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PND - Postnatal Depression
Although postnatal depression (PND) commonly follows on from the blues it can also start some time later, usually within the first postnatal year. A period of intense elation can sometimes come before the onset of PND.
Causes
It is not known for certain what causes PND, but it seems likely that in some cases it is the sudden change in hormones after the birth which may be the trigger. Research has shown that there are a number of things which may make some women more vulnerable to developing PND. These include:
a previous or family history of depression
lack of social support
no one in whom the mother can confide
a poor relationship with her own mother or partner
major life events in the 12 months before the birth (for example, bereavement, moving house, unemployment)
social circumstances (for example, poor housing, financial worries)
a traumatic birth experience (research has shown that the way the mother feels about her birth experience is more important than what actually happened)
unrealistic expectations
Symptoms
The symptoms of PND are many and varied and are experienced in different combinations by different women, or even at different times during the course of the illness. The following list is not exhaustive, but includes the most common symptoms.
Anxiety The mother may be in a state of intense anxiety, obsessed with often quite unreasonable fears about the health of the baby or herself or partner. She may only feel safe if someone is with her at all times.
Panic Attacks The mother with PND may be experiencing panic attack; her heart may beat faster, her palms may sweat and she may feel sick. She may even feel as if she is going to faint. These attacks can strike at any time, although commonly in stressful situations, like shopping or travelling by bus or train, and especially if the baby starts to cry. The mother may subsequently start to feel the symptoms of a panic attack if she is faced with this situation again and can then become afraid to go out in an attempt to avoid another panic attack.
Tension and irritability The mother may feel tense, her neck tight, her body hunched; she is unable to unwind and relax. She can be very snappy. The slightest thing can cause her to shout at the children, rant and rave at her partner.
Depression Depressive symptoms can vary in severity from a low, sad feeling to feelings of intense, almost paralysing despair. She may experience a feeling of being in a long dark tunnel with no way out. She may talk of feeling numb, empty and generally lethargic. She will have no interest in outside activities. Her thoughts will be negative, focusing on her failures.
Exhaustion She may feel constantly tired and drained of energy; unable to cope with household chores, uninterested in her own appearance or surroundings. In spite of this exhaustion, she may have difficulty sleeping; either finding it difficult to get to sleep or waking early in the morning and not being able to get back to sleep again.
Lack of concentration, inability to make decisions Depressed mothers frequently feel confused. They are unable to concentrate on reading, watching television or even conversation. Making the simplest decisions, like what to wear, seems impossible and she may spend a lot of time making lists in an attempt to get organised.
Rejection of baby/partner Some mothers blame their partner or the baby for the way they are feeling. They may also feel detached from the baby/partner and may feel that everyone would be better off if the baby/partner were to leave her. The lack of feeling towards her baby/partner can cause a mother intense distress.
Inappropriate/obsessional thoughts Some mothers can feel quite convinced that they are going mad. These thoughts can be frightening and the mother may be afraid to tell anyone about them; particularly if they involve harming the baby. She could feel guilty and may worry that her baby will be taken away if she confides these thoughts to anyone. If at all possible, it is best if the mother is not left alone with the baby as these thoughts are always worse if the mother is alone.
Loss of libido Most mothers find that it takes some time for their libido to return after having a baby. For a mother suffering from PND the last thing on her mind is her sex life. Unfortunately, this can place tremendous strain on a relationship. She will feel the need to be loved and wanted, but may be worried about being hurt or becoming pregnant again. She may also feel exhausted, and the need for sleep is of paramount importance. Her partner may be feeling upset and bewildered. He is trying to show that he still loves her and wants her, but is unable to get it right and so the vicious circle of rejection and resentment can start.
Physical symptoms A mother may be experiencing physical symptoms as well as depressive symptoms which will add to her distress. These can include, sleep and appetite disturbances, lethargy, headaches, blurred vision and stomach pains. These can all be signs of tension, the body’s way of saying that something is wrong and that help is needed. However, they can cause considerable anxiety and many mothers become convinced that there is something more seriously wrong.
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