What is PND?
Postnatal Depression is a depressive disorder which affects women. It occurs in 10-15 in every 100 women having a baby.
The symptoms of PND are very similar to the symptoms one may experience in depression . These are often characterized by low mood and biological and psychological features of depression which are pervasive and sustained for greater than a 2 week duration.
Often mothers experiencing PND will feel guilty about the way they feel , it may affect their ability to bond with the child and lead to attachment problems.
Often dependent upon severity women with PND may experience significant difficulty caring for their new born child and any other children.
Individuals with PND can experience overwhelming difficulty with simple household chores and feel defective and inadequate as a mother.
When does it happen?
PND normally starts within one to two months following birth , but can happen several months later.
Some women develop depression during pregnancy and the symptoms become more intense and overwhelming following birth.
Sometimes women develop PND and symptoms go unnoticed . Women feel that “something is just not right”
Child birth is a time of significant physiological and emotional change. Post natal baby blues are commonly experienced by 80% of mothers between the third and tenth day the baby is born, and only last for several days. This is not the same as PND , where symptoms are more intense, severe and persist for a much longer duration.
What are the symptoms of PND?
There are a range of symptoms you may experience if you are suffering from PND. These include:
- A persistent feeling of low mood and being unhappy.
- Extreme lethargy and tiredness.
- Severe disruption to the sleep architecture with marked insomnia and early morning wakening.
- Irritability and anger
- Tearfulness and emotional lability
- Appetite loss
- Impaired concentration and attention
- An inability to derive pleasure from or enjoy anything (Anhedonia)
- Loss of confidence
- Negative Thinking patterns.
- Feelings of Guilt.
- Thoughts that you are a bad mother
- Feelings that you are not bonding with your baby
- Thoughts that your baby doesn’t love you
- Anxiety features characterized by a preoccupation that there is something wrong with either you or your baby and other features of autonomic arousal such as palpitations, panic symptoms, sweating and feeling breathless
- Feelings of hopelessness and worthlessness
In severe cases of PND you may experience extreme , overwhelming and distressing feelings that you and/or the baby would be better off dead.
Occasionally women may feel like hitting or shaking the baby through extreme exhaustion and profound despair. The suicidal feelings may lead to urges which you find difficult to resist and are profoundly disturbing.
Fortunately most women don’t act upon such thoughts. 1 to 2 in every 1000 women will experience a severe form of PND which results in puerperal psychosis, whereby they develop strange delusional beliefs and perceptual disturbances such as hallucinations (voices ).
Women who have experienced affective (mood) disorder , particularly Bipolar Affective Disorder prior to pregnancy are at an increased risk of developing puerperal psychosis.
If women experience any of the above features it is imperative that they receive urgent psychiatric assessment and evaluation from a fully qualified expert consultant psychiatrist.
What causes PND?
Research indicates a range of factors which are implicated in the causation of PND and there is no single factor identified.
A previous history of mood disturbance or depression,anxiety and complications during pregnancy, recent stressful events,relationship difficulties, and physical conditions such as thyroid disorders may be relevant to understanding why you have developed PND.
Some women with milder forms of PND get better without treatment, however 25% of mothers will remain depressed even after the child is 1 year old. This can have a significant impact upon family realtionships and bonding with the child.
The choice and types of treatment are decided following a careful and detailed assessment with a consultant psychiatrist. It is important for the success of treatment to form a collaborative therapeutic relationship with the expert psychiatrist and devised an individually tailored treatment programme matched to your specific needs.
Treatment consists of talking psychotherapy treatments such as counseling and/or CBT. In severe cases medications may be indicated such as antidepressant treatments which include SSRI medications.
It is imperative that the doctor knows if you are breast feeding. Many antidepressants have not been shown to be harmful to the baby , however this needs to be an informed decision , whereby you are provided with all the necessary information and can make an informed decision with your partner on the most appropriate course of action, after considering the risks and potential benefits.
Important Dos and Dont’s
- Don’t avoid seeking professional help
- Don’t hide you feelings and simply carry on without accessing support and talking to someone.
- Don’t be afraid of the diagnosis-Remember you’re not alone and it’s a very treatable condition with right level of expertise and support.
- Don’t blame yourself-PND is another illness like other medical conditions
Make sure you:
- Involve your partner in the process for support and reassurance.
- Have good sleep hygiene.
- Eat a balanced healthy diet.
- Try and exercise.
- Take time out to relax.
- Attend local support groups.
- Use self help materials and other resources available.
- Maintain compliance and engagement with expert treatment recommendations.