Postnatal Depression

Prevalence of Postnatal Depression

Postnatal depression (PND) can be a devastating and debilitating illness that can persist and affect not just a new mother but everyone around her.  PND is not a modern condition.  Each generation calls it something different.  What we call PND today may have been called a 'nervous breakdown' fifty years ago.

PND can be mild, moderate or severe and symptoms can begin suddenly after birth or appear gradually in the weeks or months during the first year after birth.

PND occurs in all cultures and can happen to child bearing women of all ages.  Pregnancy is the common factor.  It can happen after miscarriage or stillbirth, normal or traumatic delivery, or caesarean delivery.  PND happens not only after a first baby.  It can occur after a third or fifth baby.  Sometimes it happens after a first baby only.  Sometimes it happens with a third baby, but not with the first two.  Sometimes it happens after each 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 PND, the condition might continue through the pregnancy and may worsen.  It is advisable for the woman to delay another pregnancy until she has recovered.  It is wise to wait at least a year after discontinuing medication before falling pregnant again.

Symptoms of Postnatal Depression

The severity of PND depends on the number of symptoms, their intensity and the extent to which they interfere with normal functioning. PND tends to be characterized by a combination of the following symptoms. The combination and severity of symptoms will be different for every woman, resulting in many different appearances of PND.

- Sleep disturbance unrelated to baby's sleep needs
- Appetite disturbance
- Crying or not being able to cry
- Inability to cope
- Irritability
- Anxiety
- Negative, morbid or obsessive thoughts
- Fear of being alone or fear of being with others
- Memory difficulties and loss of concentration
- Feeling guilty and inadequate
- Loss of confidence and self-esteem
- Thoughts of harm to self, baby or suicide

Some women sum it all up by saying "There is no joy in anything any more", and "I feel like I have lost myself".

Contributing Factors

PND is a multi factorial condition with biological, psychological and social factors all playing some part.  A different combination of factors is probably responsible for each woman's unique experience of PND.  It is very important for women to learn to recognise the signs and symptoms of PND so that they can ask for help as early as possible.  This forms the basis of the biopsychosocial understanding of PND.  All biopsychosocial factors need to be considered when assessing women for PND, as well as being important when making plans for treatment.

The factors thought to be responsible are:-

Biological - genetic predisposition to developing depression; sudden changes in pregnancy hormones after delivery can affect brain chemistry; nutritional deficiencies; a difficult pregnancy or childbirth experiences; a previous experience of PND, a family or personal history of mental health conditions such as depression, bipolar disorder or schizophrenia.

PsychologicalPsychological - difficult or traumatic birth, perhaps involving unexpected interventions such as an emergency caesarean; relationship difficulties with partner or parents/in law; traumatic or abusive childhood, particularly sexual abuse or certain personality types such as perfectionistic or controlling.

Social - a lack of family and community support or difficult relationships; social isolation; financial hardship; lack of close friends, particularly with children; relocation interstate or into a new area; age or stressful life events such as a death in the family or loss of job.

Men and Postnatal Depression

The prevalence of PND among men is not clear and is given little recognition.  Many of the experiences of becoming a parent also present challenges for men and PND is a reality for some.  Often partners are suffering in silence, perhaps with even less strategies or supports for dealing with how they feel.  It is important that they receive the same assessment and treatment as recommended for women.

If the partner is the main carer of the new mother with PND he will be dealing with added pressures and concerns.  Juggling work and family demands while dealing with his own transition to fatherhood are made more complex by living with a depressed person and not knowing how and when to help.  Fathers need to protect themselves because they too are then at increased risk of developing depression.  There are many things that a father can do to look after himself and to ensure that his needs are not neglected:

Look after his own health needs.
Don't be afraid or embarrassed to share the problem with family and friends.
Talk to a professional if things are getting on top of him.
Accept help from everyone to support him getting through the challenging time.
Stay active by keeping up sports and hobbies that will relieve tension and keep him healthy.  Avoid time consuming activities as these may add stress to an already stressful situation.
Try to find time to go out together on a regular basis.
Make time for himself to keep up with his friends and have time away from family.
Accept that there will be some people who do not understand the situation.
Be prepared to accept the anger and frustration of his partner without taking it personally.
Try not to confuse his need for closeness and intimacy with his desire for sex.