Understanding Emotional Health & Postnatal Depression

What are Postnatal Depression & Anxiety?

Depression and Anxiety in the Perinatal Period

Becoming a parent is a major life transition. Although it is a time of celebration and new beginning, it also brings with it significant changes and challenges. Many parents struggle to adjust to the changes, and some parents experience postnatal depression and/or anxiety at some point during the perinatal period. The perinatal period includes pregnancy and the first year following childbirth.

How common is postnatal depression and anxiety

Approximately 9% of women experience depression at any given time during pregnancy (also known as antenatal depression). Following childbirth, 13% of women experience depression (also known as postnatal depression). Anxiety is at least as common as depression during the perinatal period.

What are the symptoms of depression and anxiety?

Depression and anxiety can start at any time during the perinatal period and can come on suddenly or develop gradually. The symptoms are no different to depression and anxiety experienced at any other time in one’s life. The symptoms of depression include:

A. Feeling sad or unhappy most of the day
B. Loss of pleasure or interest in most activities
C. Significant weight loss or gain, decrease or increase in appetite, unrelated to pregnancy.
D. Difficulty sleeping or over-sleeping
E. Feeling restless or slowed down
F. Fatigue or loss of energy
G. Feelings of worthlessness or excessive or inappropriate guilt
H. Difficulties thinking, concentrating or making decisions
I. Recurrent thoughts of death or suicide

Anxiety often goes hand in hand with depression. A certain level of anxiety and drive are necessary in order to motivate us to carry out our daily tasks and responsibilities. However, when this level of anxiety gets too high it can interfere with our ability to complete tasks and enjoy life. Symptoms of anxiety include:

• Constantly worrying about many things, for example, your baby’s health, finances, relationships, etc.
• Panic attacks, heart beating really fast, trembling, sweating
• Feeling like some terrible is going to happen

How do Women Describe their Experiences ?

Jessica Rowe, an Australian news presenter, experienced postnatal depression after the birth of her baby in 2007. Jessica’s experience of PND ( beyondblue DVD Stories of Hope & Recovery).

What causes depression and anxiety in the perinatal period ?

There is no single definite cause of depression and anxiety during the perinatal period, however, a number of factors have been found to increase a woman’s risk of developing postnatal depression.

The most established risk factors include:

1. Antenatal depression
2. Antenatal anxiety
3. Limited support (particularly from partner)
4. Major life changes or events
5. History of depression
6. Low self-esteem`

Tips to help you start on the road to recovery:

1. Let someone know how you are feeling.
2. Ask for and accept help from others.
3. Spend quality time with your partner and keep in touch with family and friends.
4. Make time to play with your baby each day. It can be helpful to join a mother-infant playgroup.
5. Make a little time each day to do something nice for yourself that you find enjoyable (e.g., reading a magazine or book, having a bath, going for a walk).
6. Look after yourself by exercising regularly, eating a nutritious diet, and getting enough sleep (this might mean napping when your baby does).
7. Seek help from a health professional.

Different Treatment Options

Women experiencing depression may have difficulty recognising symptoms or may be unaware of the treatments available.

Postnatal Depression & Anxiety Can Be Effectively Treated

The first step in recovering from depression and anxiety is to recognise it and ask for some help.

• Speaking with your GP and Maternal Child Health Nurse can ensure you get a thorough assessment and discussion about treatment options.
• Support and understanding from friends and family and being able to talk about your feelings with other women experiencing similar problems can also be helpful.
• Information and support can also be obtained from self-help books, telephone support services and Internet resources.

It is important to remember that PND can and will improve with time and the appropriate treatment. This can be helpful and sufficient for some women depending on the severity of their symptoms.

Psychological Therapies

In psychological therapy, you and your psychologist will work through your difficulties and you will learn coping strategies to help improve your mood.

Given the effects of depression and anxiety on a woman’s relationships with her baby and partner, mother-infant groups and/or couple therapy are also helpful for many women.

PIRI’s research programs involve cutting edge interventions and are free of charge. They can help not only you, but may help others in the future. Click here to link to PIRI’s free treatment trials.

Medication

At times, when depression is moderate or severe, your health professional may prescribe antidepressant medication. This is often recommended to be taken in conjunction with psychological treatment, or if other treatments are not helping. There is a wide range of antidepressants that can be prescribed, but your doctor can determine which is the right medication for you. Many women are concerned about taking medication during pregnancy and while breastfeeding because of the possible risk to the baby. This is an important consideration and should be discussed with a GP or Psychiatrist who will weigh the risks and benefits to both mother and baby.

Mother and Baby Units

In some cases, where PND is seriously affecting a mother and her baby, health professionals may recommend a stay in a Mother and Baby Unit. Mothers can be referred to Mother and Baby Units by psychiatrists, GPs, obstetricians or paediatricians if a mother is experiencing severe depressive symptoms or is at risk of harming herself or others. During her stay, mothers will receive specialised treatment and monitoring, especially if complicated medical issues are involved. These units provide a safe space, support and assistance for the mother, while health professionals determine the right treatment option for when she returns home. Mothers and babies are stay together where possible, or close contact is maintained, if it is not possible.

Other Mental Health Conditions

Women who experience depression after the birth of their baby may also experience other mental health conditions in conjunction with PND. Anxiety frequently co-exists with PND: approximately 40% of women who experience PND also have an anxiety disorder. Other mental health conditions can also co-exist with PND such as:

• Eating Disorders, commonly Anorexia Nervosa or Bulimia Nervosa.
• Postpartum Psychosis which is very rare, but can involve having strange beliefs that are not based in reality and feeling irritable or full of energy.
• Bipolar Disorder which involves cycles of both manic (high energy) and depressed symptoms.

Learn more about PND and other mental health conditions that can occur in the perinatal period. Click here.

The Mother-Baby Relationship

Who is affected by postnatal depression and anxiety?

Depression and anxiety in the perinatal period can have a negative impact not only on the woman but also on her baby. The symptoms of depression and anxiety can make it difficult to engage in joyful parenting and impact upon the interactions between mother and baby.

PND can have a negative impact on the attachment relationship between the mother and her baby. Infants are very sensitive to the care they receive, and symptoms of depression can make it difficult for mothers and babies to bond. Mothers who are depressed may not be able to provide consistent responses to her infant if she is feeling irritable and withdrawn.

The Importance of Play

What About Fathers?

Depression and anxiety can also put strain on a woman’s relationship with her partner. Some partners may find they are having difficulty coping themselves and may need to seek help for their own emotional well-being.

Men can experience PND too

Many people are surprised to learn that approximately 5% men experience anxiety and depression when expecting a new baby and 10% experience anxiety or depression when they become a father. While mums often experience depression very soon after their baby’s birth, for dads depression can develop more gradually over the first year¹, with most experiencing depression when their baby is between 3 and 6 months². Despite feeling low, many fathers find it difficult to reach out for help.

What contributes to the experience of depression in Dads?

Having a baby leads to major life changes: financial, emotional and social, and the sheer number and magnitude of these changes can be overwhelming. Dads commonly feel stressed as they try to balance performing at work while sleep deprived and trying to support their partner and baby when they return home³. Dads also commonly report feeling left out and overlooked during this time as the focus is on mum and the baby³. In addition, many Dads find that there is little or no time for themselves. Dads who are supporting a partner with depression and anxiety are also more likely to experience depression themselves². This might be, in part, due to shared experiences, which can contribute to depression, such as limited family support, financial stress and sleep deprivation²

Some signs that you might be struggling

Not managing may feel different for every dad. Many dads describe some of the following when struggling with an underlying depression ^4,5:

• Loss of interest in things you used to enjoy
• Feeling flat, empty or sad most days
• On-going irritability and anger
• Physical symptoms of stress such as indigestion, headaches and muscle tension
• Feeling constantly exhausted
• Using alcohol or other unhelpful ways to avoid or escape your situation
• Withdrawing from your family and friends and feeling unable to share your struggles
• Sleeplessness (unrelated to your baby) or sleeping too much
• Changes in appetite
• Finding it difficult to concentrate and make decisions
• Feelings of worthlessness or excessive guilt
• Fear of taking care of your baby
• A loss of empathy and increased irritability towards your baby
• Feeling isolated and disconnected in your relationship with your partner
• Suicidal thoughts

Dads need to look after themselves too!

As a father, you might feel like you have to be the strong one and might not recognise your own needs for support. It’s important that if you are experiencing some of the symptoms above that you reach out for help, both for you and your family.

Here are a list of things you can do to improve your mood:

1. Share how you feel. Speak about how you are feeling to someone who can provide support: your partner, family or friend. Sharing your struggles can make you feel less alone.
2. Accept help. Accept all kinds of help from everyone. No one can do it all on their own. Help might include emotional or practical support including, a friend who will listen, food in the freezer, childcare and gardening.
3. Reconnect with your partner. Make time to reconnect with your partner and share your experience with her or him. Chose a time in the evenings when you can focus on each other.
4. Catch up with friends. Although it might feel like there is no time, try taking an hour or two out to see friends. Socialising with others can help you remember yourself.
5. Stay active. Exercise has been found to have improve mood for adults with depression. It helps to tire out your body when stressed and improve sleep.
6. Take one day at a time. Remember that this period of struggle won’t last forever. Focus on your wellbeing and the wellbeing of your family today and try to bring your mind back to the present when it starts predicting the future or saying… “what if…”.
7. Intentionally bring your mind back to the present. Stand-alone mindfulness exercises have been found to improve symptoms anxiety and depression. You can find an array of helpful guided meditations on the app: insight timer.

Where do I get help for myself if I need it?

If you feel like you are struggling to cope, overwhelmed, depressed or confused, you may wish to discuss this with your doctor. Remember that the Medicare rebate for psychological sessions applies for men too. Talk to your GP for a referral.

If you are having thoughts of wanting to harm yourself or others consider getting in touch with your GP and either calling emergency services (000), attending your local hospital or calling one lifeline on 13 11 14.

Check out symptoms of depression – click here

Some useful contacts for you are:

beyondblue: www.beyondblue.org.au 1300 22 4636

Mensline Australia: www.mensline.org.au 1300 78 9978

Post and Antenatal Depression Association (PANDA): www.panda.org.au 1300 726 306

How can Dad’s support Mum’s with PND:

How can I support my partner ?
In addition to all the other changes in your life, you may discover that your partner is experiencing difficulties adjusting to motherhood, depression, or anxiety. Here’s some tips for what you can do to help:

• Your partner needs you to be there and to listen to her concerns and to believe what she is feeling.
• Be as patient as you can.
• Don’t try to convince her that she is worrying over nothing – show you do care about her feelings and encourage her to express them.
• Just ask how she feels.
• All you have to do is listen – you don’t have to fix the problem yourself.

See Darren Jolly describe what helped for him and his family.

Click here for our expert tips for new Dads.

References:

1. Matthey, S., Barnett, B., Ungerer, J., & Waters, B. (2000) Paternal and maternal depressed mood during the transition to parenthood. Journal of Affective Disorders, 60(2), 75–85.
2. Cameron, E. E., Sedov, I. D., & Tomfohr-Madsen, L. M. (2016). Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis. Journal of Affective Disorder, 206, 189-203.
3. Pilyoung, K., & Swain, J. E. (2007). Sad Dads: Paternal Postpartum Depression. Psychiatry (Edgmont). 4(2), 35-47.
4. Musser, A. K., Ahmed, A. H., Foli, K. J., & Coddington, J. A. (2013), Paternal Postpartum Depression: What Health Care Providers Should Know. Journal of Pediactric Health Care, 27(6), 479-485.
5. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.;
DSM–5; American Psychiatric Association (2013)
6. Morres ID, Hatzigeorgiadis A, Stathi A…Theodorakis, Y. (2019). Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis. Depression and Anxiety, 36(1):39-53. doi:10.1002/da.228
7. Lowe H, Haddock G, Mulligan LD…Kylie, S.D. (2019). Does exercise improve sleep for adults with insomnia? A systematic review with quality appraisal. Clinical Psychologyl Review, 68,1-12. doi:10.1016/j.cpr.2018.11.002
8. Blanck P, Perleth S, Heidenreich T…Mander, J ( 2018). Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis. Behavioual Research and Therapy, 102,25-35. doi:10.1016/j.brat.2017.12.002

Special Challenges for Young Mothers

Perinatal Depression in Young Mothers