Family doctor

Overview:

• Postnatal depression affects about 10 percent of new mothers
• It usually begins between one month and three months after giving birth
• There is no evidence postnatal depression is related to hormonal changes
• The mother's own psychological and social condition are believed to be related
• Risk factors include a history of depression, lack of support and birth complications
• Symptoms are similar for depression but also involve anxiety about the baby
• Postnatal depression has been linked to developmental problems in children
• The first line of treatment is counselling and support. Antidepressants may also be very useful

What is it?

Post-natal depression is a mental illness which affects about 10 percent of women who have just had a baby.

Postnatal mental disorders are split into three categories. Baby blues a few days after delivery, post natal depression which can continue for months, and postnatal psychosis.

The baby blues or postpartum blues start in the first week after childbirth and usually mothers just have a couple of tearful days feeling down. This is fairly common with some studies showing rates of up to 50 percent.

Postnatal depression develops between one and three months after giving birth. The symptoms are similar to depression but with the addition of worry about the baby, and guilt about lack of love for it.

Postnatal psychosis is a serious mental illness with symptoms of mania, hallucinations, delusions and rapid mood swings. In rare cases the mother may harm her baby.

Postnatal depression has been linked to developmental problems with the child. It has been shown to impair the child's mental and emotional development. One study has found the children of mothers with postnatal depression had more difficulty performing mental tasks than others, with boys at most risk. They were also more likely to be considered behaviourally disturbed by their teachers.

Children of mothers with postnatal depression may also have poor emotional adjustment, probably due to problems with mother-infant bonding.

There is no evidence that the condition is caused by hormonal changes. Hormone levels stabilise in most women two weeks after birth. It has been suggested that thyroid problems could be responsible in some groups of women, but this may also be a symptom of stress.

It is believed that social factors and the mother's mental condition before the baby is born are more likely to impact on the development of postnatal depression.

Risk factors for postnatal depression include baby blues immediately following delivery, a history of depression, a previous stillbirth or abortion, unplanned pregnancy, complications during birth, lack of family support, marital problems, and unemployment.

Some experts believe that postnatal depression is more likely if there are problems in the mother's relationship with her own mother. She may feel dissatisfied with the care she herself received as a child, and becoming a mother may bring back these feelings leading her to resent her partner and baby.

What are the symptoms?

The symptoms for postnatal depression are similar to depression, but also include anxiety about the baby and mothering skills.

The following symptoms could indicate postnatal depression:

• being over anxious
• easily upset, tearfulness
• poor appetite
• being tired but unable to sleep
• worry about the baby's health
• guilty about inadequate mothering or lack of love for the baby
• problems coping with the baby and domestic routines
• loss of interest in sex
• fear of harming the baby
• thoughts of harming yourself

Postnatal depression usually lasts up to six months, but some symptoms may remain a year after the baby was born.

Some women may not feel depressed but suffer from an anxiety disorder or panic disorder instead. They may have symptoms of intense anxiety, rapid breathing and heart rate, shaking and dizziness.

Some women also suffer from obsessive compulsive disorder following birth. Symptoms include repetitive thoughts (possibly about harming the baby), avoiding the baby, and anxiety.

What can be done to help?

Do not delay seeking professional help.

Treatment may involve a combination of drug treatment and psychotherapy. Often simple measures like more rest and time out will be very beneficial.

The initial treatment is counselling and is best carried out by health professionals visiting the mother at home.

A study of women who received nine visits over 13 weeks found an improvement in their mood compared to those who had the standard primary care.

Home visits by trained counsellors has also been shown to improve bonding between mother and baby. Early intervention is believed to be the best way to stop developmental problems in the infant.

Drug treatment can involve hormone therapy. There is debate over the effectiveness of progesterone but oestrogen has shown an improvement in some women with severe depression. One antidepressant, fluoxetine (Prozac) has been proven to help lift depression among new mothers, in combination with counselling.

Postnatal depression may be missed by health professionals. Don't be afraid to ask for help if you think you are suffering from depression.

Joining a support group for women suffering from postnatal depression may also be helpful.

Medical assistance is essential for women suffering from postnatal psychosis.

Future trends

Researchers are looking to develop prevention strategies to help stop new mothers becoming depressed.

Getting help

Your doctor, Plunket nurse, Family Planning Clinic, or local mental health team will be able to help.