Feeling blue? Postnatal depression and the blues: know the difference
YOUR ENTIRE LIFE
is turned upside down when you have a baby. Suddenly there’s a whole new dimension to your identity as you’ve become somebody’s mom – and yet sometimes you feel as if that’s all you are, and other identities have been lost. It’s quite normal for this change to affect you on an emotional level, but when it starts affecting how you interact with your baby, there could be something deeper at play.
THE BABY BLUES
Don’t be surprised if you feel a bit tearful around three days after giving birth. The baby blues affects around 80 percent of new moms, says clinical psychologist Lana Levin. “The baby blues is a normal change of mood, post-delivery, and are a result of the sudden drop in hormones,” she explains. “During pregnancy, the placenta produces oestrogen, progesterone and endorphins in overdrive. With the baby’s delivery, the placenta is expelled and so these ‘feelgood’ hormones are no longer made in such high quantities. It takes a few days for the hormones to drop. Add this to the angst of new motherhood and sleep deprivation, as well as mom’s breastmilk coming in, and it’s no wonder so many women get weepy and feel overwhelmed around day three.” Your mood should stabilise within about 10 days. Try not to feel guilty about these feelings – you’re a new mom, and you are allowed to cry if you need to.
If the baby blues continue for two weeks or longer, you may be experiencing a condition called postnatal depression (PND). It’s important to note that PND can develop at any point of baby’s first year. Besides feelings of sadness and uncontrollable tearfulness, you may also be feeling anxious, have sleep difficulties beyond those related to caring for a newborn, struggle to concentrate, experience changes in appetite, lose interest in things you previously enjoyed, have a loss of libido, and even have thoughts of suicide. Take heart in the fact that PND is common – around 10 to 15 out of every 100 mothers experience it, says Levin. “PND is associated with tremendous guilt. There’s a sense of doubting whether you can cope with being a mom, even feelings of regret for having brought the child into the world – even if you very much wanted the baby and had an easy birth. These symptoms aren’t connected to the taking care of the baby and extend beyond the normal changes associated with new motherhood,” explains Lana. “PND can seriously impact the mother-child bond. Fortunately, the condition is treatable and highly responsive to medication and many women are still able to breastfeed, even on medication. Having said that, I feel this decision needs to be made in terms of what is in the best interests of both mother and child. If the PND is severe, stronger medication is essential and breastfeeding may not be possible. In these circumstances, the mother’s mental health needs to take precedence over breastfeeding.” Women who have been diagnosed with a mood or anxiety disorder before pregnancy could be at a higher risk of developing PND. To prevent this, discuss your condition, as well as any medication you’re taking, with your gynaecologist and psychiatrist. Some medications can be taken during pregnancy, and others pose a risk to the baby, so any decisions regarding treatment are very important. “I would also suggest that a clinical psychologist who is well versed in postpartum issues be brought on board in terms of psychotherapy. The therapist can look at building up mom’s coping skills, as well as facilitating her understanding of the illness and getting her through the feelings of guilt that accompany PND and related disorders,” adds Lana. “Moms and moms-to-be need to realise that sometimes PND just happens! Even moms who’ve never had mood disorders can develop PND.” There’s nothing shameful about having PND, but it’s a condition that requires medical attention – the sooner, the better. If you, or the people around you, have noticed any of these symptoms, speak out and get help. It’s important that you accept the help on offer, so that you can get well and give your baby your best. “Psychiatrists are essential in treating PND. Many people go to their GP or even their gynae, but I always remind my clients that they wouldn’t go to the butcher to get a haircut. Therefore, the correct medical specialist needs to be sought for mental health issues,” says Lana. “PND is best treated with a combination of psychotherapy and medication.”
WHEN THINGS GET SERIOUS
On the extreme end of the scale is a condition called postpartum psychosis. “This is relatively rare, occurring in only one to two out of every 1 000 pregnancies,” explains Levin. “It’s a condition that comes on very suddenly (usually within the first two weeks) and presents as a psychiatric emergency. It can involve manic (or racing) thoughts, an inability to plan or take care of the baby, as well as paranoia and/or severe confusion. There may be hallucinations (the experience of sensory events without there actually being anything there, like hearing voices or feeling things crawling on the skin) or delusions (strange or unusual beliefs that do not change even though there’s no basis for them in reality, like the baby is going to die or that mom has somehow poisoned her child). Again, risk of suicide is high. Patients normally require hospitalisation as well as medication, including mood stabilisers, antipsychotics and antidepressants,” she says.
JUST KEEP SWIMMING
The most important thing for new moms to keep in mind, says Lana, is that this too shall pass. “Sometimes we all need to fall apart so that we can be put back together. This is never truer than when you’ve had a baby – and particularly if you have other children at home. Stay connected, let go of the guilt, take care of yourself, and allow others to help you until you are strong again. Allow people to cook for you (or bring you meals), don’t worry if your house isn’t perfect, forget the washing, and let go of the expectations that you need to keep it all together.”