Dealing with feeling depressed or anxious during the post-natal period

New mothers and fathers naturally expect the time around childbirth to be a very happy time. However, it is a time of great change in our lives, and there can be a range of emotions from happiness and excitement to sadness and worry. You have probably heard of, or experienced, the “baby blues”, which women commonly experience a few days after the birth, often related to tiredness and hormonal change. The blues may trigger tearfulness and irritability, and they settle within a couple of weeks.

However, significant anxiety and depression can also develop after birth. Post-natal depression (PND) and anxiety occurs in up to 10–20% of all women during the first year after childbirth, and remember too that about 10% of men also experience PND. PND describes the more severe or prolonged symptoms of depression that last more than a couple of weeks and interfere with the ability to do daily tasks, or to relate to the baby or others. It often goes hand in hand with anxiety.

Causes:

PND develops because of biological, psychological and social factors. It is important to rule out medical causes of symptoms similar to PND, such as low thyroid hormone or anemia. Biological factors might also include a genetic vulnerability to depression (is there a family history?), previous episodes of depression, and hormone fluctuations during and after pregnancy.

Childbirth and becoming a parent involves change and stress, probably the most significant you may ever experience. Plus sometimes there can be other stresses such as financial stress, relationship stress or even grief around the same time. There may be lack of support. Fatigue is a very important factor, and being sleep-deprived makes us more vulnerable to depression, as do difficulties with breastfeeding or having an unwell baby.

Watch out for symptoms occurring most of the time and nearly every day for at least two weeks:

1. Sadness, depressed mood, tearfulness or irritability.
2. Loss of interest in daily activities, or enjoyment in activities usually enjoyed.
3. Loss of confidence; feelings of guilt or worthlessness.
4. Fatigue, reduced energy (beyond what typically occurs when caring for a baby), low motivation.
5. Broken sleep (irrespective of the baby).
6. Change in appetite, weight loss or gain.
7. Inability to concentrate or remember things.
8. A sense of hopelessness, guilt or shame.
9. Thoughts of self-harm, not wanting to be alive or suicide (seek help immediately).

If you have either of the first two symptoms, plus a few of the others, then you may be suffering with PND. Also notice symptoms of anxiety, such as worrying excessively about the baby, your health or feeling panicky. Anxiety can also cause physical symptoms such as a racing heart, breathlessness, nausea or feeling shaky. It can disturb sleep or cause a sense of dread.

Getting some help:

If you are concerned, then in the first instance see your GP or health professional (community nurse, psychologist). They can talk with you and assess whether depression or anxiety are present as well as offering support and advice. There are a range of treatment options, depending on the severity of the depression or anxiety, and the person’s preferences. These include:

• Support and counselling.
• Lifestyle changes, such as getting more sleep, doing relaxing activities, eating well, getting out for walks.
• Support in adapting to change and dealing with the sense of stress and loss and grief it can bring.
• Cognitive-behavioural therapy or CBT (learning to be aware of thoughts and underlying beliefs that might trigger low mood, such as high expectations of yourself, wanting to be 100% perfect or in control – not possible with a baby).
• Inter-personal therapy (IPT) and couple therapy, focussing on resolving issues such as conflict or self-focussed behaviours which might be contributing. Attachment-based therapy can assist with relating to the baby.
• Practising meditation or mindfulness i.e. being in the moment, which is relaxing and can help you enjoy your baby. There are now mindfulness-based therapies which can assist.
• Complementary therapies.
• Medication, such as antidepressants which can relieve depression and anxiety.

How to support mothers and fathers:

There are a number of ways you can support mothers and fathers affected by PND and anxiety. Here are some ideas:

• Acknowledge there has been significant change in life, with the stress and maybe sense of loss that goes with change.
• Get some sleep. This is most important e.g. sleep when the baby sleeps.
• Be practical and accept reasonable help, if you have a partner, then share household chores as much as possible, even if one person is working; or accept help from family or friends.
• Share taking care of the baby so each of you can have some time out for yourselves, even if it’s only 15 minutes whilst having a shower or going for a walk. Time out is vital. Maybe you can involve other family members in caring for the baby to facilitate this too.
• Encourage the person to seek professional help. It may also help to make the initial phone call for them or go with them to the appointment.
• Ask a child health nurse or lactation consultant about ways you can help with night-time feeds so the mother can get as much sleep as possible.
• Encourage both parents to be involved with the baby, and for each to have space to do this. Allow fathers to explore fatherhood without being watched over all of the time to allow his confidence to grow.
• If you have a partner, remember that just because each of you does things a bit differently, that doesn’t mean the other is wrong.
• Be aware that fathers might become frustrated or anxious when they can’t “fix” the problem. This can be their nature.
• Talk about how you are feeling to your partner, family, friends or health professional.
• Take time out as couple if there is a partner.
• If you have a partner, go to appointments together at times. This will involve both of you as a couple and with the child and give each of you the opportunity to talk to a health professional.

Other tips in relation to PND:

1. Focus on eating well, getting as much sleep as you can, and going for a walk regularly.
2. Use relaxation techniques, meditation, mindfulness or self-hypnosis.
3. Remember that it takes time to bond with the baby, to breast-feed, to learn the role of being a mum or dad, and so lessen the expectations on yourself.
4. Let go of any tasks that you can, as well as the need to be in control all of the time!
5. Quit self-criticism and be kind to yourself (see the e-book on self-compassion).
6. Seek out support from others (partners, family, friends, other mums or dads) e.g. new parents’ groups.
7. Seek out professional assistance if you are concerned. Therapy or medication may be helpful or needed.

Overall, remember that we need to be a good-enough parent and not a perfect parent (see blog on perfectionism), and to value your own health and wellbeing and your role as a parent – it’s a tough job, but a rewarding one! Seek out other mums or dads through community groups, and also develop a good relationship with your GP and see a counsellor early on if you need support.

You can also call Beyondblue on 1300224636, or your local community or emergency mental health service (in SA 131465) for assistance. The following websites may also be helpful.

• beyondblue.org.au
• blackdoginstitute.org.au
• http://www.panda.org.au
• http://www.betterhealth.vic.gov.au