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Postnatal depression

John Sheehan explores postnatal depression in this video.
Hello. My name is John Sheehan, and I am a consultant psychiatrist in the Rotunda Hospital in Dublin. I want to talk to you about postnatal depression. Most people have heard about postnatal depression, which generally means becoming depressed after the birth of a baby. So what are the typical symptoms of depression? Compared to normal tiredness or occasional low mood, a woman with depression will experience persistent depressive symptoms over several weeks. She will feel low in mood, have a loss of interest or enjoyment in her little baby, and feel very anxious or worried. She will feel very irritable and may feel quite guilty about feeling irritable or down.
She will frequently feel that she is not a good enough mother, have negative thoughts, and feel useless or worthless. She may feel helpless to change her situation and may want to run away. At times, she may feel hopeless and think that life is not worth living. Sometimes a woman may actually experience thoughts of harming herself or avenging her life or of suicide. She may feel overwhelmed at times or feel unable to cope. She may develop disturbing intrusive thoughts, which pop into her mind, which may be quite upsetting to her. These thoughts are actually quite common. There can also be physical symptoms, such as loss of appetite or overeating.
Even though she is feeling exhausted, she may not be able to sleep. She may report difficulties bonding with her baby and feel detached from the baby, or the opposite, be overly attached so that she won’t let anyone else look after or care for the baby. So when can postnatal depression start? Most episodes of postnatal depression start within six weeks of giving birth, but episodes may occur at any time within the first year. Often, it can be undetected because there is still a stigma about depression in society, and women can be reluctant to tell people they are feeling depressed after the birth of the baby.
Society expects mother to be feeling good, and they may feel ashamed and inadequate because they feel unwell. Many women ask what is the cause of postnatal depression? In fact, there is no one specific cause. Pregnancy and childbirth are major life events. Labour and delivery can be traumatic. Becoming a mother is a major change in a woman’s life. And the first weeks, or even months, are physically very demanding. A woman will be sleep deprived and very tired. Psychologically, it is a big responsibility having a baby. A woman will experience a loss of independence and a loss of freedom. And her identity will change, as will her values. The adjustment to motherhood is major.
Motherhood will also have an impact on the woman’s relationships, particularly with her partner. What are the risk factors for postnatal depression? A woman is more at risk of developing a depression if she has previously had an episode of depression. She will also be more at risk if she has had a lot of problems in the pregnancy or during the birth, also if her baby has been born prematurely, is sick, or has problems such as a birth defect. A woman is also at risk if she has limited emotional and practical supports. Having good supports, good relationships, and practical help in place can help prevent depression. So how is depression diagnosed?
Sometimes if a woman has experienced depression in the past, she will identify the same symptoms coming back, and she will ask for help. However, frequently, it is the partner or a family member or health professional who notices that the woman is depressed. For a woman, the first thing to do is to tell someone how you are feeling. Tell your partner, a family member, or a friend. They may encourage you to speak with a health care professional, such as a family doctor. How is depression treated? Self-care is very important. Think about what you’re eating. Ask someone to prepare a meal for you. Can you get more sleep by sharing night feeds? Ask for and be prepared to accept help.
Try to mobilise supports. Avoid alcohol and engage in gentle exercise or some activity daily. In many places, there is a lot of help available from your public health nurse. Engage with counselling services through your doctor, or go to a group, such as a mother and baby group or a breastfeeding group. They’re usually very supportive. In about 50% of cases, a woman will benefit from an antidepressant. There are several antidepressants used even if you are breastfeeding. They are not addictive, but they take a few weeks to work. A small number of women are referred to mental health services, and a smaller number still require hospital care, particularly if the woman has a very severe depression called a psychosis.
A psychosis is more likely in a woman who has a very strong family history of mental illness. Will you recover? Well, most women fully recover within six months. As you improve, it’s important to think about why you became depressed. What were the particular triggers? Is there a meaning behind the depression? What might need to change in your life? How can you prevent it happening again? These questions are often best addressed when you are feeling a lot better, rather than when you are feeling very down, low, and have pessimistic thoughts. Identifying depression and going for help is very important because early treatment not only helps the mother, but of course, is very beneficial for the development of the baby.

Becoming a mother and looking after a baby can be stressful and tiring. Maternal mental health problems are mental health issues that arise during pregnancy or in the year after childbirth. They effect about one in five women.

Postnatal depression is the term used for depression that some women may experience in the first year after having their baby.

Postnatal depression can develop differently in each woman, for some, the symptoms start out as baby blues (which is a short period of depression soon after birth, which usually resolves within two weeks) and progresses into a longer-term postnatal depression.

Other women may experience a period of baby blues that resolves completely but have postnatal depression emerge at 4-6 months postpartum.

Women who experience baby blues after birth are more at risk of developing postnatal depression later on.

Up to 15% of women will develop postnatal depression within the first year of giving birth. It is important to recognise the signs and symptoms of postnatal depression. So that you can receive early diagnosis and treatment

In this video, John talks about the common symptoms of depression, some important considerations to encourage positive mental health, and how to seek help for postnatal depression.

We have included a list of support groups below if you need support for any of these issues.

John Sheehan
John Sheehan is a Consultant in Perinatal Psychiatry at the Rotunda Hospital, Dublin and an Associate Clinical Professor in the UCD School of Medicine. He graduated in Medicine from UCD in 1980 and trained in General Medicine and Psychiatry in Ireland, Zambia and at Guy’s Hospital, London. His clinical and research interests include perinatal psychiatry, transplantation psychiatry, depression in the medically ill and alcohol use disorders.
John Sheehan
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Women’s Health After Motherhood

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