Perinatal or postnatal depression affects about 15 – 20 per cent of women in Australia. For about 40 per cent of these cases, the symptoms begin in pregnancy and can last up to two years.
Even though postnatal depression is hormonal and not brought on by circumstances, other factors can contribute to the onset of PND. For example, the experience of adverse life events or childhood trauma, or caregivers who may have been physically or emotionally absent in the mother’s family of origin can all contribute to PND.
Current life stress can also be a causal factor. Lack of access to family or social support can be a really big issue so it is crucial that these issues are addressed in the perinatal period to seek and access the necessary support especially if support is lacking.
The good news is that treatment and support is available.
What is Postnatal Depression?
Postnatal depression (PND), also known as postpartum depression, is a longer lasting form of depression with signs and symptoms intense and persistent. In general, the signs and symptoms of PND start to develop within the first few weeks of giving birth although they can present as early as pregnancy and up to a year or even up to two years after giving birth.
PND signs and symptoms include depressed mood or mood swings, excessive crying, difficulty bonding with your baby, irritability, anger, changes in appetite, hopelessness, restlessness, feeling worthless, severe anxiety and panic attacks, thoughts of death or suicide, as well as harming yourself or your baby.
What Postnatal Depression is Not
Postnatal depression is not ‘the baby blues’. The baby blues generally refers to a brief period that lasts a few days to a couple of weeks after childbirth and includes mood swings and anxiety and impacts on sleep and appetite. PND lasts longer than the baby blues and is more severe and debilitating.
Postnatal depression is also not postnatal psychosis. Postnatal psychosis can generally develop within the first week up to 12 weeks of childbirth and is a medical emergency in that the mum may experience difficulty in thinking clearly, hallucinations, paranoia and delusions. Medication is indicated for postnatal psychosis as well as hospitalisation in most cases.
Diagnostic Tools – The Edinburgh Postnatal Depression Scale
The Edinburgh Postnatal Depression Scale (EPDS) is the most commonly used screening instrument to identify and diagnose women with postpartum depression or PND. The EPDS is a 10-item standardised questionnaire validated in many different populations, available in almost every language. It is important to note that a high score on the EPDS does not necessarily amount to a positive diagnosis for PND but rather points towards a more thorough diagnostic evaluation being needed.
Treatment of Postnatal Depression
Some treatment options for PND include:
A supportive partner can have a positive effect. Studies have displayed that a partner who is able to just ‘hold’ the mother and tolerate her distress, allowing her to sob, cry or scream to release her emotions – other than helping her practically with looking after the baby — has a curative function and is extremely containing. The premise behind this is that if the partner can tolerate his/her partner’s distress, understanding the huge toll the mum’s body has taken and the different hormonal blood concentrations, the mum will be better able to look after their baby and herself. This process allows her to feel what she needs without trying to ‘fix’ anything. In some cases, if the partner launches into criticism saying ‘stop acting like a crazy person’ or ‘you have to pull yourself together’, this only creates a situation which is fraught with undesirable guilt and helplessness, which may lead to further depression and anxiety.
Medication can assist in some cases but should be used in conjunction with therapy. Having a baby is an enormous adjustment and while it is full of blessings it is a major life change regardless of whether it is a first pregnancy or a second, third or fourth child.
Psychotherapy can assist to help provide evidence-based strategies and tools for the mum. Sometimes the partner can accompany the mum at her therapy session to learn more about PND. The therapist can provide psychoeducation about PND and help in exploring ways to support the partner with PND.
Support groups like mothers groups can help. Although in some instances they can add to the stress and anxiety. It depends on the individual and personal preference.
COVID-19 has added another Thick Layer of Stress
Over the past 18 months COVID-19 has brought immense stress to all types of people, all walks of life, across the world. For mums, COVID-related stress has brought with it increased uncertainty and heightened a mother’s protective instinct in the face of a new, unpredictable and unexpected threat.
PND, Fathers and Partners
While PND is in its symptomatology hormonally driven, fathers or partners can also experience PND either independently or together with the mother’s PND. There is scientific evidence that hormonal changes also occur in men around the time of childbirth.
Help and Support is Available
There are a number of places that can help and support you or your partner with postnatal depression.
PANDA – 1300 726 306
Beyond Blue – 1300 22 4636
Pregnancy, Birth and Baby – 1800 882 436
Circle of Security at St John of God Burwood – 02 9744 1866
The Winn Clinic – website
Romy Kunitz is a clinical and developmental psychologist in Sydney NSW with extensive experience in working with adults, adolescents and couples and provides therapy to many individuals and couples in the pre and postnatal period. Romy also works with LGBT couples and individuals and enjoys supporting people from conception through their journey post birth. Reaching out for help and support is a healthy and positive sign that pregnancy and birthing are huge adjustments and like almost everything in life require time, patience and tolerance of the uncertainty and distress.