise you to follow a course of hormone treatment or anti-depressant drugs while you are pregnant as a preventive measure, but not everyone agrees that the benefits to the mother outweigh the risks. Ask your doctor to explain these to you so you can make up your own mind. Remember, you have a right to this information.
Some women feel that the experience of postnatal depression. though painful. has helped them to understand themselves better. Others prefer to leave it behind them and work at making up lost ground, strengthening their relationships with their children and others close to them.
> This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.
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