The experience of postnatal depression is a difficult one not only for the new mother, both psychologically and physically, but has negative consequences for her relationship with her infant, the development of the infant and her relationship with her partner. Depression delays the physical recovery from pregnancy and birth and causes mothers to view their child care in a negative light and therefore, it seems more difficult. Mothers feel more helpless, disorganised and less able to respond to the needs of their child. The attachment bond between mother and infant is impaired and the cognitive and behavioural development of the child is compromised. The impact extends to the mother’s other relationships placing additional strain on marriages or partnerships.

It seems that many cases of postnatal depression go unnoticed and untreated. Many mothers are not able to acknowledge their struggle either because they do not know that they suffer with depression or because they fear the stigma of not having the ideal experience that they expected or others expect of them. Many will have concerns about using medication whilst breast-feeding. But this should not deter someone from seeking help.

Are all women at equal risk for developing postnatal depression? It would appear that some women are at an increased risk of developing depression at this time. A previous history of psychiatric illness, in particular, depression or anxiety associated with an earlier pregnancy or childbirth may pose an increased risk. Older and younger mothers, single parents and first-time mothers are more susceptible, as well as high achieving women with a tendency to perfectionist style. The absence of adequate support from a partner and low socio-economic class are possible contributing factors towards the development of depression.

Postnatal depression is described as a ‘smiling depression’ in that women have an outward display of normality despite the emotional pain that they quietly endure. The symptoms are varied. Typically, at 6-8 weeks post delivery, women find that they do not feel that they have been able to return to their normal selves. They experience a sense of confusion, becoming overwhelmed by trivial matters, fatigue, tearfulness, irritability and feeling unable to cope. Their sleep pattern is disturbed in that they struggle to sleep as a result of worry and not because of frequent waking of the baby. There is a lack of enjoyment and low esteem as a mother and in addition to feeling low, some will experience unpleasant panic attacks. In severe cases, mothers may even contemplate suicide.

Why does this happen? Some women are, biologically, more vulnerable to illness. Abnormalities in the thyroid gland may be causal. The postnatal period is one of extremely low levels of the hormones that are typically abundant in late pregnancy. The precipitous fall off in progesterone, oestrogen and corticotrophin-releasing hormone (CRH) that occurs in the weeks following delivery may explain the development of mood symptoms. These biological factors, in addition to the emotional and physical adjustments incumbent to the new mother, contribute to the development of depression.

Treatment exists and works. There is no need to suffer silently. The first step is to ask for help from a partner, a family member, a GP, your gynaecologist, your paediatrician, a mental health practitioner or from an organisation like the PNDSA (Post Natal Depression Support Association). Counselling and supportive therapy are effective and available means of treating this depression. Other therapies; such as Interpersonal Therapy, which focuses on role transitions and relationships, and Cognitive Behavioural Therapy, which focuses on abnormal thoughts and behaviours, are known to be effective. These are the first options in treatment but, if unsuccessful, medication can be used. Careful consideration of the appropriate antidepressant, whether breast-feeding or not, is an option for treatment in more severe cases. From a medical perspective, the exclusion of anaemia, thyroid abnormalities and any other relevant medical cause of a depression is essential.

In a modern society, women rarely share the responsibilities of childcare with other women in their families or communities. Today’s women is often isolated in her mothering. In addition to managing the need to work and run a home, mothering alone, is sometimes an overwhelming task. However, coping alone, is unnecessary.

Dr Terri Henderson
Thanks to local psychiatrist Dr Terri Henderson for this informative article.

For more information and help on post natal depression, contact:
PNDSA
tel/fax (021) 797 4498
082 882 0072
083 309 3960

References:
1) Newport DJ, Hostetter A, Arnold A, Stowe Z. The Treatment of Postpartum Depression: Minimizing infant Exposures. J Clinical Psychiatry 2002;63 (supplement 7)
2) Chrousus G, Torpy D, Gold P. Interactions between the Hypothalamic-Pituitary-Adrenal Axis and the Female Reproductive System: Clinical Implications. Annals of Internal Medicine Volume 129(3) pp229-240
3) Fredman S, Rosenbaum J. Mood Disorders and their Treatment in Women Across the Reproductive Life Cycle.Medscape.
4) Nonacs R, Cohen L. Depression During Pregnancy: Diagnosis and Treatment Options. J Clinical Psychiatry 2002;63 (supplement 7)