POST NATAL DEPRESSION

WHAT IS PND?

Postnatal depression (PND) is a serious mental health problem that affects up to 10% of women. It is estimated that majority of women will experience some from of emotional breakdown following the birth of a child. This is due to the intense stress of labour and the sudden huge responsibility of caring for a newborn. This phenomenon is termed the BABY BLUES and it is temporary and self limiting. Another entity in the spectrum of post-partum mental disorders is POSTPARTUM PSYCHOSIS. This is characterized by irrational behaviour, bewilderment and perplexity, and sometimes sensory hallucinations.

We will concentrate on PND in this discussion, being the most important and potentially life-threatening, if not recognised and managed promptly.

What causes PND?

There is no single direct cause of this disorder but there are several risk factors that may predispose a woman to having it. These factors include:
*Past history of PND
*Family history of PND (in immediate female family members)
*History of depression
*History of other mental health issues
*Lack of support during pregnancy, labour and delivery
*Traumatic labour and delivery
*Bereavement, including death of the baby
*Domestic abuse
*Unwanted pregnancy or pregnancy resulting from sexual assault
*Alcohol and drug abuse
*Social deprivation, unemployment, or being in a minority social group
*Use of certain medicines, such as methyldopa

How can PND be recognised?

The core symptoms of depression are low mood, low energy and feeling of hopelessness and worthlessness. In PND, the problem revolves around the newborn child as well. Therefore, the woman feels incapable of caring for the baby and, in severe cases, she may feel the need to harm the baby.
If you think that the initial “baby blues” is getting a bit worrisome or prolonged, you should seek help by contacting your doctor or midwife. He/she will ask you a few questions about your mood and general mental status…

*During the past month, have you often been bothered by feeling generally sad, worthless or hopeless?

*During the past month, have you often been bothered by having little interest or

pleasure in doing things?

You may also be asked about features of anxiety using a specialised scale…

*Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious or

on edge?

*Over the last 2 weeks, how often have you been bothered by not being able to stop or

control worrying?

After gathering these information from you, they will decide whether to refer you to a mental health specialist or offer you other form of help.

What are the other symptoms of PND?

trouble sleeping at night and feeling sleepy during the day

feeling that you’re unable to look after your baby

problems concentrating and making decisions

loss of appetite or an increased appetite (binge eating)

feeling agitated, irritable or very apathetic (you “can’t be bothered”)

feelings of guilt, hopelessness and self-blame

difficulty bonding with your baby with a feeling of indifference and no sense of enjoyment in their company

frightening thoughts – for example, about hurting your baby; these can be scary, but they’re very rarely acted upon

thinking about suicide and self-harm

Do men have PND?

Yes, some husbands also suffer from PND, mostly “sympathetically”, but it can also occur without the wife having PND. This is usually due to the inability to cope with the challenges of taking on the role as a new father. That is why the partner and other close relatives must be involved in the care of women with postpartum mental illnesses.

How can PND be managed?

There are three main modalities in the management of PND. All 3 can be used together, or stepwise, depending on the severity…

1. SELF HELP – All women should learn various coping strategies during pregnancy, labour and postpartum. Measures should be put in place even before getting pregnant. Partners should be actively involved in the antenatal and postnatal care. Preexisting mental health issues should be managed before the baby comes into the picture. Women should have access to books, classes and online resources on how to cope with the stress of motherhood. Do not be afraid to seek help from family, friends, neighbours and even colleagues. Take as much time off work as you possibly can. Basic lifestyle modifications should be made to optimize the general wellbeing – such as regular exercise, healthy diet and alcohol/smoking cessation. Social and religious groups and clubs that improve moral support should be also be availed. Above all, pray, pray and pray.

2. PSYCHOTHERAPY – A referral to a mental health team may be warranted. They will offer you support in form of cognitive and behavioral therapy and teach you more effective coping skills. With strict adherence and additional socio-emotional support, you should be fine.

3. MEDICATIONS – Severe and persistent cases may require the use of certain medicines, and even hospital admission for your safety and that of the child. These medications may need to be taken for a long period of time and compliance is highly crucial. Of course, these medications are known to have side effects. Feel free to ask your doctor and express your concerns, as modifications can be made in order to minimise these side effects.

In addition, women suffering from PND need lots of time to recover before trying for another baby. Effective contraception should be commenced no later than 6weeks postpartum.

In summary, PND is a serious but manageable mental health problem. Untreated cases can jeopardise the life of the mother and baby, therefore early detection and prompt treatment is the best way to tackle the problem. We all have a role as individuals and society, to identify women at risk and give them all the support they need.

©KT

References: NHS guidance (UK)

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