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Postnatal Depression, also referred to as PND, is suffered by 16-20% of Australian women after the arrival of their babies. With anywhere from 250,000 to 300,000 babies being born in Australia each year over the last 10 years, too many women are currently enduring this often crippling illness. You don't have to be in that 16-20% to benefit from this information, read it, pass it on, talk about it. It might just help you or someone you know reach out to a Mum in need.
What is Postnatal Depression?
PND is depression experienced by a mother up to one year after the birth of a baby. Those who do or have suffered depression are more likely to experience PND. Antenatal Depression is depression experienced during pregnancy and collectively these are referred to as Perinatal Depression, meaning around the time of pregnancy & new motherhood.
Bringing a newborn baby home is often the most significant, life changing event a family is faced with and can be incredibly overwhelming for many. Nothing can prepare you for the arrival of a new baby and many women have unrealistic expectations of themselves and feel pressure to be happy and excited about bringing their bundle home. In reality it can be frightening, overwhelming and exhausting. When these emotions take hold it can be difficult to experience the joy and see the brighter side of life.
Recognising PND
PND is vastly different to the fourth day blues which almost every mother experiences after the happy hormones from childbirth have worn off and the reality of being on call 24hrs kicks in!
Maternal & Child Health Nurses routinely ask new Mums at 4, 6 & 8 weeks if they would like to participate in the Edinborough Postnatal Depression Scale (EDPS), a checklist used to determine their risk or likelihood of PND.
This asks women to think about things like their ability to see the funny side of things, to look forward to things or experience joy and happiness, self blame, the presence of anxiety for no apparent reason, poor sleep patterns, prolonged episodes of crying and sadness and difficulty coping.
These symptoms can be sudden or gradual and occur during pregnancy or within the first 12 months after giving birth.
So many women feel it’s a reflection on their abilities as a mother and for many this difficult time can affect their bonding and getting to know their baby.
What are some causes?
According to PANDA (Postnatal and Antenatal Depression Association Inc.), hormonal and chemical changes in the body and brain after childbirth are thought to play a part, but it is not usually that simple. Other stress factors such as a demanding baby, lack of sleep and a difficult delivery may be part of it, as well as a previous depression, isolation, lack of support, childhood abuse or a difficult relationship with her partner or her own mother.
The Implications
There’s so much pressure on society as a whole, but especially women, to cope with the pressures of raising happy, healthy children, running a household, to be independent and have a career and be a loving and supportive wife or partner. Many people feel embarrassed to discuss their difficulties in any of these areas and unfortunately for this reason, combined with a lack of support, PND can go undiagnosed.
Most of us have an idea of the kind of mother we’d like to be, but experiencing sadness, anxiety or despair can dramatically affect the way we parent and bond with our child, sometimes causing a Mum to become unresponsive and detached which can have negative effects on the child in the long term.
The road forward
An important consideration is reducing a mother’s chances of developing PND by learning about the symptoms and talking about it before or during pregnancy. It helps to understand what is happening should she experience feelings and symptoms consistent with postnatal depression, after the baby is born.
PANDA recommends sensible and practical suggestions for overcoming PND, including having someone to talk to, to help her deal with her feelings, but recovery may also involve building her support network of family and friends. Seeing a counsellor or joining a postnatal depression support group with other women sharing similar experiences can also be very important to her recovery. With early detection, support, counselling and maybe medication, most mothers do get better and enjoy their baby and the experience of motherhood.
Beyond Blue seems to promote a very medicalized model of treatment. The feeling from them is not particularly positive when it comes to “Alternative Treatments” for PND. In fact their definition of alternative is anything other than counselling or medication. Their website states under “Alternative Treatment” …….. “Many people with depression try to manage the illness themselves. Common behaviour like drinking more alcohol or smoking cannabis is unhelpful and may make things worse.
“Some people may try alternative therapies or adjust their daily routine. Increasing physical activity or getting enough sleep may be beneficial.”
So this perhaps says that drugs and alcohol are a large part of many people’s self treatment regime when in fact, this would make the problem considerably worse, reinforcing the fact that a network of family and friends is essential for families to get support.
Beyond Blue’s pdf on Alternative Treatment has a table which lists several methods from those that are proven to be effective by science, such as St John’s Wort & exercise, to those that have little evidence like chocolate and prayer. Essentially demeaning the use of “alternative therapies” and minimising their importance (personal opinion of the author, not stated to be a fact!).
It is important to note that there are different scales of any kind of depression, from mild to moderate or severe. If someone is suffering severe depression urgent medical care is required for the safety of the person and those around them.
Antidepressant medication serves the purpose of altering brain chemistry so that more serotonin is available, whilst this has a positive effect on mood and general outlook, unfortunately it can mask the initial or underlying causes, therefore not allowing complete healing and recovery to take place. This is certainly not to say that medication has no place or recommending people not take them, but it is important to consider all available options and use medication in conjunction with other therapies.
A Holistic Perspective
A practitioner of natural therapies will consider the whole self when deciding on a treatment plan, this means all body systems; circulation, immune, digestive, nervous and endocrine systems are of particular importance here. So yes, your whole body!
A holistic practitioner (naturopath, herbalist, homoeopath etc.) will assess your lifestyle, household dynamics, diet particularly sugar intake and use of stimulants such as caffeine. It is important that your road to recovery be as complete as you are complex.
Here’s a list of things to try or recommend to a friend or family member who is suffering mild to moderate depression. It is important that a professional make this judgment on the severity of PND rather than self-diagnosing and missing important treatment options.
These are not recommended as one particular form of treatment but rather a range of changes to incorporate into your diet and lifestyle.
Counselling
There are many different forms including cognitive Behavioural Therapy (CBT) which is the most common form of treatment for depression, Creative Arts Counselling, group counselling sessions with other women or couples counselling. See the PANDA website for more information.
Increase your support network
Forget the dishes! Chat, have a laugh, catch up for a coffee, spend an hour on the phone, meet at the park and get some fresh air.
Here's some great ways to Meet Other Mums
Exercise
Increasing your heart rate, working up a sweat, getting the blood flowing, letting of some steam, all in the name of looking good, has even more benefit when it comes to feeling good. The positive effects on emotional wellbeing are well documented, fairly quick to be felt and can be long lasting. Not only are you releasing feel good hormones (endorphins & adrenalin), you also attain a well earned sense of achievement from completing a challenging work out. You can join a gym, play a team sport, push the pram to the park, ride a bike, go for a swim or plug in the ipod and go for a solo jog around the block.
Often taking that initial step to get out and do it can be difficult so start slow with walking or ask a friend to help you find a little motivation and exercise with you.
Want to find out more information about Exercise & Breastfeeding?
Nutritional Therapy
Many nutrients can have an effect on mood if a deficiency is present, but particularly the B Group vitamins. The list of symptoms affecting the nervous system in a person with any B vitamin deficiency is long and exhausting and includes things like depression, listlessness, anxiety, irritability, forgetfulness, insomnia, delusions, paranoia, hysteria and confusion.
Vitamin B6, folic acid and B12 all have particular roles in treating general depression but so do the rest of them so it’s very important to take all B vitamins together in a multivitamin or B complex.
B vitamins are found in most of the foods we eat but are sensitive to heat & food processing, so are generally thrown out with the cooking water or by the time we get to eat a food it has been so heavily tampered with that it’s void of any nutritional value, despite what the marketing of large food companies claim. For this reason subclinical deficiencies are more common than you would think.
Taking a multivitamin or B complex may not be the end-cure for postnatal depression, but it will certainly increase your energy levels, assist you in dealing with everyday stresses, reduce anxiety and will also do no harm.
B vitamin supplements are very safe to take while breastfeeding, but check the label to ensure there are other ingredients that are not safe.
Deficiencies in Omega 3 Essential Fatty Acids (EFAs) are known to affect behaviour, mood and mental function. According to Udo Erasmus, author of Fats that Heal, Fats that Kill, Omega 3 EFAs “ Improve brain function: mood, intelligence , behavior, and vision. Our brain is over 60% fat. EFAs are important components of the entire nervous system. They are necessary to make the neurotransmitter serotonin. Depression and other brain diseases show decreased levels of n-3”
EFAs are very safe to use while breastfeeding, in fact it’s an important nutritional ingredient of breast milk. The World Health Organisation (WHO) recommends pregnant and breastfeeding women take 2.6g of Omega
3 EFAs each day.
S-adenosyl-L-methionine (SAMe) is a compound produced by the liver and used throughout the body in a chemical process called methylation. Methylation is one of the last steps in the production of the brain chemicals serotonin, dopamine and noradrenalin (which regulate mood).
SAMe has been proven to be effective for people with depression in the following ways; slows the breakdown of serotonin, dopamine & noradrenalin, allowing them to work longer; speeds up production of the receptors which these neurotransmitters are received by; and possibly make the receptors more responsive so they are better able to receive messages from the neurotransmitters.
The research specifically for the treatment of PND is scarce, so the above information applies to Depression alone, but the fact that it is a safe supplement means if offers promise to those suffering from PND.
Eating Well
Tryptophan is an amino acid that serves as a precursor for serotonin, a neurotransmitter that helps the body regulate appetite, sleep patterns, and mood. Because of its ability to raise serotonin levels, tryptophan has been used therapeutically in the treatment of insomnia, depression, and anxiety but is not available in supplement form in Australia so it’s important to eat foods that contain it. Unfortunately it’s not found is quantities as high as other amino acids but being an amino acid (which make up protein) then you can consume it by making sure you eat enough protein. This means, fish , especially (also high in EFAs), especially shellfish & tuna, lean red meat, dairy foods (cottage cheese is a great source), soybeans, nuts & seeds.
For more information about general healthy eating guidelines see Nutrition & Breastfeeding or Protein, Carbohydrates & Fats (PCF)
Things to avoid;
- Refined sugars (anything white has had all the nutritional value taken out, adding nutrients back in does not have the same effect as eating the food in its whole state. Regular consumption of highly refined and high sugar foods leads to a condition called hypoglycaemia (low blood sugar levels) which has symptoms of headache, depression, anxiety, lack of concentration and shakiness to name a few
- Alcohol is depressive to the nervous system and any positive effects on mood are very short lived. It impairs your judgment and ability to respond to your baby or children effectively, has a negative effect on sleep patterns and leads to low blood sugar levels which results in sugar cravings.
- Avoid drugs that have a mood altering affect including marijuana, cigarettes, caffeine & sedatives (sleeping tablets)
This may sound like it was written by the Fun Police but it is important to note that it’s easy to fall into the trap of grabbing a quick fix to get a quick lift, over and over again throughout the day. It doesn’t take long to rely on this artificial high, no matter how small it is and before you know it you’ve come to rely on it as a way of coping. Things that are not so good for you can generally be consumed in moderation or enjoyed during times of celebration or occasional indulgence as long as they are not having negative effects on your health and wellbeing.
Catch up on Sleep
Yes it's often easier said than done but it's important to take any opportunity you can to fit in a cat nap here and there or ask someone else to be an night duty occasionally. If you are breastfeeding try expressing and get your partner or a grandparent to do a night feed. If you give your baby a dream feed/rollever feed then perhaps they can do that so you can have an early night. Going to bed at 8:30pm might make up for the hours missed if you're up during the night or early morning.
If your baby is sleeping through but you aren't, you'll find some useful information here in I Need SLEEP Too!
Aromatherapy
According to Valerie Ann Worwood, author of The Fragrant Pharmacy (Bantam Books) a combination of any of the following is beneficial for PND; Bergamot, Neroli, Narcissus, Clary-sage, Grapefruit, Immortelle, Mandarin, Geranium, Rose & Angelica – up to 30 drops in 30ml of vegetable oil can be used for massage, 2-3 drops in an infuser (oil burner), 4-6 drops in a bath or dab it on like perfume.
More Ways to relax, reguvenate and pamper yourself
It is so important that mother's value their own health and wellbeing as much as they do their family's. An overall approach to making diet and lifestyle changes can be an essential part of recovery, but most importantly, know that help is out there. Talk to someone and find out what your options are.
If you are concerned about yourself or someone you know contact PANDA
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