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who am I? ( i.e. don't believe everything you read on the www without deciding for yourself if the information is reliable!)
what are Perinatal Psychiatric Disorders?
is it my hormones?
treatment
some sources of information
a copy of my information leaflet. Feel free to download and distribute this. (this is zipped in WordPro format and as an ASCII file)
other Perinatal Psychiatry resourcesinformation about:
birth experiences
psychological issues
medication
side-effectscontact PaNDa
would you like to contact me?
return home Who am I?
What are Perinatal Psychiatric Disorders?
The term 'Perinatal Psychiatric Disorders' is poorly defined! I mean it to refer to a group of psychiatric disorders that can occur from the time of conception until the end of the first year after birth. Even the terminology used during this time can be confusing; such as postnatal depression or postpartum depression, which really mean the same thing. Some people make it even more complicated by only 'allowing' the terms to be used for depression that begins within 4 weeks of birth. Others such as Obstetricians refer to the postnatal period as lasting for 6 weeks, and many Psychiatrists, Psychologists and Social Workers who work in this area include problems that start within 6 or even 12 months after birth.
What we can say is that the antenatal and postnatal period is a time of vulnerability to depression rather than a time of universally good mental health for all women as used to be believed. A women is 4 times more likely to become depressed at this time than at any other stage in her life. are postpartum depression (a depression that starts after birth) and antepartum depression (depression that starts during pregnancy). Depression is a real problem for 10-15% of women, that is at least one in ten. This is different from 'the blues' which is a brief period of lowered, irritable and fluctuating mood that occurs about 3-5 days after giving birth, in 20-50% of women. Even this is variable in intensity and duration, but as long as it is transient, we regard it as a normal event and not as an illness.
Depression is different from just 'feeling sad'. When you are feeling sad you can cheer yourself up and it is just a temporary condition. When you are depressed your mood is low and/or irritable most of the day and on most days. You can have trouble sleeping, although the extreme exhaustion that accompanies postpartum depression can mean that you wake up exhausted despite maybe getting a reasonable sleep. You can lose your appetite although the postpartum period is a time when weight loss is normal.There is still ongoing debate about whether Postnatal depression is different from 'ordinary depression' or if it is the same. My own belief is that it is phenomenologically different, that is, many women consistently report experiences that are rarely found in depression at other times of life. Whether this means that PND as an 'illness' is the same or different from 'ordinary depression' as an 'illness' is less clear though.
The worst part really is how you feel. Your self esteem can be very low and you can be tortured by intrusive thoughts that you are a bad mother. Remember though, if you really were a bad mother you probably wouldn't worry about being bad. Sometimes things look so bleak that you can wish you were dead, or that the world is so bad that both you and your baby are better off dead. These thoughts can be very scary. It is a very terrible experience. If you experience these thoughts it is imperative that you discuss them with your doctor, your nurse, a psychologist, social worker, family member - anyone. These thoughts are not a normal event and there are people out there who want to help. If the first person that you do approach cannot help you ask them to refer you to someone else who can.
Not all forms of postpartum depression are quite like this though. Some women feel excessively anxious, some women worry obsessionally, clean the house compulsively, and some women say that their head just feels fuzzy and that they can't think straight. Decision making is often very difficult.All women with babies and young children experience extraordinary tiredness, and a level of exhaustion that has never been experienced before.
Some forms of Depression are much milder of course and symptoms may vary. If in doubt, ask.
Who is at risk?
women who have been depressed before
Is it my hormones?
Probably not!! Some studies have shown some benefit from Oestrogen hormone treatment in some women but there is no consistent evidence that it works. Maybe it will turn out that there are a small group of women who have a hormonally mediated depression, but at the moment we have no idea which women this may be so it isn't routine treatment as it isn't without some risk. On the other hand there is fairly good evidence that Progesterone, a naturally occurring sex hormone in women but also a component of the Pill, and the only ingredient of the Mini-Pill, can cause depression. If you are depressed perhaps you should consider a different form of contraception.
Treatment
Depression is a problem that DOES need treatment. In many cases this will include medication, however this is only part of successful treatment. The good news is that there is a very high likelihood of getting completely better. There are medications that are probably safe during pregnancy and also safe with breast feeding, however you must be the one who weighs up the side effects and risks versus the benefits. I recommend that medication continue for 6-12 months AFTER YOU GET COMPLETELY BETTER. This is to minimise the chances of becoming depressed again. Discuss your treatment with your doctor. Bring your partner with you, after all your depression affects him too. (actually up to 5% of partners may actually get depressed as well)
Other important parts of effective treatment include maximising family and community support, and organising assistance with childcare. This in particular is sometimes harder to accept as it can reinforce the feeling of being a failure as a mother. It is important to have some time to do things for yourself, and rediscover your new sense of self. Many countries have support groups for women with postnatal or antenatal depression and they provide a crucial support and source of information.All parents, not just those who develop depression, find that parenting brings its own psychological challenges. All of us are influenced in this by our own experiences as children - after all, this is the time we looked, experienced and learnt what being a parent was all about. Often we come to terms with these experiences as we grow up, and go on to lead normal and happy lives. For some people however, the postpartum period is a time when these issues return and have a major influence on how we care for our children, and the expectations that we set for ourselves as parents. Resolving these issues is difficult enough when you aren't tired and constantly putting the needs of your family ahead of your own!
These issues are difficult to resolve without some form of talking treatment. Professional therapists are not the only people who can help with these issues of course, however they are usually helpful in exploration and resolution of these issues.
Longer term Outcome
The major problem with postpartum illnesses is failure to seek treatment. Studies show that behavioural problems in children are less likely to result from a single episode of depression, than from a recurrence or a long-term untreated or under treated episode. This appears to have a larger effect on the outcome for children than sociodemographic problems such as poverty. Untreated depression and it's effects on relationships has a significant level of relationship break-ups.
Some sources of information
you may search for books on perinatal psychiatry at amazon.com by using this link...
in Melbourne Australia (where I live)
PaNDa (Post and Antenatal Depression Association) This is a self help group established by women who have all experienced Perinatal Psychiatric illness themselves. It provides an invaluable resource for information, education nights, and 24 hour telephone support. If you live in the state of Victoria please contact PaNDa on:
for support. As this is a volunteer organisation it is not staffed all the time so you may be greeted by an answering machine. Do not be discouraged, leave a message and they will return your call.Please look at the PaNDa web site for further information
your General Practitioner
The bad news
Like most public psychiatry services in Victoria this is now blindly following the mantra of 'we're here to treat serious mental illness'. You and I and every other citizen on the planet would recognise Postpartum illness as 'serious mental illness' but this label is really a cover for rationalising and restricting access to public mental health clinics to essentially ONLY those with Schizophrenia and severe mood disorders.If you also think that this is outrageous, please complain.
The Good News
We now have a 4 bed mother and baby unit at Rosebud Hospital! Please phone us on 0359 860 670We can admit mothers and their babies (up to 12 months of age) for a period of 1 week (Mon - Fri). It may be possible to return for a second week if indicated. This service is operated under the Victorian Government casemix funding formula which pays us the grand total of $600 per admission!
This Mother Baby Unit is under threat of closure by the Victorian Government
This Mother Baby Unit has had its budget seriously curtailed by the Victorian Government
Reading and Resource list (please send me suggestions for additional items you may have found useful)
Journal Articles
Hobfoll et al. Marce Bulletin. Marce Society. 1995.
Brockington IF et al. Puerperal Psychosis phenomena and diagnosis. Arch. J. Psychiatry, 1981;38:829-833.
Weick A, Kumar R, Hirst AD et al. Increased sensitivity of dopamine receptors and recurrences of affective psychoses after childbirth. British Medical Journal. 1991;303:613-6.
Weissman MM,Bland R, Joyce PR, et al. Sex differences in the rates of depression: cross-national perspectives. J Affective Dis. 1993;29:77-84.
O'Hara MW, Zekoski EM et al. Controlled perspective study of postpartum mood disorders: comparison of childbearing and non-childbearing women. J Abnorm Psychol. 1990;99:3-15.Kumar R, Robson KM. A prospective study of emotional disorders in childbearing women. Brit J Psychiatry 1984;166:191-95.
Ballard C et al. Postnatal depression in mothers and fathers. In: Recent advances in childbearing and mental health. Abstracts of the 6th International Conference of the Marcé Society. Brit J Psychiatry 1992;164:782-8.
Gordon RE, Gordon KK. Social factors in the prevention of emotional problems. Obstet Gynaecol 1960; 15:61-78.
Wisner KL, Wheeler SB. Prevention of recurrent Postpartum onset Major Depression. Hospital ~Community Psychiatry 1994; 45:1191-1196.
Stewart DE, Klompenhower JL, Kendall RE. Prophylactic Lithium in puerperal psychosis - the experience of three centres. Br J Psychiatry 1991;158:393-7.
Gard PR, Handley SL et al. A multivariate investigation of postpartum mood disturbance. Brit J Psychiatry. 1986; 158:567-75.
Henderson A, Gregoire A, Kumar R. Treatment of severe postnatal depression with oestrogen skin patches. Lancet. 1991; 338:816-7.
Health Department Victoria. Having a baby in Victoria. Melbourne. Health Department of Victoria 1990.
ACT Division of General Practice. Better Coordination Better Continuity. Canberra ACT Division of General Practice. 1996.
Pope S. Report on Childbirth Stress and Depression. Perth. King Edward Hospital for Women. 1995
Cox J, Holden J, Sagovsky R. Detection of Postnatal depression: development of the Edinburgh Postnatal Depression Scale. Brit J Psychiatry 1987; 150:782-6.
Cox J, Murray D, Chapman G. A controlled study of the onset, prevelance and duration of postnatal depression. Brit J Psychiatry 1993;163:27-31.
Murray D, Carothers AD. The validation of the Edinburgh Postnatal Depression Scale on a community sample. Brit J Psychiatry 1990;157:289-90.
Harris B, Othman S. Association between postpartum thyroid dysfunction and thyroid antibodies and depression. British Med Journal. 1992;305:152-156.
Kendall RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. British J Psychiatry. 1987; 150:16-27.
Watson JP, ElliotSA, Rugg AJ. Psychiatric Disorder in Pregnancy and the first postnatal year. British J Psychiatry. 1984; 144:35-47.
Morris JB Group therapy for prolonged postnatal depression. British J Medical Psychology. 1987; 60:279-81.
Goulden A, Dorkings E. A mothers group in a child guidance clinic. Psychiatric Bulletin 1992; 16:286-7.
Paul C, Thomson-Salo F. A Mother-Baby Therapy group. Australasian Psychiatry 1996; Vol4:5 249-51.
Editorial. Comprehensive Prenatal and Postpartum Psychiatric Care for Women with Severe Mental Illness. Psychiatric Services. 1996. 47:10. 1108-1111.
Zelkowitz P, Milet TH. Screening for post-partum depression in a community sample. Can J Psychiatry 1995; 40(2):80-6.
Pitt B. 'Atypical' depression following childbirth. Brit J Psychiatry. 1968;114:1325-35.
Yalom ID. The theory and practise of group psychotherapy. New York. Basic Books 1985.
Have you seen my page on medications during pregnancy and lactation?
Have you seen Dr Valerie Raskin's page on side effects of medication?
If you have experienced an episode of antenatal or postpartum depression or psychosis and you feel comfortable about sharing your experience on this web site, please email me.
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