Postnatal depression 101

Queen Victoria probably had it. Men can get it. And there’s help available to manage it, writes Adam Dudding.

As part of a new Stuff mental health podcast series, Out of My Mind, one episode follows ‘‘Hanna’’, a South Island mother who was driven to the brink of disaster after the birth of her second child.

Hanna tells her story in her own words, but no two experiences of mental distress are ever quite the same.

So with help from a clinical psychologist, here’s a brief guide to the realities of postnatal depression.

How long have doctors known about postnatal depression?

Forever – sort of. It was only in the 1990s that postnatal depression (PND) got its own special mention in the psychiatric ‘‘bible’’ – The Diagnostic and Statistical Manual of Mental Disorders (DSM). But mood disorders in women after childbirth were being noted as early as the 4th century BC by the Greek physician Hippocrates.

A 16th-century doctor in Rome, Castello Branco, wrote about a patient who ‘‘always enjoyed the best of health, was attacked after childbirth by melancholy, and remained insane for a month, but recovered’’.

It’s also always been there in the writing of women themselves, says Auckland clinical psychologist and author Natalie Flynn: ‘‘Looking at letters, and the diaries that women kept post-childbirth, they’d give it different names, but it’s always been around. Women have been documenting about their pregnancies – their fear of childbirth, feeling disconnected after their children were born – for as long as they’ve been writing.’’

Is there much of it about?

Yes. Maternity blues, when a mother feels down and tearful in the week after birth, is extremely common, affecting about four out of five mothers. Ten to 15 per cent of women will also go on to experience postnatal depression.

That’s serious depression that starts within the first few months (or even up to a year) after the baby’s birth. Very rarely, a mother will experience postnatal psychosis, where on top of mood disturbances, they lose touch with reality.

It’s all about pregnancy hormones, right?

Not exactly. During pregnancy, estrogen and progesterone levels go through the roof then fall rapidly after the baby arrives. That sudden drop can have dramatic effects on mood. Changes in the thyroid hormone, testosterone and cortisol may also be relevant.

But hormonal changes clearly aren’t the only cause of PND, says Flynn, because the condition affects people who’ve not even carried the child for nine months.

‘‘Parents who have adopted babies get postnatal depression. Men get postnatal depression. Same-sex partners that haven’t given birth get postnatal depression. Grandparents get it if they have fulltime care of babies.’’

OK. But if it’s not just hormones, what else causes it?

The single most predictive factor for PND, says Flynn, is if you have previously experienced depression or anxiety, including during the pregnancy.

But other risk factors include: a difficult relationship with your partner; a baby who happens to cry a lot; a difficult or traumatic birth; a past miscarriage; a history of abuse, a difficult relationship with one’s mother; being socially isolated; having had IVF.

The IVF-related risk is something of a vicious circle, says Flynn, because you get mothers who then feel bad about feeling bad.

‘‘I see lots of women who are saying, ‘But I’m not allowed to be depressed. This was a $20,000 baby, and everyone was cheerleading for me.’ And I say. ‘You’ve got as much of a right to feel depressed as any other mother. And you had an even harder road getting here than most.’’’

Sleep deprivation is also hugely important. ‘‘A lot of times,’’ says Flynn, ‘‘if people could just get some sleep, then that would solve the problem.’’

Certain myths about motherhood can make things worse too, she says – such as the idea that having pain relief during birth might harm your baby, or that long-term outcomes for a formula-fed baby are worse than for a breastfed baby.

Neither is true, says Flynn, but if a mother has internalised these beliefs, ‘‘they can start their mothering feeling guilty’’.

‘‘When you have certain expectations, and you don’t reach those expectations, you can feel like a failure. And when you feel like a failure, depression

can set in.’’