Pregnancy-related depression is not just confined to after the baby's
birth, but can begin during pregnancy, according to the Mother and Baby
Unit at the South London and Maudsley NHS Foundation Trust (SLaM).
A study recently published in the British Journal of Psychiatry found
that women who have suffered a miscarriage or stillbirth are more likely
to suffer from depression during and after subsequent pregnancies.
SLaM's Mother and Baby Unit regularly sees women who have developed
depression during pregnancy or a relapse of a serious mental illness
triggered by becoming pregnancy.
Dr Trudi Seneviratne, consultant psychiatrist in SLaM's Mother and Baby
Unit, said that while depression usually followed the birth of a child,
this was not always the case.
"Postnatal depression is understood to be, as the name suggests,
depression that is triggered by the birth of a child," she said.
"While depression following birth is the most common form of
pregnancy-related depression, it can also begin during pregnancy, or
months after giving birth. Pregnancy can also trigger other mental
health conditions or cause women with a previous history of mental
illness to relapse."
The Mother and Baby Unit at the South London and Maudsley NHS Foundation
Trust (SLaM), treats both expectant and new mothers suffering from
severe depression. Part of SLaM's Perinatal Service, the unit offers
specialised care and treatment for women from across the UK, who develop
a mental illness or have a relapse of serious mental illness during
pregnancy and the postnatal period.
Despite the prevalence and awareness of postnatal depression, the
reality is that women who are actually experiencing it, feel very, very
alone. It is estimated that postnatal depression (PND) affects around
one in 10 mothers in the UK, and also a small number of fathers who are
struggling to cope with a new baby or supporting their partner.
PND usually develops in the first four to six weeks after childbirth,
although in some cases it can develop some months later. It may also
start in pregnancy and continue into the postnatal period. If
untreated, the mother's depression can have significant effects not only
on her own mental health, but on the relationship with the baby, the
baby's development, as well as affecting her partner and wider family.
Dr Seneviratne said it is important to differentiate PND from the 'baby
blues' or postnatal 'blues', which is common , affecting 60-70% of women
and usually occurs in days following birth and usually resolves after a
few days.
"It is very important for new mothers struggling with depression to
understand that having PND does not mean they do not love or care for
their baby," Dr Seneviratne stressed.
"Most women aren't aware when they are experiencing PND, which means it
is extremely important for partners, family and friends, along with
healthcare professionals, to recognise the signs of PND as early as
possible, and recommend treatment. Women often feel guilty about
expressing their feelings as having a new child should be a 'happy'
time," she said.
Most women experiencing PND following the birth of a child are treated
at home through a combination of therapy and medication. Only the most
extreme cases of PND require inpatient hospitalization, and such cases,
a specialist service like the one at SLaM is able to provide more
intensive care.
"PND can be a lonely and scary experience for new mothers, but it is
not a permanent condition. With time and treatment, you will recover,"
Dr Seneviratne said.
There is no single cause for PND, and it can be triggered by a number of
factors such as social factors including relationship worries, money
problems or having limited support from family and friends. Indeed,
having a baby itself is a life-changing event that can be extremely
exhausting and stressful.
"Some women feel unable to look after their baby, or maintain their
relationship with their partner. They may feel anxious about leaving
the house, or that they simply cannot cope," Dr Seneviratne said.
The most common symptoms of postnatal depression include low mood,
overwhelming guilt, feeling unable to cope and difficulty sleeping.
While most mothers will experience some form of exhaustion and possibly
mild depression,-prolonged low moods are an indication of a more serious
problem.
Dr Seneviratne said it was important for new mothers who are struggling
to cope with their new baby, and the changes to their life, to seek help
from their GP.
If a new mother has been feeling down, depressed and hopeless, and is
unable to take interest in normal interests and pleasures, they are most
likely suffering from PND. They may not enjoy their baby and struggle
with maintaining societal cultural pressures such as maintain breast
feeding. A GP should ask questions and look for common symptoms of PND,
then offer the most appropriate form of treatment.
Psychological interventions or therapy are often recommended, although
the most important step is simply recognising the problem and talking it
through with family and friends and helpful professionals. Medication,
such as antidepressants, can be used to treat PND. It is important that
the mother is adequately supported and that any treatment plan is
tailored to her wishes
Dr Seneviratne said in more serious cases, women may experience
frightening thoughts about harming themselves or their baby.
"Thinking about hurting yourself or your new child can be extremely
alarming for new mothers, although it is surprisingly common. Again,
women experiencing these thoughts must talk to their GP who can
recommend treatment," she explained.
Part of SLaM's Perinatal Service, the unit offers specialised care and
treatment for women from across the UK, who develop a mental illness or
have a relapse of serious mental illness during pregnancy and the
postnatal period.
The service helps mothers struggling with depression to develop a
relationship with her child, and reduce the impact of the mother's
illness on the child. Fathers and partners are encouraged to be
involved in the treatment. Babies are accepted on to the ward with
their mothers. Other times it is more appropriate to admit the mother
without their baby and begin a programme of gradual reintroduction of
the baby to the mother while on the ward.
In addition to PND, SLaM's Perinatal Service also treats less common
forms of mental illness among new mothers, such as postnatal psychosis
or pre-existing mental health conditions. Postnatal psychosis is rarer,
and can include symptoms such mood changes (irritability, elation,
depression) delusions (false beliefs), hallucinations and irrational or
suicidal thoughts.
Symptoms of postnatal depression:
The symptoms of postnatal depression usually include one or more of the
following:
- Low mood for long periods of time (a week or more)
- Feeling irritable for a lot of the time
- Tearfulness
- Panic attacks or feeling trapped in your life
- Difficulty concentrating
- Lack of motivation
- Lack of interest in yourself and your new baby
- Feeling lonely
- Felling guilty, rejected or inadequate
- Feeling overwhelmed
- Feeling unable to cope
- Difficulty sleeping and feeling constantly tired
- Physical tension, such as headaches, stomach pains
or blurred vision
- Lack of appetite
- Reduced sex drive
Myths surrounding postnatal depression
PND is commonly misunderstood. Some of the most common myths around the
conditions include:
-- PND is less severe than other types of depression
- in fact PND is just as serious as other depressions.
-- PND is entirely caused by hormonal changes
- there is no one factor, PND it is triggered by a number of
factors.
-- PND will go away by itself - usually, treatment is
needed for PND.
Notes
Dr Dr Trudi Seneviratne is a Consultant Psychiatrist with
SLaM's Perinatal Service, based at the Bethlem Royal Hospital. She is
Lead Consultant for Specialist Perinatal Services and a Lead for
Children's Safeguarding. She heads a multidisciplinary team that
assesses and works with women who suffer from mental illness during
pregnancy and/or after birth, as well as the families who are affected.
SLaM's Perintatal Service specialises in the treatment of
antenatal and postnatal illnesses. Our service is for women who develop
a mental illness or have a relapse of serious mental illness during
pregnancy, and women who have developed postnatal depression, post
partum psychosis or have had a relapse of serious mental illness
following the birth of their baby.
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