Postnatal depression

The time when a woman becomes a mother is one full of emotional and physical changes.  According to research, between ten and twenty per cent of all mothers, suffer from postnatal depression in the first few months after their child is born. Many mothers do not realise how much stress the birth and the time immediately afterwards have have caused them- and that they are actually suffering from depression. Other mothers are so ashamed because of the negative feelings they have for their babies and of how overwhelmed they feel, that they do not share their worries with anyone else.

Symptoms of postnatal depression 

  • feeling tired and exhaused,
  • sadness,
  • feeling guilty,
  • feeling empty inside,
  • fears,
  • irritability,
  • loss of appetite, difficulty concentrating,
  • ambivalent feelings towards the child,
  • suicidal ideation,
  • psychosomatic problems

If some of these symptome persist over several weeks it is time to seek help. It is important for the mother and the baby and their new relationship that help and support are provided quickly. Mothers who are suffering from depression, are often so preoccupied with themselves that they have great difficulty catering for the needs of their newborn baby. Other depressed mothers have a tendency to be overly anxious, which may lead to phases of exhaustion. Babies can only develop into well balanced social beings, if they are in interaction with others who are able to perceive, correctly interpret and react promptly to their needs. Mothers in a depressive phase have great difficulty being a sensitive partner to their baby.

Causes
The causes of postnatal depression are multifactoral. The time after the birth is one of great hormonal change in the mother, which may create a sense of emotional and even psychological imbalance. Psychosocial risk factors, such as a difficult relationship with a partner, social disadvantage or stressful life events (e.g. the death or illness of a relative), can also play a great part in the development of depression. In addition, women who have suffered from depression before the birth, are more likely to have a depressive episode after childbirth, in comparison with women who have never been depressed.

Other postnatal illnesses
Apart from postnatal depression mothers may also suffer from the milder baby blues or the more severe postnatal psychoses.

Baby blues
Fifty to eighty per cent of all mothers experience the baby blues in the first three to five days after the birth of their child. The characteristic symptoms are: sadness, tearfulness, mood swings, exhaustion, anxiety and difficulty in concentrating. These symptoms mostly disappear after a couple of days and may be interpreted as temporary mood swings. If a mother suffers from the above symptoms continually for more than 2 weeks, she should consider seeking professional help to prevent the development of more serious postnatal depression.

Postnatal Psychosis
Postnatal Psychoses is the most severe form of post birth crisis and is seen in between one and three in every 1000 mothers. Women suffering from post-birth psychoses after the birth are usually so extreme in their behaviour (suicidal ideation, very depressed, manic or hallucinating) that they are quickly admitted to a psychiatric clinic. In these cases medication is almost always a must, as well as being an in- patient for several weeks. Increasingly there are psychiatric clinics which are able to treat the mother as well as cater for the baby’s needs in a supportive environment. This enables the mother to build up a relationship with her baby in the early days and gives their relationship a better foundation.

Psychotherapeutic help
The prognoses of fully recovering from an emotional illnesses after child birth is excellent. Depending on the severity of the depression it may be sensible to take anti-depressant medication in conjunction with psychotherapeutic treatment. The pros and cons of this decisions – which may entail stopping breastfeeding – should be carefully discussed with the psychiatrist.

Main issues to be worked on 

  •  Understanding the disorder, i.e. why did I become depressed now?
  •  positive identification with the maternal role and strengthening the mother-child relationship
  •  which signals is my baby giving me and how can I understand them better?
  • questioning the exaggerated feeling of responsibility
  • catastrophizing
  • installing a supportive network for the mother

Literature

Shields, Brooke (2006). Down came the rain, Hyperion, New York.

Dalton, Katharina (2001). Depression after Childbirth. Oxford University Press.