Postnatal Depression (PND) and Seeking Support

Your emotional and mental well-being is very important. It's very common for new parents to feel tired, overwhelmed, and anxious. Mental health problems during pregnancy or after having a baby are common, and 1 in 8 women and 1 in 10 birthing partners develop postpartum depression.

Dr. Sonali Mohanty Quantius, mum of twins who experienced PND for 4 years, shares her experience.

“I had the most comfortable pregnancy, and I had no idea that I was at high risk for depression and anxiety as a mother of multiples. On the other hand, I also had access to some of the best healthcare in the world, and I had no clue that I could be one of those one in 5 women who experience depression and anxiety. But it happened, and two weeks after we came home from the hospital with the twins, everything just fell apart. I became absolutely disoriented, and the worst part was I was angry. I was so angry at everything. Now I know that postpartum rage and anger are symptoms of postpartum depression, but I didn’t know that at the time, and I felt like I was drowning half of the time.”

Symptoms of postnatal depression are:

Sleep disorders
Mood swings
Changes in appetite
Fear of injury
Serious concerns about the baby
Excessive sadness and crying
Sense of doubt
Difficulty in concentrating
Lack of interest in daily activities
Thoughts of death and suicide

Causes of postnatal depression (PND)

Remember, depression is not your fault; there is a biological basis for this. Dr. Lisa Falco explains the physiology behind PND.

When we are pregnant, the placenta produces large amounts of pregnancy hormones, progesterone and oestrogen.They have very positive effects on us while we are pregnant, and they are the ones triggering all the changes in our body.

Baby blues is something very common and happens to 80% of all women, and it should normally go away after a couple of days. Postnatal depression (PND), on the other hand, is something else. It can be triggered by many different reasons and can also be an accumulation of factors.

One of the reasons could be the increased stress levels. Stress increases a hormone called cortisol, which in turn breaks down the “feel-good” hormone serotonin, making it impossible for serotonin to reach normal levels.

Another reason is the sudden drop of progesterone after the placenta is delivered. Progesterone has calmed us down during pregnancy, but with this gone, it can lead to depressive symptoms.

The arrival of a baby brings many changes, and you and your partner are particularly vulnerable during the first phase after giving birth.

Why is this so?

The birth of your child is an essential event in your life. The baby is here, and you are faced with a new role and have to adapt to it, which is not always easy. Pregnancy itself has already brought about changes, not only physical but also psychological and social. Suddenly, you lose control over several things: the pregnancy, the birth, and even the type of baby you end up having. How women deal with this uncertainty varies, but most find ways of coping. But a new stage in life, accompanied by a host of uncertainties, is always likely to cause suffering or even a psychological crisis for the person affected.

Is ‘baby blues’ a suitable term for a mild form of depression?

No, baby blues is not depression. It is a completely normal experience that many women go through after childbirth: alternating between happiness and crying spells, mixed emotions – it’s all part of the process. Feeling overwhelmed, down, or tearful is normal because there is so much to handle! These feelings are natural, as long as they don’t persist. That’s the key difference between baby blues and depression, which doesn’t simply fade away. When dealing with depression, you don’t suddenly shift from a cheerful, relaxed state to one of despair and depression overnight.

A young mother, let’s call her Maya, is suffering from postpartum depression. What are the signs? Maya can barely find the strength to get out of bed and get dressed. She lacks energy. She looks after her baby as best she can, but every day seems like an insurmountable mountain. She struggles desperately, plagued by negative thoughts. She is constantly depressed and lost in thought. Even when her parents visit and bring her cake, for example, she has no appetite and finds it hard to follow the conversation. When the baby sleeps, she lies awake in bed and feels guilty. Shouldn't she be happy? She’d rather go away. It's hard to get yourself out of this situation...

It's essential that you talk to a professional, for example, your midwife, paediatrician, gynaecologist, or parent-child consultant. Postpartum depression should be treated as soon as possible, and no mother should suffer from it. Nor should your partner stand by helplessly. So, it's important to act early.

The website of the association Dépression postpartale, for example, offers an application with an online diary in which you can record your daily moods (self-test) – whether you are feeling well or not. This also shows whether the emotional state is low only on certain days or whether it refers to the person's general state.

You can also try a questionnaire called the Edinburgh Postnatal Depression Scale (EDPS), which was developed to identify women who may have postpartum depression.

In the latter case, there's only one solution: consult a psychologist or a psychiatrist. I’m in favor of a change in mentality on this subject: when you have a knee problem, you consult an orthopaedist to get a clear diagnosis and possible treatment, which could also include taking medication. This should also be the case for mental illness.

What happens once a diagnosis of ‘postpartum depression’ has been made?

Once the diagnosis has been made, professionals work with you to find an appropriate therapeutic approach. There are several methods of psychotherapy. In some cases, talk therapy or behavioural therapy may be helpful. If you suffer severe depression, treatment with psychotropic drugs can also help you regain the strength and stability you need to deal with the issues in therapy. Depending on the case, inpatient treatment may also be indicated.

And what about my baby?

It is very likely that if you are suffering from postpartum depression, you might also struggle with guilt. Despite this, you are generally able to look after your baby, but it can also happen that your psychological state prevents you from bonding with your child. In this case, it is important to understand that this is part of the illness and not because you are a ‘bad mother’. Here too, there are therapies available (mother-child interaction therapies) to help foster and strengthen the relationship.Other mothers suffer from obsessive thoughts, which may or may not be due to depression. Obsessive thoughts (sometimes called ‘impulse phobias’) cause mothers to feel anxious and guilty. For example, they may fear hurting their baby or 'pushing him under the water during the bath, drowning him.’ Mothers feel guilty about having such thoughts and try to avoid certain situations, such as giving the bath. It's important to remember that obsessive thoughts are not put into practice (unlike delusions in the case of psychosis), but that they cause great suffering for the person concerned. It is therefore important to seek professional help.

Should all pregnant women be prepared for the possibility of depression?

Depression can have many origins, but it rarely occurs for no reason. Previous mental illnesses are definite risk factors, such as burnout, anxiety disorders, panic attacks, anorexia, and bulimia. Or external factors, such as financial worries, a difficult family situation, childbirth, or a baby crying all the time. Hormones may also be involved. Often, it's a combination of factors that leads to depression.

What are the figures for postpartum depression?

Postpartum depression affects 15-20% of women. However, it's difficult to pinpoint these figures accurately, as there is no structured mental health screening system. Not everyone affected goes to a specialist. But what we do know is that mental health problems are on the increase among young women, and they can also manifest themselves during pregnancy. And it's not just mothers who are affected, but fathers too. Around 8-10% of fathers also experience some form of postnatal depression. Family doctors play an important role here, as men often consult their doctors for physical problems whose symptoms could be masking depression. Less stigmatised than it used to be, postpartum depression is also increasingly discussed, for example, on social networks. It's important to stress that suffering from depression during this first period with a baby is no indication of a mother's qualities. Quite the opposite: by seeking help, you are striving to change your situation, which requires a great deal of strength and, above all, courage.