Counsellor and psychotherapist Corina Voelklein reports on postnatal depression
Postnatal depression (PND) seems to be widely known these days but is not yet properly understood. Indeed, about half of the women affected by it are afraid to tell their health visitors because they fear they could be seen as bad mothers, or even that social services might take away their children.
PND is surprisingly common, affecting 10-15% of women after a birth. It often starts within two months but can emerge at any time within the first year. It can come on gradually or suddenly, and may last for weeks or months.
A number of factors make it more likely. Suffering from depression or other mental health issues before having a child makes postnatal depression more likely, as does experiencing depression or anxiety during pregnancy. Other factors are a lack of support as a parent, and the recent experience of stressful events such as a traumatic delivery, a relationship break-up, or the death of someone close.
But while these may make certain women more prone than others, PND can happen whatever your situation and irrespective of whether the baby is your first. It can even affect new fathers, particularly if the mother also has PND.
How do I know I have PND?
Different from the baby blues that can make you moody and tearful between the third and tenth day after birth, PND lasts for at least two weeks. As with other forms of depression, symptoms may include anxiety or irritability, difficulty sleeping (even when your baby sleeps), poor appetite or overeating, guilty, negative or suicidal thoughts, inability to enjoy things, and finding it hard to look after yourself and your baby. Some people report hostility or indifference towards their partner or baby, obsessive fears about the baby’s health, or physical symptoms such as headaches, stomach pains or blurred vision. Others develop panic attacks or feel lethargic to the point of numbness.
If depression rapidly alternates with feelings of elation (mania) along with confusion, hallucinations or delusions, this is not PND but a more severe mental illness called postpartum (or puerperal) psychosis. This is a psychiatric emergency and requires immediate treatment. Fortunately, it is very rare, affecting only about 0.1% of women who have a baby. However, if you are concerned that anyone is suffering from this, please contact the medical services.
How can I help myself to get better?
PND usually improves with time, but it can take up to a year. It may put considerable strain on your relationship with your partner. And it may weaken your ability to care for and bond with your baby and thus also affect your child’s development and behaviour later in life.
Even if you have been depressed for a while, it’s never too late to seek help and you could start with your health visitor or GP. The best conventional treatment for PND has been found to be a combination of practical support and advice, sometimes from friends and family, along with counselling or psychotherapy, and if necessary, anti-depressant medication. In severe cases mother and baby may be treated in hospital, often in specialist mother and baby units designed to protect the bond between the two.
Antidepressants do have different side-effects, and some are safer than others for breastfeeding. Moreover, they usually take at least two weeks to start working, and you need to take them for around six months after you start feeling better. Herbal remedies like St John’s Wort may not be completely safe for breastfeeding either, and may interfere with other medication such as the contraceptive pill.
Can counselling help?
You may find it hard to talk about how you feel, very stuck and alone in this deep, dark place. Unravelling your thoughts and feelings with someone trained to listen in an empathic, non-judgemental and supportive way can bring relief and help you gain a different perspective. Counselling can help make sense of your depression in terms of your ways of thinking and behaving and/or in terms of what happened to you in the past. It can also support you in coming to terms with your role as parent and its impact on your identity and the relationship with your partner and family.
I am thinking of offering group therapy for women suffering from PND as this can create a strong support network. I envisage a six-week programme based on cognitive-behavioural techniques for overcoming anxiety and depression, but also enabling participants to share their struggles, learn from one another, and celebrate achievements on their way to recovery. Weekly sessions would last 90 minutes on a Saturday in Kentish Town.
If this is something you are interested in, please contact me on 07940 818391 or email@example.com.
Association for Postnatal Illness www.apni.org Helpline 020 7386 0868 (Mon-Fri 10am-2pm), information leaflets and a network of volunteers who have themselves experienced PND.
Post Natal Illness www.pni.org.ukOnline chat forum, inspirational stories of recovery and book recommendations.
The Royal College of Psychiatrists www.rcpsych.ac.ukUnder Mental Health Information, easy to read leaflets on postnatal mental health including the latest research findings