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ABOUT POSTNATAL DEPRESSION
To recover from PND, most women will require help from an experienced health professional. Several effective treatment options are available. These include:
- support groups
- individual counselling
- couple counselling
- therapy groups
- medication
- hospitalisationn, and
- electroconvulsive therapy.
Each of these options can be effective. Often, a combination of treatment approaches is used, and medication plus some form of counselling can be especially effective. The earlier a woman seeks professional help for PND the better her prospects are for a full and speedy recovery.
Support groups
In many suburbs and towns, regular, informal meetings are held for women who have PND. PND support groups are often lead by a woman who has recovered from PND and who has experience in facilitating groups, or by a health professional who has expertise in dealing with PND and in running groups. Such groups can provide a useful source of information, advice and emotional support to women with PND. Most women with PND find a well-run support group helpful.
Individual counselling
Some general practitioners (GPs) offer individual counselling, but most refer women with PND for counselling by a counsellor, psychiatrist, or psychologist who has expertise in dealing with issues relevant to PND. For women with mild-to-moderate PND, individual counselling may be all that is needed for recovery.
In individual counselling, a woman who has PND may be encouraged to discuss how she feels about herself, her relationships and motherhood, identify and attempt to resolve any problems she had prior to pregnancy and childbirth that may have contributed to the development of PND, identify and attempt to resolve any issues that have arisen as a result of PND that have made her unhappy and inhibited her enjoyment of her baby, and develop strategies for coping with the day-to-day challenges of living with PND.
Several techniques, or ‘talk therapies’, are used. Generally, though, an experienced therapist will recommend a therapy or therapies that she or he considers most likely to meet an individual client’s needs. One therapeutic approach might be used to develop strategies for coping with the day-to-day difficulties of living with PND, or to reduce or manage anxiety. Another might be used to build a woman’s self-confidence and self-esteem. Yet another approach might be used to focus on finding solutions to aspects of new motherhood that a woman finds most difficult. Cognitive behaviour therapy is often used for a woman who has PND. The therapist will identify and challenge the negative thoughts and beliefs - ‘I am a hopeless mother’, for example – that are so common in women who have PND.
Women who have PND may benefit from psychotherapy, which is usually offered by psychiatrists and psychologists. To understand and resolve any underlying psychological factors that may have contributed to the development of PND, a psychotherapist will encourage a woman to freely discuss intimate fears and express emotions without fear of judgement. Psychotherapy can be a lengthy process, but can be especially helpful to those women with PND who have a history of depression or difficult relationships, or who have experienced traumatic childhood events.
Couple counselling
It is often difficult, in individual cases, to determine whether pre-existing relationship difficulties contribute to the development of PND, or whether PND contributes to the development of relationship problems. It can be said that pre-existing relationship problems can contribute to the development of PND, that PND is likely to exacerbate any pre-existing relationship problems, that PND places an enormous strain on all couples, even on those who have had no previous problems, and that PND can contribute to the development of relationship problems where none existed previously.
In couple counselling with a psychologist or counsellor, a woman and her partner will be given an opportunity to address any relationship problems they have that pre-date the birth of their baby, are a result of the strain of adjusting to a baby, or are a result of the woman being depressed.
Therapy groups
A counsellor, psychiatrist, or psychologist may facilitate a structured therapy group. Typically, therapy groups are ‘closed’. A group will meet with a facilitator for a set number of sessions. Once a group has begun meeting, no new participant is accepted.
In therapy groups, women who have PND may be taught strategies for coping with distressing symptoms; they may be encouraged to see their expectations of themselves and others as unrealistic, and how these expectations might be modified; and they may be taught how to lift their mood by changing the way they think about themselves and others. Women with moderate-to-severe PND often find therapy groups useful, sometimes in conjunction with individual counselling.
Medication
Antidepressant medication is designed to treat depression, and in most cases is effective. Antidepressants correct chemical imbalances in the brain that are thought to contribute to depression and anxiety. Typically they take two-to-three weeks to take effect, but may take longer. Antidepressants must be taken exactly as prescribed, and are usually taken for six months-to-two years. Sometimes a few weeks or even a few months elapse before a medication and a dose is found that is effective.
While she takes antidepressants, a woman’s condition will be monitored by her doctor. Medication is usually prescribed for some time after symptoms have disappeared. The doctor may then decide to gradually reduce the dose until the medication is no longer needed.
Some women who could benefit from antidepressants are reluctant to take them because they fear they may be harmful. But antidepressants are not addictive, are not tranquillisers, do not ‘change your personality’, and some can safely be taken by women who are breast-feeding.
Hospitalisation
Some women with moderate-to-severe PND may be treated in hospital, often in a specialised mother-baby unit, until their condition improves. Such units are often situated in an obstetric or psychiatric hospital, specialise in treating PND, and admit mothers and their babies together. Some units have facilities for fathers and older children to stay overnight. Nurses in mother-baby units have both psychiatric and infant health qualifications.
Electroconvulsive therapy
Electroconvulsive therapy (ECT) can be used to treat severe cases of PND, when medication has been ineffective, or when a woman is at risk of harming herself or her baby. ECT is safe and can be an effective and relatively speedy form of treatment.