who am I? ( i.e. don't believe everything you read on the www without deciding for yourself if the information is reliable!)
what are Perinatal Psychiatric Disorders?
is it my hormones?
treatment
a copy of my information leaflet. Feel free to download and distribute this. (this is zipped in WordPro format and as an ASCII file)
other Perinatal Psychiatry resourcesinformation about:
psychological issues
medication
side-effectscontact PaNDa
What are Perinatal Psychiatric Disorders?
The term 'Perinatal Psychiatric Disorder' is poorly defined! I mean it to refer to a group of psychiatric disorders that can occur from the time of conception until the end of the first year after birth. Even the terminology used during this time can be confusing: such as 'postnatal depression' or 'postpartum depression', which really mean the same thing. Some people make it even more complicated by only 'allowing' the terms to be used for depression that begins within 4 weeks of birth. Others, refer to the postnatal period as lasting for only the first 6 weeks, and many Psychiatrists, Psychologists and Social Workers who work in this area include problems that start within 6 or even 12 months after birth.
What we can say is that for some people, the antenatal and postnatal period is a time of vulnerability to depression rather than as a time of universally good mental health for all women, as used to be believed. A women is 4 times more likely to become depressed at this time than at any other stage in her life. Depression is a real problem for 10-15% of women, that is at least one in ten. This is different from 'the blues' which is a brief period of lowered, irritable and fluctuating mood that occurs about 3-5 days after giving birth, in 20-50% of women. Even this is variable in intensity and duration, but as long as it is transient, we regard it as a normal event and not as an illness.
Depression is different from just 'feeling sad'. When you are feeling sad you can cheer yourself up and it is just a temporary condition. When you are depressed your mood is low and/or irritable and/or anxious, most of the day and on most days for at least a couple of weeks. Anxiety is extremely common: anxiety about something happening to your baby, anxiety about being home alone; anxiety about not knowing what to do or a concern that you may do something wrong and it will harm the baby; anxiety about being cut off from your normal social supports and your place in the community. These anxious thoughts can go around and around in your head and beome particularly bad at night. Sometimes a mother can have 'scary thoughts', that is a fear that she will harm herself or her baby. Whilst these thoughts are probably fairly common, it is rare for a mother to act on these thoughts. It is more common to have thoughts of 'escape' - wishing that you were somewhere else or doing something else.
It is a universal phenomena for parents to become angry at their children at times, but many new parents often worry about this, particularly if they themselves have grown up in a family with angry parents or siblings. They worry that their anger may traumatise their children, or that they may act on their angry feelings and harm their children.
Decision making is often very difficult, and it can be difficult to leave the house. Some women feel very angry or irritable, some women worry obsessionally, clean the house compulsively, and some women say that their head just feels fuzzy and that they can't think straight or can't concentrate.
You can have trouble sleeping, although the extreme exhaustion that accompanies postpartum depression can mean that you wake up exhausted despite maybe getting a reasonable sleep. You can lose your appetite and lose weight, although the postpartum period is a time when weight loss is normal. Of course it is quite normal to lose weight if you are breast-feeding.
There is still ongoing debate about whether Postnatal depression is a different problem from 'ordinary depression' or if it is the same. My own belief is that it is phenomenologically different (i.e. you experience different things), that is, many women consistently report patterns of experience that are rarely found in depression at other times of life. Whether this means that PND as an 'illness' is the same or different from 'ordinary depression' as an 'illness' is less clear though. Sometimes depression of postnatal onset is a harbinger of further depression at other times of life, or is another episode of pre-existing depression or anxiety.
The worst part really is how you feel. Your self esteem can be very low and you can be tortured by intrusive thoughts that you are a bad mother. Remember though, if you really were a bad mother you probably wouldn't worry about being bad! Sometimes things look so bleak that you can wish you were dead, or that the world is so bad that both you and your baby are better off dead. These thoughts are very scary. It is a very terrible experience.
If you experience these thoughts it is imperative that you discuss them with your doctor, your nurse, a psychologist, social worker, family member - anyone. These thoughts are not a normal event and there are people out there who want to help. If the first person that you do approach cannot help you ask them to refer you to someone else who can.
All women with babies and young children can experience extraordinary tiredness, and a level of exhaustion that may never have been experienced before. Sleep deprivation can be a cause of lowered mood in its own right, and can also contribute to 'mental clouding'. It can also exacerbate a co-inciding depression. If sleep deprivation is the sole cause of lowered mood it will usually resolve with 1 or 2 nights good sleep. If your sleep, mood or irritability problems continue or recur, see your doctor
Some forms of Depression are much milder of course and symptoms may vary. If in doubt, ask.
Who is at risk?
women who have been depressed before
Is it my hormones?
Probably not!! Some studies have shown some benefit from Oestrogen hormone treatment in some women but there is no consistent evidence that it works. Maybe it will turn out that there are a small group of women who have a hormonally mediated depression, but at the moment we have no idea which women this may be so it isn't routine treatment as it isn't without some risk. On the other hand there is fairly good evidence that Progesterone, a naturally occurring sex hormone in women but also a component of the Pill, and the only ingredient of the Mini-Pill, can cause depression in a small group of vulnerable women. If you are depressed, and particularly if you have had mood problems with the Pill in the past, perhaps you should consider a different form of contraception.
Treatment
Depression is a problem that DOES need treatment. In many cases this will include medication, however this is only ever a part of successful treatment. Medication alone without counselling will decrease your chance of recovery and increase your likelihood of subsequent relapse. Medication without treatment that specifically addresses your relationship with your baby may also leave you feeling better but your baby still struggling to overcome the effects of your illness. There is clear evidence to show that babies can remain traumaised and distressed even when mothers have resolved their depression, so effective treatment should always involve treating both the mother and her relationship with her baby.
The good news is that there is a very high likelihood of getting completely better. There are medications that are probably safe during pregnancy and also safe with breast feeding, however you must be the one who weighs up the side effects and risks versus the benefits. I recommend that medication continue for 6-12 months AFTER YOU GET COMPLETELY BETTER. This is to minimise the chances of becoming depressed again. Discuss your treatment with your doctor. Bring your partner with you, after all your depression affects him too. (actually up to 5% of partners may actually get depressed as well)
Other important parts of effective treatment include maximising family and community support, and organising assistance with childcare. This in particular is sometimes harder to accept as it can reinforce the feeling of being a failure as a mother. It also awakens feelings of difficulty with separation and can feel like it is the wrong thing to do. It is important to have some time to do things for yourself, and rediscover your sense of self. Consider, it is almost impossible to look after your baby if you are unsure of how to look after yourself. As an older child, your child will learn to value and care for themself by looking to you and your partner as role models.
Many countries have support groups for women with postnatal or antenatal depression and they provide a crucial source of affirmation, support and a source of information.
All parents, not just those who develop depression, find that parenting brings its own psychological challenges. All of us are influenced in this by our own experiences as children - after all, this is the time we looked, experienced and learned what being a parent was all about. Often we come to terms with these experiences as we grow up, and go on to lead normal and happy lives. For some people however, the postpartum period is a time when these issues return and have a major influence on how we care for our children, and the expectations that we set for ourselves as parents. Resolving these issues is difficult enough when you aren't tired and constantly putting the needs of your family ahead of your own!
These issues are difficult to resolve without some form of talking treatment. Professional therapists are not the only people who can help with these issues of course, however they are usually helpful in exploration and resolution of these issues. Talking treatment can take many forms: it can happen in a group or an individual setting; it can be problem and solution focused, concentrate on identifying and challenging abnormal and illogical thoughts; or it can be an exploration that leads to an understanding of the developmental origins of your issues. This latter form of talking treatment is the form of treatment I prefer, but research shows that all of these forms of treatment are successful, you have to find the right approach for you.
Longer term Outcome
The major problem with postpartum illnesses is failure to seek treatment. Studies show that behavioural problems in children are less likely to result from a single episode of depression, than from a recurrence or a long-term untreated or under treated episode. This appears to have a larger effect on the outcome for children than sociodemographic problems such as poverty. Untreated depression and it's effects on relationships has a significant level of relationship break-ups.
Search this site for information on perinatal psychiatry
-can't find it? Look here-
Some more sources of information
you may search for books on perinatal psychiatry at amazon.com by using this link...
in Melbourne Australia (where I live)
PaNDa (Post and Antenatal Depression Association) This is a self help group established by women who have all experienced Perinatal Psychiatric illness themselves. It provides an invaluable resource for information, education nights, and 24 hour telephone support. If you live in the state of Victoria please contact PaNDa on:
Phone: 03 9428 4600 Fax: 03 9428 240 ,Email: panda@vicnet.net.au for support. As this is a volunteer organisation it is not staffed all the time so you may be greeted by an answering machine. Do not be discouraged, leave a message and they will return your call.Please look at the PaNDa web site for further information
your General Practitioner or family doctor
your Maternal & Child Health Nurse
your local Mental Health Clinic (see the White Pages)
The bad news
Like most public psychiatry services, those here in Victoria are now blindly following the mantra of 'we're here to treat serious mental illness'. You and I and every other citizen on the planet would recognise Postpartum illness as 'serious mental illness' but this label is really a cover for rationalising and restricting access to public mental health clinics to essentially ONLY those with Schizophrenia and severe mood disorders.If you also think that this is outrageous, please complain.
| 1.1 | The Mercy Hospital for Women This Mother Baby Unit is located in Werribee |
9270 2222 |
| 2.1 | Monash Medical Centre This Mother Baby Unit has had an 8 bed inpatient unit |
9550 1111 |
| 3.1. | Albert Road Clinic, South Melbourne (private hospital) I work
here! This is an inpatient unit with 8 beds for mothers and babies/toddlers up to the age of 2. The programme also offers a day programme, home visiting support, and runs Monday - Thursday. |
9256 8311 |
| 5.1 | Masada Hospital, StKilda East(private hospital) This unit offers a 5 day inpatient programme that focuses on settling and feeding difficulties. |
9527 5145 |
| 6.1 | Mitcham Private Hospital (private
hospital) Rosebud
Hospital |
Have you seen my page on medications during pregnancy and lactation?
Have you seen Dr Valerie Raskin's page on side effects of medication?
If you want more information, or if you have experienced an episode of antenatal or postpartum depression or psychosis and you feel comfortable about sharing your experience on this web site, please email me.
Last modified November 2003
