Approximately 13% of women experience the “thief of motherhood” that is postpartum depression. On this very site I recently read about two women’s experiences – one ending, tragically, in suicide. Thankfully, this is a rare occurrence, but it informs us of the seriousness with which we need to take this issue.
What Are the Symptoms of Postpartum Depression (PPD)?
Firstly what I’m talking about is not the ‘baby blues’ – which is medically defined as mild symptoms, including some that I list below, that resolve after two weeks at most. We need to be careful about confusing the two. Sufferers are feeling fragile and awful enough without also feeling misunderstood or worse – dismissed.
By the time patients are referred to me for psychological intervention they will report some or all of the following list of symptoms, and will often have been suffering greatly for months, often in isolation, ashamed that they are not happy with their newborn bundle of joy (or maybe noise and poop??).
‘Cos your supposed to be grateful, happy and radiant with a newborn crying baby, sleep deprivation and a complete life-change for which there is no preparation or training, right??!! (Hmm….)
Anyway – here’s the list. You’ll be likely nodding and saying ‘yup’ a lot as you read through it. That’s OK because, and please remember this, after these feelings are normal postpartum (yes they are, you are not incompetent, weird or a bad mother). If they persist for longer than a couple of weeks and it still feels bleak and unmanageable, that’s when you might be moving from ‘baby blues’ to PPD.
- Anxiety / fearfulness
- Loss of interest in yourself, grooming, washing, dressing etc
- Absence of interest in the baby – ranging from indifference to loathing
- Guilt for having those feelings
- Loss of appetite
- Loss of libido
- Social isolation
- Anger and rages
- Mood swings
- Emotional emptiness or numbness
- Sleep disturbance
- Reduced cognitive abilities – memory glitches, speech or writing errors.
In rare cases women suffer from postpartum psychosis. The main symptoms of this are hallucinations, paranoia and severe confusion. The big risk factors here appear to be existing bipolar depression or schizophrenia. It’s usually treated with antipsychotics and mood stabilisers like lithium.
Medical science cannot yet provide us with a full description of exactly what happens during PPD – or indeed during depression itself. The serotonin hypothesis hasn’t faired too well in recent years casting doubt over the (still widespread) use of SSRI antidepressants. Many doctors though will still prescribe SSRI’s for depression and PPD – you maybe take them yourself. They are still in the top ten most prescribed drugs list in the US (showing us how commonly depression is diagnosed) generating a sales figure in 2014 of $4,095,537,942.
So medically speaking for now at least, what we are left with are theories, which I accept isn’t much use when you feel you’re in hell and what you want is a definite, preferably quick and easy way out.
But I do believe there is a way out. It’s just hidden from plain view.
What Causes Postpartum Depression?
The physical: The medical model tells us that oestrogen, progesterone and thyroid hormonal levels are implicated in PPD. A condition called Postpartum Thyroiditis and new onset Graves Disease should be ruled out for example – the latter being present in 7% of PPD patients as contrasted to 0.2% for the ‘normal’ population according to a study I recently read. It may also be useful to rule out Hashimoto’s as an underlying or triggering cause. Speak to your doctor about testing if they haven’t already done so.
Both oestrogen and progesterone levels pretty much crash after giving birth and it is theorised that these hormones are connected very much to female mood and sense of well being and health. This is why some women are prescribed hormonal treatments like the pill.
But what if antidepressant and hormonal treatments don’t work? (Here’s the way out):
The emotional: I would say this of course being a therapist (#NotBiassedAtAll) but it seems to me that the problem and solution to PPD both lie within the emotional world of the mother. So I routinely check several things when a new client arrives with a medical diagnosis of PPD. If you suffer or have suffered maybe mentally walk through this with me and see if you can relate.
Are you at risk?
Here’s a helpful checklist to help you determine if you might be at risk:
- Is there a family history of depression and/or PPD?
- Have you miscarried?
- Have you suffered a bereavement which is unresolved?
- How supported do you feel by your partner, if you have one?
- Are you under financial pressure?
- Have you moved house recently?
- Did you want this baby?
- Did your partner want this baby?
- What was the pregnancy like?
- What was the birth like?
- Did you have a birth-plan and did that work out?
- How were you treated by your birthing professionals?
- Did you feel safe and respected by your gynae/ midwife?
- How does your baby sleep?
- Are you still in physical pain after the birth?
- Are you able to breastfeed if that’s what you want to do?
- How is your sex life?
- Was this pregnancy the result of consentual sex?
- Were you ever sexually assaulted, raped or abused?
Some of the connections here are obvious. Birth can also trigger emotional responses to issues that might at first seem unrelated to the birth itself. When I explore the above questions with clients it transpires that these issues feature in PPD sufferers’ lives with great consistency – indeed there is much research to confirm this. My experience is by no means isolated or special!
So these questions help me get the invaluable information that will ultimately help my client to understand what has been triggered by the pregnancy and/or birth. We tend to forget how huge giving birth is. Birth has become medicalised and scheduled. So often the emotional needs of the new mother can go unnoticed, and unmet. This is why her relationships and their reliability are vital to her mental well being. People and places where there is intimate connection are important – parents, partner, friends, midwife, gynae, the home, the workplace. Change, loss or reduced security will cause upset that can lead to a diagnosis of PDD. Naturally.
We are not immune to vulnerability, exhaustion and physical pain. We aren’t born with parent training manuals and we do not have parenting instincts that are immune to self doubt.
As you can imagine, no drugs will make these issues disappear. So if you are on medication for a known hormonal issue but still feel awful, then maybe what’s really going on is on or related to something on this list. And that means it’s workable. It’ll just take some time, maybe some help. Both of which you deserve.
In my next piece I’ll look at some of these issues more closely. And meanwhile:
If you are finding that reading this piece is bringing up painful memories or feelings, please be OK with asking for help. Superwomen don’t exist!!