ABOUT POSTNATAL DEPRESSION

Signs and symptoms
No one sign or symptom indicates PND, but a new mother who exhibits or experiences some of the following may have PND:

• sleep disturbance
• anxiety
• fear of being alone
• low mood
  
• crying or feeling sad
  
• loss of interest in activities enjoyed previously
  
• appetite disturbance
  
• negative thoughts
  
• obsessive thoughts
  
• irritability
  
• sensitivity to noise
  
• memory problems and loss of concentration
  
• exhaustion
  
• inability to make decisions
  
• feelings of guilt and inadequacy
  
• loss of confidence and self-esteem, and
  
• thoughts of suicide or death
  

Sleep disturbance
Disturbed sleep patterns are typical of PND. By the end of each day, most new mothers are exhausted, and with reason. Once their baby is asleep, they quickly fall asleep. But, even when their baby sleeps soundly for several hours, some new mothers who have PND experience sleep disturbance. Some can’t fall asleep. While their baby sleeps, they lie awake, often for hours. Some fall asleep only to be woken by nightmares. Other women wake early and can’t get back to sleep. Other new mothers who have PND experience other kinds of sleep disturbance. Some complain of tiredness, and want to sleep, ‘all the time’, but no amount of sleep satisfies them. Some don’t seem to need much sleep - much less, in fact, than they needed before their baby was born. These women feel unusually energetic and, while everyone else in the house sleeps, want to ‘do something’.

Anxiety
‘Anxiety’ is a feeling of uneasiness, apprehension or dread. To be ‘anxious’ may be a rational response to a situation a person finds herself in, such as an impending exam or job interview. Such anxiety may help her to cope and indeed to perform well. But anxiety can be irrational, with no specific event, object or situation prompting it, and it can be overwhelming. When anxiety interferes with a person’s ability to cope with everyday life, professional help is needed.

Anxiety is a common symptom of PND. For some women with PND, anxiety is their main symptom. Because these women often don’t feel ‘sad’ or ‘depressed’, they can find a diagnosis of PND hard to accept.

In women with PND, anxiety can take several forms - general or non-specific anxiety, irrational concerns for their own health, or for the health of their baby, or as ‘physical’ symptoms. In some cases of PND, anxiety can be so severe that women experience panic attacks.

Some women with PND experience general anxiety - they feel anxious, but are unable to pinpoint what they are anxious about. Some women with PND feel irrational concern about their own health, or the health of their baby, and some continue to feel that way even after repeated assurances that all is well. In some new mothers, even in those who don’t ‘feel’ depressed or anxious, anxiety can cause headache, visual problems, diarrhoea, vomiting, stomach cramps, chest tightness and rapid breathing. Often, doctors investigate these ‘physical’ symptoms for several months before they diagnose PND-related anxiety.

Anxiety can be so severe that women experience panic attacks, episodes of acute fear or discomfort that can last for up to fifteen minutes. During a panic attack, women may experience rapid heart-beat, feel dizzy or light-headed, tremble, or feel unable to catch their breath. Some women fear they are choking, or feel like they are ‘being smothered’. Nausea, numbness, tingling or chest pains can also accompany panic attacks. Often a heart attack or stroke is feared. Women who experience panic attacks often feel disoriented, and some fear that they are ‘going mad’.

Fear of being alone
Many women with PND are afraid to be alone.

Low mood
Many women with PND describe feeling ‘low’ or ‘flat’. Some say they ‘don’t feel much at all’.

Crying or feeling sad
Women with PND are often sensitive and emotional, and without knowing why, they often cry. Other women say they feel like crying, but can’t.

Loss of interest in activities enjoyed previously
Women with PND report little interest in activities they enjoyed previously, including sex. In cases of severe PND, it is common for women to show no interest in or take no pleasure from any activity. Some new mothers, when asked to describe how PND feels, simply say, ‘There’s no joy in anything any more.’

Appetite disturbance
Some women lose all interest in food. Others, in an attempt to control their anxiety, overeat.

Negative thoughts
Persistent negative thoughts trouble many women who have PND. Often these thoughts are intrusive, irrational and distressing. Many women become convinced that something terrible will happen to themselves or to someone they love.

Obsessive thoughts
Many women with PND worry obsessively about aspects of their lives that wouldn’t usually concern them unduly. Often, they exaggerate rational concerns out of all proportion, and may become obsessed with money, cleanliness, or time.

Irritability
This is the symptom most often noticed by partners of women who have PND.

Sensitivity to noise
Many women with PND become intolerant of noises they’ve lived with for years.

Memory problems and loss of concentration
For women who have PND, concentrating on simple tasks is often difficult, and many complain of being forgetful.

Exhaustion
Many women with PND complain of being exhausted all the time.

Inability to make decisions
Some women with PND find that making even simple decisions is ‘too difficult’.

Feelings of guilt and inadequacy
Feelings of guilt and inadequacy are common in women with PND. Many blame themselves for their illness. Some believe they are poor mothers, and think their baby would be ‘better off with someone else’. Even when those around her tell her what a good job she is doing, these feelings of guilt and inadequacy often persist.

Loss of confidence and self-esteem
The lack of confidence that is so often symptomatic of PND can have a devastating effect on a woman’s self-esteem.

Thoughts of suicide or death
Many women with PND, those who are so depressed that they cannot see how they will recover, but also those who are not so severely depressed, think about death and dying. These thoughts are usually about how they might end their lives, to ‘escape’ from what they see as an intolerable situation. They might ‘see’ themselves running their car off the road, or walking in front of a train. These women usually find such thoughts frightening and intrusive. For most, these thoughts are fantasies, and do not indicate risk of self-harm. But any new mother who thinks about death and dying should discuss these thoughts openly, honestly and promptly with a health professional who is qualified to assess her risk of self-harm.

Seek help!
If you experience some of the symptoms listed, and you think you may have PND, see a health professional, one who is experienced in recognising and treating PND. If you do have PND, the first step to recovery is to admit that something is wrong, and to seek help.