POSTNATAL DEPRESSION
Society and the media play a role in depicting motherhood or parenthood as joyous, intuitive and rewarding - and of course it is. However, there are some aspects of parenthood that are glamourised - and the reality can often confronts us. It is important to remember that it is normal to experience ups and downs as you navigate the challenges, triumphs and learnings of life and of parenthood. It is when these feelings are impacting on your daily functioning or concerning you that it is important to seek help. The following symptoms are common in postnatal depression:
- Panic attacks (a racing heart, palpitations, shortness of breath, shaking or feeling physically ‘detached’ from your surroundings)
- Persistent, generalised worry
- The development of obsessive or compulsive behaviours
- Abrupt mood swings
- Feeling constantly sad, low, or crying for no obvious reason
- Being nervous, ‘on edge’, or panicky
- Feeling constantly tired and lacking energy
- Having little or no interest in all the normal things that bring joy (like time with friends, exercise, eating, or sharing partner time)
- Sleeping too much or not sleeping very well at all
- Sleep problems unrelated to the baby’s needs
- Losing interest in sex or intimacy
- Withdrawing from friends and family
- Being easily annoyed or irritated
- Extreme lethargy: a feeling of being physically or emotionally overwhelmed and unable to cope with the demands of chores and looking after baby
- Fear of being alone with baby
- Intrusive thoughts of harm to yourself or baby
- Finding it difficult to focus, concentrate or remember (people with depression often describe this as a ‘brain fog’)
- Engaging in more risk taking behaviour (e.g., alcohol or drug use)
- Having thoughts of death or suicide
THE EDINBURGH POSTNATAL DEPRESSION SCALE
The Edinburgh Postnatal Depression Scale is a screening tool used by GPs and other professionals to assist in the diagnosis of postnatal depression.
You may have completed a similar questionnaire in the past or even during your pregnancy.
It is advised that you complete this questionnaire in the presence and with the support of a healthcare professional however it can be completed by visiting Beyond Blue's website.
It may be helpful to discuss your answers to the questionnaire with family as a starting point. Sometimes handing them the piece of paper that says "this is my score on a screening tool for postnatal depression" can assist in opening the conversation if you feel uneasy about broaching the subject. Team this document with the Letter To My GP for further clarity. Don't be discouraged if your family do not respond in the way that you expected. It can be difficult to hear that someone you care about is struggling. They may feel confused, helpless or upset. Give them time and some links from this website so that they can personally access some support.
Scoring 10 or above is usually indicative of a depressive illness. However, if you know in your heart that you're not your usual self, you're unhappy or having symptoms however do not score high on the scale, do not let this discourage you from seeking assistance. You matter and deserve support.
You may have completed a similar questionnaire in the past or even during your pregnancy.
It is advised that you complete this questionnaire in the presence and with the support of a healthcare professional however it can be completed by visiting Beyond Blue's website.
It may be helpful to discuss your answers to the questionnaire with family as a starting point. Sometimes handing them the piece of paper that says "this is my score on a screening tool for postnatal depression" can assist in opening the conversation if you feel uneasy about broaching the subject. Team this document with the Letter To My GP for further clarity. Don't be discouraged if your family do not respond in the way that you expected. It can be difficult to hear that someone you care about is struggling. They may feel confused, helpless or upset. Give them time and some links from this website so that they can personally access some support.
Scoring 10 or above is usually indicative of a depressive illness. However, if you know in your heart that you're not your usual self, you're unhappy or having symptoms however do not score high on the scale, do not let this discourage you from seeking assistance. You matter and deserve support.
FOR YOUR GP
Making an appointment to see your GP is usually the first port of call and a brave step in your recovery. Saying "I need help" takes courage. It may be helpful to have a support person tag along to your appointment so that they can offer additional information and what they've noticed. This person can then also support you with treatment options.
WHAT TO EXPECT
Each GP is different in their approach - but you can often expect a lot of questions about symptoms (onset, duration and severity) and safety (thoughts of harm to self or baby or suicide). It is important to be honest - it's a common misconception that a mother's baby will be taken away if she is diagnosed with postnatal depression. Instead, all professionals involved will support you to recover.
You can expect to complete the Edinburgh Postnatal Depression Scale - either by hand or on the GPs computer. He or she may then refer you for counselling or another appropriate service or prescribe medication. It is important that you ask as many questions as you feel necessary. Getting a diagnosis of postnatal depression may prompt a number of different feelings - shock, relief, disappointment. Notice these feelings without judgment - and bring them up with your healthcare professional or support person.
Sometimes, you may find it necessary to 'lead' the treatment process by suggesting what kind of treatment you are most comfortable with/interested in. It may be beneficial to research local services in your area or treatment options.
The following document has been created to ensure important information is shared freely and in detail. It is also useful to have this information in writing to add to your file or reflect back on later as your treatment and recovery progresses. Before you attend your initial GP appointment, you may find it useful to download the following document, complete as best you can and take this with you to your appointment. Alternatively, fill it out with the support of a loved one or take a blank version to your midwife or GP and complete in their presence.
You can expect to complete the Edinburgh Postnatal Depression Scale - either by hand or on the GPs computer. He or she may then refer you for counselling or another appropriate service or prescribe medication. It is important that you ask as many questions as you feel necessary. Getting a diagnosis of postnatal depression may prompt a number of different feelings - shock, relief, disappointment. Notice these feelings without judgment - and bring them up with your healthcare professional or support person.
Sometimes, you may find it necessary to 'lead' the treatment process by suggesting what kind of treatment you are most comfortable with/interested in. It may be beneficial to research local services in your area or treatment options.
The following document has been created to ensure important information is shared freely and in detail. It is also useful to have this information in writing to add to your file or reflect back on later as your treatment and recovery progresses. Before you attend your initial GP appointment, you may find it useful to download the following document, complete as best you can and take this with you to your appointment. Alternatively, fill it out with the support of a loved one or take a blank version to your midwife or GP and complete in their presence.
CLICK HERE TO DOWNLOAD THE GP APPOINTMENT TOOL
Please note that this is an interactive document which can be completed on your computer and then saved or printed. Alternatively, you can save or print a blank version for a loved one or future reference.
TREATMENT
There is no 'one size fits all' approach to treating postnatal depression - what works for you, may not work for others and vice versa. We are all different, and as such, the treatment that we choose to engage in must reflect our personal needs, values and symptoms. Some of the following treatment options may not be available in your area - if possible, do not shy away from travelling to receive a specialised service such as staying in a Mother and Baby Unit (MBU) as required.
PSYCHOLOGICAL TREATMENT
Depending on the services in your area and your treatment needs, you may be referred to a counsellor or psychologist. Sometimes this can be as simple as attending a few sessions to debrief about your birth; learn new skills in coping with some of your thoughts, feelings or symptoms; and coming up with a plan for your wellbeing in the future. A referral to such a professional is often accompanied by a Mental Health Care Plan which entitles you to 6 free sessions with a psychologist or other mental health professional. When you use these sessions, a decision will be made as to whether you require further treatment. In this instance, another 4 sessions may be offered to you - but this is on a needs basis.
Of course, you can seek professional support in a private setting at your own cost.
Another option is seeking a long-term counsellor or mental health professional to work therapeutically to establish new patterns of thoughts and behaviour and a continual solution to a more severe or persistent case of postnatal depression. You can do this by asking for a referral to your local mental health services - often located at your local hospital. This service is usually free and your friendly appointed mental health professional can assist in other appropriate referrals or organise a hospital admission as required.
Of course, you can seek professional support in a private setting at your own cost.
Another option is seeking a long-term counsellor or mental health professional to work therapeutically to establish new patterns of thoughts and behaviour and a continual solution to a more severe or persistent case of postnatal depression. You can do this by asking for a referral to your local mental health services - often located at your local hospital. This service is usually free and your friendly appointed mental health professional can assist in other appropriate referrals or organise a hospital admission as required.
MEDICATION
Deciding to take medication for treatment can be difficult for some mothers. An assumption is often made that mothers cannot breastfeed whilst taking an antidepressant and this causes them to wean prematurely or not attempt to breastfeed. It can be useful to speak with your GP about a referral to a psychiatrist as they are specialists in medication and will be able to answer any questions you may have. Another option is to speak with your pharmacist.
LactMed is an excellent source of information on maternal and infant drug levels and how drugs or dietary supplements can affect breastfeeding. They also have an app which can be downloaded for free here.
The Monash Drug Information Line is also excellent and can be reached by phoning (03) 9594 2361.
LactMed is an excellent source of information on maternal and infant drug levels and how drugs or dietary supplements can affect breastfeeding. They also have an app which can be downloaded for free here.
The Monash Drug Information Line is also excellent and can be reached by phoning (03) 9594 2361.
MOTHER AND BABY UNITS (MBU)
In most capital cities and larger hospitals, there is usually a Mother and Baby Unit (MBU). This is a hospital setting, either public or private, which is designed to offer intensive support from a range of specialists in postnatal depression such as psychiatrists, psychologists, nurses, child health nurses, mental health professionals, GPs and counsellors. The importance of the bond that a mother and baby share is valued within this setting and your baby will stay with you in the unit. If you are struggling to establish a connection with your baby (which is nothing to feel guilty about - it is a whole new relationship!), there may be someone there to assist by facilitating some sessions and activities between yourself and your baby.
If you are taking or considering medication, the benefit of the MBU is that psychiatrists (specialists in medication for mental health) will be able to monitor dosage, drug types, any withdrawal or establishment symptoms you may experience. They will also be able to offer answers to any questions you may have that the GP wasn't able to answer.
At the MBU, you will be required to care for your baby however you will be offered assistance if you are struggling.
If you are taking or considering medication, the benefit of the MBU is that psychiatrists (specialists in medication for mental health) will be able to monitor dosage, drug types, any withdrawal or establishment symptoms you may experience. They will also be able to offer answers to any questions you may have that the GP wasn't able to answer.
At the MBU, you will be required to care for your baby however you will be offered assistance if you are struggling.
LINKS
Clicking the images below will take you to the corresponding service information.
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FOR LOVED ONES
If someone you care about is struggling with postnatal depression, it is so great that you are here - reading this - and doing all that you can to support them. It is important that you seek support also - either from the same GP, your own GP, involved healthcare professionals or supportive organisations such as PANDA.
Sometimes it is difficult for the person to put into words how they are feeling. This isn't what they expected parenthood would be. They may feel guilt, resentment or despair - none of which are pleasant feelings - and it's especially exhausting to keep up appearances in a society that expects women to wear many hats - mother, father, parent, partner, lover, housekeeper, employee, employer, human being. This practical list has been compiled from experience and is designed to inform you in detail about how you can help the person you care about.
On another level, spending time with the person - listening with compassion and respect - can be very beneficial as parenthood can be isolating. Sometimes, an assumption can be made that the person is either too busy or overwhelmed by visitors that they would not like you to make contact - but if enough people think this, no one visits, and the person is left overwhelmed by the lack of support that is shown. The best thing that you can do is be consistent in offering your support but let the person know that you will only do this if the person is comfortable.
People often think that keeping the baby occupied while the person gets things done is the most helpful thing to offer – and sometimes it is. But it is very important for the person to bond with their baby and postnatal depression can make this difficult.
It is assumed that because you are reading this, you want to help – but don’t know how. Therefore, this list isn’t intended to offend or by no means should you feel obligated to support in this way – however, it can be difficult for people to ask for help at the best of times. Here are some ideas – if you’re comfortable and willing:
Sometimes it is difficult for the person to put into words how they are feeling. This isn't what they expected parenthood would be. They may feel guilt, resentment or despair - none of which are pleasant feelings - and it's especially exhausting to keep up appearances in a society that expects women to wear many hats - mother, father, parent, partner, lover, housekeeper, employee, employer, human being. This practical list has been compiled from experience and is designed to inform you in detail about how you can help the person you care about.
On another level, spending time with the person - listening with compassion and respect - can be very beneficial as parenthood can be isolating. Sometimes, an assumption can be made that the person is either too busy or overwhelmed by visitors that they would not like you to make contact - but if enough people think this, no one visits, and the person is left overwhelmed by the lack of support that is shown. The best thing that you can do is be consistent in offering your support but let the person know that you will only do this if the person is comfortable.
People often think that keeping the baby occupied while the person gets things done is the most helpful thing to offer – and sometimes it is. But it is very important for the person to bond with their baby and postnatal depression can make this difficult.
It is assumed that because you are reading this, you want to help – but don’t know how. Therefore, this list isn’t intended to offend or by no means should you feel obligated to support in this way – however, it can be difficult for people to ask for help at the best of times. Here are some ideas – if you’re comfortable and willing:
HOW YOU CAN HELP
HOUSE
- Bring meals that are easily reheated or frozen (curries, pasta sauces, soups etc)
- Cook our dinner while I nap or spend time with my baby
- Dishes, tidying, cleaning the bathroom, vacuuming, changing the sheets
- Walking the dog (encourage me to come with you – exercise is important for my recovery – but if I don’t feel up to it, that’s okay – we’ll try again another day)
- Clothes washing – brownie points if you take the washing to your place and return it clean, dry and folded so that we can spend time together during our visit
- Take my car for a drive to refuel – if I need to sleep, feel free to take my baby and use a pay at the pump fuel station
- Pick up groceries, nappies and toiletries
TIP: I may say “no” when asked if there’s anything you can do to help. The right question is: “I am going to do the dishes. Are you okay with that?”
BABY
- Bathe my baby while I watch on – sometimes it’s too exhausting to wash myself!
- Bring or use my own homemade/prepackaged baby food and feed baby while I watch on and laugh with a cuppa
- Wash and sterilise my breast pump or bottles – this can be a fiddly and tedious task but it needs to be done!
FAMILY
- Organise with me for family to visit when you’re free so you can play hostess
- Inform others (where appropriate and ONLY when discussed with me prior) that I’m a bit under the weather as it can be exhausting repeating my story
- Call support lines like PANDA to get advice on how to help me best but also for support for you
- Research postnatal depression to gain a better understanding of what I’m going through
- Attend appointments with me and make phone calls on my behalf where appropriate and possible
- Attend a Mental Health First Aid course