Postnatal Depression

Understanding postnatal depression

Postnatal depression, often referred to as postpartum depression, is a type of mood disorder that causes feelings of sadness, anxiety and fatigue. It can be incredibly hard on new mothers who may worry that it is a sign of weakness or that they are bad mothers, but this couldn’t be further from the truth.

According to the World Health Organisation (WHO), approximately 10% to 15% of women in high-income countries and a significantly higher percentage in low- and lower-middle-income countries experience a mental health issue during pregnancy or after childbirth.

Among these mental health challenges, postnatal depression stands out as a prevalent concern. In the UK, it’s estimated that more than 1 in 10 women will develop postnatal depression within a year of giving birth. It is also worth noting that while less common, men can also experience depressive symptoms following the birth of a child, further underscoring the far-reaching impact of this condition.

While symptoms can vary widely among individuals, some common postnatal depression signs include:

• Persistent sadness or hopelessness: While occasional blues might be typical for new mothers, feeling a constant sense of despair or a prolonged sadness that doesn’t fade is a significant postnatal depression sign.

• Loss of interest or pleasure: A noticeable lack of interest in activities that were once enjoyable, including spending time with the baby or other loved ones.

• Sleep disturbances: Despite feeling constantly fatigued, many women with postnatal depression find they can’t sleep or, conversely, find it hard to get up.

• Appetite changes: This could manifest as significant weight gain or loss due to not eating or overeating.

• Irritability or anger: Feeling constantly on edge, with bouts of irritability or anger that seem disproportionate to the situation.

• Feelings of worthlessness or guilt: Persistent thoughts like “I’m a bad mother” or “My baby deserves better.”

• Difficulty bonding: An inability to bond with the baby, feeling indifferent or even resentful.

• Difficulty thinking or making decisions: Feeling foggy, forgetful or finding it challenging to make even simple decisions.

• Severe anxiety or panic attacks: Overwhelming anxiety that leads to rapid heartbeat, dizziness or shortness of breath.

• Thoughts of harming oneself or the baby: This is a severe symptom, and anyone experiencing such thoughts should seek help immediately.

These symptoms can be distressing, and women need to understand that these feelings don’t indicate a lack of love for their child but are manifestations of a treatable medical condition. Recognising and seeking help for these symptoms is a sign of strength and the first step towards recovery.

Postnatal depression doesn’t discriminate; it can affect any new mother, regardless of age, race or socioeconomic status. While the exact cause is multifaceted and can be different for everyone, several factors have been identified that may increase the risk or contribute to the onset of postnatal depression:

• Hormonal changes: A woman experiences a significant drop in hormones such as estrogen and progesterone after childbirth. This sudden decline can lead to mood swings, possibly contributing to depression. Other hormones produced by the thyroid gland may also drop sharply, leaving women feeling fatigued and lethargic and causing depression.

• Physical changes: Giving birth brings several physical and emotional changes. There’s the obvious physical recovery from childbirth, but a new mother must also deal with drastic changes in her body shape, which can impact self-image and confidence.

• Sleep deprivation: The consistent lack of sleep most new parents experience can lead to physical discomfort and exhaustion, which can contribute to the symptoms of depression.

• Emotional factors: The pressure of assuming responsibility for a new life, doubts about competence as a mother, feelings of loss regarding her former identity or feeling less attractive can all potentially contribute to postnatal depression.

• History of depression: Women who have had episodes of depression before pregnancy or experienced depression or anxiety during pregnancy are at a higher risk.

• Stressful life events: Recent bereavement, financial struggles, partner violence, or lack of support can compound the risk of developing postnatal depression. The COVID-19 pandemic is thought to have increased the prevalence of postpartum depression at the time, while mothers who have HIV also show increased rates.

• Birth-related trauma: A traumatic birthing experience, such as a complicated delivery, unplanned C-section or concerns about the baby’s health, can trigger postnatal depression.

• Breastfeeding challenges: Breastfeeding issues, including difficulties in latching, milk supply concerns or pain, can lead to feelings of inadequacy and despair.

Postnatal depression is a complex enough condition on its own, but many women experience a blend of conditions or symptoms that can coexist or overlap with postnatal depression, further complicating the diagnosis. These include:

Chronic fatigue syndrome (CFS)

Some of the symptoms of CFS, such as persistent fatigue, sleep disturbances and concentration issues, overlap with postnatal depression, with both conditions potentially fuelling each other. However, while both conditions can coexist, they have different root causes and treatment approaches.

Anxiety disorders

Postnatal anxiety is separate, but it can often coexist with postnatal depression. Some women may find themselves dealing with intense fears, obsessive thoughts or debilitating panic attacks, which, alongside the symptoms of postpartum depression, can be incredibly debilitating.

Thyroid disorders

The thyroid gland, responsible for regulating our metabolism, can sometimes malfunction post-pregnancy, leading to conditions like postpartum thyroiditis. Symptoms include fatigue, mood swings and weight changes, which can be mistaken for postnatal depression.

Physical health problems

Conditions such as anaemia, infections or other complications from childbirth can result in symptoms that mirror postnatal depression.

Postnatal depression can sometimes be misinterpreted as mere “baby blues,” but its persistence and intensity set it apart. A thorough diagnosis process is imperative for accurate treatment and support with a focus on understanding the mother’s emotional landscape and ruling out other medical conditions.

Here’s an insight into how healthcare professionals approach this diagnosis:

• Clinical interviews and assessment: A comprehensive discussion with a healthcare professional is the primary step. They will ask about feelings, emotions and daily routines and encourage mothers to respond honestly for accurate understanding.

• Questionnaires: Structured questionnaires, like the Edinburgh Postnatal Depression Scale (EPDS), are commonly used tools to gauge the severity of depression. It encompasses questions related to mood, enjoyment levels, guilt feelings, anxiety and even suicidal thoughts.

• Physical examinations: While postpartum depression is primarily a mental health issue, certain physical conditions can contribute to or exacerbate depressive feelings. For instance, an underactive thyroid can produce symptoms similar to PND, so a blood test may be recommended to rule out such conditions.

• Differentiating from other mood and mental health conditions: The healthcare professional will carefully distinguish between postnatal depression, the “baby blues”, and other mood and mental health disorders. Factors like onset time, symptom severity and duration all play a role in this differentiation.

• Feedback and communication: After assessments, the healthcare professional will provide feedback on the diagnosis. If postpartum depression is confirmed, they will discuss potential causes, treatment options and supportive interventions.

• Early diagnosis and intervention: The earlier postnatal depression is identified, the better the outcome for the mother. Early diagnosis paves the way for timely interventions, reducing the risk of the condition becoming severe or prolonged.

• Role of healthcare professionals: It is not just GPs who can identify postpartum depression. Midwives, health visitors and obstetricians also play a crucial role, especially during post-delivery check-ups. They are trained to spot early signs and provide initial guidance.

At UKAT London Clinic, we understand that navigating the often-overwhelming tide of postnatal depression demands a multi-faceted approach. While each person’s journey is unique, combining evidence-based treatments and bespoke support structures can pave the way for recovery. These may include:

Psychotherapy

Psychotherapy offers structured methods for understanding and managing emotional distress, which is particularly effective in addressing the unique challenges of postnatal depression. Some effective forms of therapy include:

Cognitive behavioural therapy (CBT): CBT is a goal-oriented therapy that seeks to identify and alter negative thought patterns, teaching practical skills to manage these thoughts and improve mood.

Interpersonal therapy (IPT): Focused on improving interpersonal relationships and social functioning, helping new mothers navigate the complexities of changing personal dynamics.

Counselling: A supportive environment for mothers to express their feelings and fears, receiving guidance on managing emotions and adapting to motherhood.

Holistic and lifestyle strategies

These natural and integrative approaches emphasise overall well-being, helping mothers manage depressive symptoms while fostering a balanced life:

Exercise: Even gentle activities like walking can boost endorphins, alleviating depressive symptoms.

Diet: Consuming balanced, nutritious meals can support mental health, with certain foods like omega-3-rich fish potentially offering mood-boosting benefits.

Relaxation techniques: Mindfulness, meditation and deep-breathing exercises can all reduce anxiety and improve mood.

Medications

Medicinal interventions can offer relief from severe postpartum depression symptoms, with choices based on individual needs and potential breastfeeding concerns. Potential medications may include:

Antidepressants: These can be effective in treating postnatal depression, especially when combined with therapy. It’s vital to discuss potential side effects and implications for breastfeeding.

Hormone therapy: Some women benefit from hormone treatments to counteract the drop in oestrogen after childbirth, which might be linked to mood disruptions.

Other medications: Depending on individual symptoms, antipsychotics or mood stabilisers may also be prescribed.

Mental health support

Navigating postnatal depression should never be a solitary journey. Support networks and groups can provide understanding, shared experiences and immediate assistance during acute distress.

UKAT London Clinic prioritises mental health support for all our clients to ensure they are never left alone to struggle.

Postnatal depression, while profoundly challenging, is not an insurmountable obstacle. Countless women have walked this path and, with the right interventions and support, have found their way back to joy, connection and well-being. It is paramount to remember that seeking help isn’t a sign of weakness but one of immense strength and love for yourself and your family.

UKAT London Clinic stands with you on this journey. Our expert team understands the unique struggles of postnatal depression and provides compassionate, comprehensive treatment programmes tailored specifically to your needs.

Take the first step towards healing. Contact UKAT London Clinic today.