15 Nov Postpartum Depression: Perinatal Mood Disorder

By Anchen Verster – registered nurse and midwife, SA certified perinatal educator, Mother of 4 including twins

Christina had been waiting 4 years for her precious baby. She miscarried two pregnancies and eventually gave birth to a beautiful boy. During the pregnancy she was continually worried that she would lose this baby because of her previous losses. She did everything she could to stay healthy. She rested regularly, did moderate exercise throughout the pregnancy and ate extremely balanced, regular meals. The birth did not go exactly according to plan but she still felt it was a positive experience. She visited a lactation consultant before the birth to plan the breastfeeding and so her start at breastfeeding went much better than her roommate in the hospital. On day 3 she went home and her mother came to stay to help her because her husband was returning to work.

The first night at home felt like a nightmare. Her milk started coming in, the baby would not settle and wanted to drink every two hours and her emotions hit a low. The next day was hard but the day after felt better. By the end of the first week her baby was gaining weight and feeding 9 times in 24 hours. Things were going very well.

By week 3 the progress in feeding and weight gain was still good but Christina was finding it difficult to get up to do feeds – every time she heard her baby waking to drink, she felt like she was carrying a bag of bricks on her back and her heart would start beating faster. The next feeding, burping, nappy changing drill felt like a mountain she could not climb. Her husband would come home by 6pm in the evening and ask her what she had eaten during the day. Apart from two rusks she had not felt like breakfast or lunch. He was worried. He phoned Christina’s mom and asked her to come and stay for a few days again. When Christina’s mom arrived Christina handed the baby to her mom and climbed into bed. Her mom would bring him to her for feeds and then take him to change and wind. All Christina felt like doing was sleeping. If someone had asked her she would have told them that she didn’t want to be left alone with her baby – she had strange thoughts of harming her baby. The thoughts popped into her head and terrified her.

Her husband and mom thought a few days of extra help and extra sleep would do the trick but it made little difference. He decided to phone their gynaecologist who referred Christina to a psychiatrist. The psychiatrist gave her an emergency appointment the next day. He asked her lots of questions and prescribed an anti-depressant for her. Within 48 hours she started to feel a strong longing to care for her baby and hold him for longer periods. By the end of the second week on treatment she was a different person. Her mom went home and she continued to manage on her own.

Perinatal Mood Disorder (PMD) is the term that refers to a group of diagnoses during pregnancy and the postnatal period. PMD includes Anxiety, Depression, Obsessive Compulsive Disorder and Bipolar Mood Disorder. Some include Post Traumatic Stress Disorder here too.

Perinatal Depression fits into this group and can present during pregnancy and up to 1 year after the birth. For the sake of this article we will talk about Postpartum Depression all though it can present during pregnancy too.

Symptoms of Postpartum Depression include:

• Loss of interest in life
• Feeling like you cannot care for your baby
• Feelings of anger, sadness, hopelessness, guilt or irritability
• Not enjoying the activities you used to enjoy
• Unable to sleep or sleeping too much
• Loss of appetite or excessive appetite
• Thoughts of harming your baby
• Thoughts of harming yourself or suicidal thoughts

You may have all or some of these symptoms. This is different from “Baby Blues” which affects 80% of new mothers in the first week after birth and can continue into the second. Baby Blues often hits on day 3 or 4 and is characterized by feeling intensely emotional, vulnerable, tearful and overwhelmed. Usually within a day or two the feelings subside.

Perinatal depression can start during pregnancy or after the birth – even a few months after the birth. It is also often characterized by periods of anxiety.

How will I know the diagnosis is correct and it is not a normal reaction to having a baby?

It is important that the correct diagnosis is made and should be assessed by a qualified health professional such as your Obstetrician. When a postnatal mother or her family seeks help for postnatal depression it is a good indicator to the clinician to do a thorough assessment. Usually the family will try other helps first like extra sleep for the mother or extra help and when they see that does not help they seek help from their clinician. Then the clinician will use an assessment tool to assess the presence or severity.

There are assessment tools such as the “Edinburgh Postnatal Depression Score” or “Patient Health Questionnaire” (PHQ-9) or the “Generalized Anxiety Disorder Assessment” (GAD-7). These are also available on the World Wide Web in online forms if you wish to complete one before seeing your clinician.

Risk factors for Perinatal Depression include:

• Lots of childcare stress
• Lack of support from family or perceived lack of support
• Previous depression or family history of depression or other mental illness
• Stressful life events
• Anxiety or depression during pregnancy
• Poor relationship with partner or close family

Why is treatment important?

Perinatal depression can have a severe impact on relationship – particularly the relationship with your partner and new baby. The months after the birth of your baby are characterized by plenty breastfeeding and caring for your baby. Meeting these needs and interacting socially and emotionally with your baby are the building blocks of bonding with her and her forming an attachment with you. This relationship then forms the foundation for other relationships to come so it is imperative that this relationship forming is not disturbed.

Mothers who have postnatal depression will struggle to meet the needs of their baby and may not be able to care for themselves either. This period of depression and/or anxiety – if the mother does not receive treatment – may have a significant impact on the bonding relationship. There are a few antidepressant medication options that are safe to use during breastfeeding. Some may decrease milk supply while others may have the opposite effect. If postnatal depression is untreated it may lead to postpartum psychosis, which is dangerous to the mother and baby and usually means a period of separation from each other until the mother is well again. This of course will also have an impact on the breastfeeding relationships as well as the bonding. This happens to 1-2 mothers per 1 000 births.

Apart from medication, what else can help?

In many illness circumstances we can often rely on alternative remedies and other tools to alleviate symptoms, but with postpartum depression most clinicians would prefer to treat with an antidepressant because the progression of the illness can have a devastating effect on the mothers relationship with her baby and her immediate support network. However, we all know that there are good habits and tools that help us cope better in life. Some that may contribute to healing:

• Enough rest and sleep (not always easy for a new mother but try and get at least one nap during the day)
• Exercise (in the beginning it can be pilates or walking with your baby or core strengthening, but after 6 weeks you can increase intensity)
• Regular healthy meals (eating high glycaemic foods will just make your “lows” lower)
• Join a support group – meeting up with other mothers struggling with depression and/ or anxiety can make you feel that you are not alone
• Take time out – this may mean a short trip to the grocery store or catching up on errands but ideally it should be something that you enjoy and doesn’t entail any form of “work” or “responsibility”
• Check in regularly with a councillor or social worker or health care provider so that they can assess how you are doing
• Limit or avoid anxiety provoking tasks or people, for example don’t sit reading your work emails while you are on maternity leave
• Book a massage or reflexology appointment
• Join a music therapy group with your baby or on your own

Important to know…

• Dads can also suffer from Perinatal Mood disorder
• Adoptive Parents can suffer from Perinatal Mood disorder
• If you are not yet pregnant but currently taking medication for a mood disorder or other Psychiatric illness, it is important to speak to your psychiatrist and gynaecologist prior to conception to make sure the medication you are using is in no way harmful to an unborn baby.
• Never abruptly stop medication you are using for depression or anxiety – discuss with your care provider if it is suitable to wean yourself off the medication and how best to do it (weaning is a slow tapering off the medication).
• After you are fully weaned off the medication – under the care of your clinician, continue to attend support groups. This is a great way to check in every month or few months with how you are coping.