About postnatal depression

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Where to get information

beyondblue: postnatal depression	http://www.beyondblue.org.au/postnataldepression/
BluePages	http://bluepages.anu.edu.au
Moodgym	http://moodgym.anu.edu.au
Men's Line Australia	http://www.menslineaus.org.au
Multicultural Mental Health Australia	http://www.mmha.org.au
Clinical Research Unit for Anxiety & Depression	http://www.crufad.com (go to "Self Help")
Anxiety Network Australia	http://www.anxietynetwork.com.au
Panic Anxiety Disorder Association of Australia (PADA)	http://www.panicanxietydisorder.org.au

From beyondblue

Because we don't want to reinvent the wheel and because the information on the beyondblue website about postnatal depression is excellent, we've simply duplicated directly from the beyondblue postnatal depression website. To view the information at beyondblue go to http://www.beyondblue.org.au/postnataldepression/index.aspx?link_id=33

What is postnatal depression?

Postnatal depression is the name given to the mood disorder that occurs in approximately 14 per cent of women in the months following childbirth. It can develop at any time in the first year after your baby is born and can begin suddenly or develop gradually and may persist for many months. If left untreated, it could develop into a chronic depression or recur after a subsequent pregnancy.

Are postnatal depression and the 'baby blues' the same thing?

No. Postnatal depression is different from experiencing the 'baby blues'. The 'baby blues' is a relatively mild period of sadness, which peaks three to five days after birth and affects up to 80 per cent of women. Women with the 'baby blues' cry more easily, may be more irritable and more easily upset than usual. There is usually no specific treatment aside from empathy and emotional support from family, friends and hospital staff.

What causes postnatal depression?

A combination of physical, psychological and social factors contribute to postnatal depression. Studies have shown that some factors are associated with an increased risk of developing postnatal depression. These factors include:

A past history of depression
Depression during the current pregnancy
Experiencing difficulties in your relationship with your partner
A lack of practical and emotional support
Stressful life events (eg. moving house, illness, death of someone close)
A family history of mental disorders
Single parenthood
Experiencing severe 'baby blues'
A prolonged labour and/or delivery complications
A partner who has a mental disorder
Problems with the baby's health
Having an unsettled baby (eg. easily upset, difficulties with feeding and sleeping)
Dysfunctional ways of thinking.

How common is postnatal depression?

Postnatal depression affects around 14 per cent of all women giving birth. There are about 250,000 live births in Australian each year, so between 25,000 to 50,000 women may be affected.

How do I know if I have postnatal depression?

Not everyone who has postnatal depression will have the same symptoms. If you have a few symptoms for a short period of time, you may not have a severe problem. However, if you feel very 'low' and lose interest or pleasure in your normal activities and have any four of the following symptoms, then you may have clinical depression and should consult your GP.

Postnatal depression may include some, but not necessarily all, of the following symptoms:

Experiencing 'low' moods
Feeling inadequate and a failure as a mother
Feeling a sense of hopelessness about the future
Feeling exhausted, empty, sad or tearful
Feeling guilty, ashamed or worthless
Experiencing anxiety or panic
Fear for the baby and of the baby
Fear of being alone or going out
Lack of interest or pleasure in usual activities and routine
Insomnia, or excessive sleep, nightmares
Appetite changes, not eating or over-eating
Less energy and motivation
Withdrawing from social contact
Not looking after personal hygiene
Inability to cope with a daily routine
Inability to think clearly or make decisions
Lack of concentration and poor memory
Ideas about suicide
Thoughts of running away from everything
Worrying about your partner leaving
Worrying about harm or death occurring to your partner or baby
Having negative, obsessive or morbid thoughts.

Am I a bad mother if I become depressed?

NO! The tasks of motherhood are enormous and there are lots of things to learn. Most women want to be good mothers and anything less than perfection can seem like an enormous disappointment. Some people have unrealistic expectations of pregnancy and motherhood.

These expectations may lead women to blame themselves and be reluctant to seek help. Mothers may worry that they will be labelled as an inadequate or poor mother, rather than recognising that it takes time to adjust to motherhood.

Some of the myths of motherhood are that:

Pregnant women are always happy
I'll always enjoy pregnancy and parenthood
Being pregnant won't interfere with my work or lifestyle
My life won't change
Having a baby will improve my relationship with my partner
I will lead a healthy lifestyle for my baby
I should instinctively know how to look after my baby
I will always feel content and in control
There is something wrong with me if I can't cope
Mothers should immediately recognise and love their baby
Good mothers don't have negative feelings toward their children
All other mothers are coping well.

What treatments are available for postnatal depression?

There are several treatment options available, including counselling, psychological treatments (eg. cognitive behaviour therapy), group treatment, support strategies and medication.

Less severe postnatal depression may be helped by regular contact with state-based consumer support groups. Some groups hold coffee mornings where groups of mothers with postnatal depression come together to share their experiences. Other strategies may include ensuring that you have a balanced diet, get plenty of rest and exercise, have someone help with the baby or housework to give you a break, and engage in pleasurable and relaxing activities. Each of these strategies has a place in an overall treatment plan. The best approach for you will depend on your situationity of your symptoms and the services available.

Counselling and support groups may be useful for women with mild depressive symptoms or adjustment problems. A combination of antidepressant medication and psychological therapy may be useful in treating moderate to severe depression. Anxiety disorders require different treatments such as anxiety management strategies and relaxation training that can be taught by specialist mental health practitioners.

More information on treatments is available at the beyondblue website.

How will my baby or family be affected?

As well as affecting your wellbeing, postnatal depression may also impact on your family. Partners may be more likely to become depressed and it may place a higher than normal stress on your relationships. Untreated postnatal depression can also have implications for the wellbeing of your baby and other children. It is important to talk with your family and your GP or other health care provider if you are worried about the wellbeing of your baby or family.

Can I be depressed before I have my baby?

Yes. There is growing evidence to suggest that women who have depression following their pregnancy may also show signs of distress before they have their baby. It is important to note that feelings of anxiety during pregnancy may be a normal response to the impending birth. However, this does not mean that feelings of distress prior to the birth should be over-looked. It is important to talk with your GP or mental health specialist and have a thorough evaluation.

Will I get better?

YES! Depression is a treatable condition and one from which you can recover given appropriate medical treatment, support and time.

It is important to talk to someone and seek help when you are feeling like something is not right (eg. if you are feeling depressed, angry, anxious or confused). Depression is not always something you can get over by yourself and the most difficult part is to reach out and seek help.

Talking about how you are feeling also gives those around you the chance to support you in finding the appropriate help and treatment.

Will I get postnatal depression again when I have my next baby?

Unfortunately, there is evidence to suggest that the risk of recurrence with any future pregnancies is higher in women who have had a previous psychiatric illness in the postnatal period. However, this does not happen in all cases.

The likelihood of recurrence is uncertain, however there are a number of factors that are likely to increase the risk of developing postnatal depression again, such as:

Severity of the illness
Being pregnant within two years of the child with whom the illness first occurred
Inability to fully recover
Continued psychological stress.

There are ways of helping to ensure that the risk of recurrence is low. These include:

Delaying pregnancy until two years after the birth of the child with whom the illness first occurred
Making a full recovery
Stopping medication for at least one year
Talking with a mental health professional throughout the pregnancy and period after birth
Actively involving your partner prior to, and throughout, the pregnancy
Receiving practical and emotional support, in particular to minimise the stresses associated with the birth and early postnatal period.

Is it safe to use medication whilst breastfeeding?

All medications, including antidepressants, pass through breast milk to the infant. However, most studies have shown that only a small fraction of the maternal dose is present in breast milk. Longer-term follow up studies show no negative effects on children whose mothers took antidepressants while breastfeeding, however these studies are few. There is also evidence that breast milk affords considerable benefits to the infant and to the development of an intimate mother-infant relationship. The decision to take medication while breastfeeding is a very individual one and should be made in consultation with a doctor after considering the risks and benefits to both the mother and infant.

How can I help myself?

There are many things you can do to assist in making the experience of pregnancy and parenting easier. Here are some suggestions:

The changes that occur during pregnancy can be stressful, try to be aware of these and talk about them with people you trust
Plan to have additional support in the first couple of months by asking your partner or a family member to stay at home with you
Discuss with your partner the changes you think a baby will make to your lives and the changes you think may need to be made to your daily routines
Try not to make major life changes (eg. moving house, changing jobs) in the first few months after the birth of your baby, or late in pregnancy
Have regular health check-ups
Try to maintain a sense of humour
Work with your partner from the beginning to care for the baby together
Try to rest or sleep when your baby is sleeping
Develop strong support networks (eg. family, friends, the local MCHN, mothers group)
Try to take some time out to do the things you enjoy
Try to spend quality time with your partner
Get a referral from your GP to speak with a health professional with experience in child-birth related mental health difficulties
Try to share the load by talking with people you trust.

How can my partner help?

Here are some suggestions for ways your partner may assist you:

Be encouraging about your partner (the new mum) by seeking professional help and accompanying her to the appointments
Be aware of your own health and wellbeing and seek professional help if you are feeling low or depressed
Provide support and help to your partner
Be actively involved in the care of your new baby
Try to be understanding of your partner's needs and be aware of the expectations you may place on her
Try to accept reasonable offers of help from friends and family
Plan time together as a couple to do the usual activities that you both enjoy
Be aware that women often have a decreased sexual desire following childbirth. Try to be affectionate and intimate without the pressure for sex.