The symptoms of postnatal depression appear any time before and after delivery of your baby. Around 1 in 7 (14%) of women will develop postnatal depression and 10% experience symptoms during the pregnancy (antenatal depression).
Antenatal depression is often overlooked. A pregnant woman that is feeling overwhelmed and anxious for more than two weeks and cannot function in day to day activities may be suffering from antenatal depression. The risk factors for developing antenatal depression are listed below. Approximately half of women with antenatal depression will develop postnatal depression.
- Complicated, unwanted or unplanned pregnancy.
- Discontinuation of medications.
- Family history of depression.
- Lack of support or financial concerns.
- Previous infertility.
- Relationship difficulties.
- Stressful life events.
In post natal depression the symptoms might appear suddenly or take some weeks or months to become evident. Post natal depression is known to occur after miscarriage, stillbirth or delivery. It is most commonplace with the first baby but can occur with any pregnancy.
The risks posed by post natal depression are significant. Partners and family members are asked to monitor the woman for signs of suicidal thoughts, self harm, harm to the baby or substance abuse.
Causes of Postnatal Depression
Postnatal depression doesn't have a sole cause. A number of risk factors combine to cause depression and anxiety. The most common causal factors for post natal depression are having a family and personal history of depression, a stressful pregnancy, severe 'baby blues', a complicated or prolonged delivery and problems with the neonate's condition.
Signs and Symptoms of Postnatal Depression
The signs and symptoms of post natal depression are the same as for general depression. These are listed below.
- Always exhausted or hyperactive.
- Anxiety or panic attacks.
- Confusion and guilt.
- Constantly thinking in a negative way.
- Crying uncontrollably or feeling teary.
- Eating too little or too much.
- Feeling scared and alone, but not wanting company.
- Inability to enjoy life.
- Irritable or sensitive to noise or touch.
- Loss of confidence and low self esteem.
- Loss of interest in sex.
- Poor concentration.
- Poor coping skills.
- Preoccupied with obsessive or morbid thoughts.
- Thoughts of self harm or harm to the baby.
- Unrealistic feelings of inadequacy.
Assessment of Postnatal Depression
Recording a complete physical, social and family history is a good place to start the assessment. The symptoms of post natal depression are examined specifically after the general history and diagnostics are obtained. A self rating scale is used to screen for postnatal depression and measure the severity of the depression.
A common scale is the Edinburgh Post natal Depression Scale (EPDS). A score of 10 or more indicates the woman may be depressed and the woman should be referred to a psychologist or psychiatrist for diagnosis. The EPDS is a useful comparator of the woman's depression over time when administered regularly.
Diagnosis of Postnatal Depression
The actual diagnosis of post natal depression is straightforward. Basic diagnostic tests are used to rule out any possible underlying source of depression. The clinician examines in detail the stressors in the woman's life. The major obstacle is trying to convince women to seek help.
Women with antenatal depression are likely to conceal their symptoms and carry on regardless. There is a misconception that motherhood is easy and a joyful experience. This is the case for some women but other new mothers do not share this experience. The stigma of mental illness adds to the depression.
Complications of Postnatal Depression
Left untreated, post natal depression has a negative impact on the women's relationship with her baby, partner, family and friends. Most women with postnatal depression express that they love their child but a connection between mother and baby has not been established.
Postnatal depression doesn't resolve on it's own. If the depression is not identified, it cannot be treated. The post natal depression will linger and possibly reappear as another form of depression in later life. Most women completely recover from post natal depression without any long term complications.
Treatment of Postnatal Depression
Postnatal depression responds well to a combined treatment strategy consisting of emotional support, psychological support and medications. Antidepressant medication is the mainstay of treatment. Most women will remain on antidepressants for six months to two years. Women with postnatal depression should be informed that antidepressants are not addictive and can be taken safely during breast feeding.
Cognitive behaviour therapy is an effective therapy for relieving depression and anxiety by providing the individual with realistic strategies to manage their illness. This encourages self management of stressful events and depression.
Hospitalisation is indicated when a woman is suicidal, a risk to herself or others or if medical care has not achieved mood stability. Ideally the mother and baby are admitted to a mother-baby unit. A woman in postpartum psychosis is admitted to a mental health facility without her baby until the psychosis has been resolved.