Julie Watts, Clinical Psychologist

Although becoming pregnant and giving birth are amazing experiences women it is also an enormous time of transition which impacts on every aspect of your life. For some it can be a time when they experience symptoms of depression and / or anxiety that can significantly interfere with the enjoyment of this time. Estimates of depression and anxiety vary depending on the assessment used, overall about 9% will have depression in pregnancy and about 15% postnatally. Rates of anxiety have been found to be about 20% with 2/3 of those also having depression.

The symptoms of antenatal/postnatal depression and anxiety can often be difficult to recognise as many woman and people around them may attribute some of the symptoms to being pregnant or a new mum, such as sleep problems, mood changes, fatigue, social withdrawal, loss of libido. However, with careful assessment it is important to separate these out. It is normal to feel tired but not to lie awake for a long time worrying. It can be hard to get out of the house but that is different to losing interest in contact with others. You will have some ups and downs but if your mood is persistently low for at least 2 weeks that is a sign of depression. Other common symptoms of depression include: loss of interest or enjoyment in activities, frequent tearfulness, feeling unmotivated and unable to cope with the daily routine, feelings of guilt and worthlessness, loss of confidence and self esteem, loss of appetite or comfort eating. Some women may feel so hopeless they think others would be better off without them and may have thoughts of escape or even suicide.

Other women many notice more symptoms of anxiety which can include: feeling agitated, constantly on edge, inability to relax, irritability, being preoccupied by worries, have difficulty concentrating or making decisions, and some may experience panic attacks. Some women also experience very troubling thoughts about something awful happening to their baby and may fear being on their own with the baby.

For some women these difficulties can significantly impact on the relationship with their baby and they may feel quite disconnected, that they are going through the motions of caring for the baby or even feel it as if they are caring for someone else’s baby. Yet for other women time with their baby maybe the only thing they enjoy. Experiencing anxiety or depression at this time is obviously very difficult as you are trying to also manage all the huge changes in your life and demands that a new baby brings at the same time. Women can also feel very guilty that they are experiencing this at a time when they and others around them expect them to be so happy and contented. This feeling can be exacerbated if they conceived after pregnancy losses, or though IVF. This can mean women are reluctant to admit they are struggling and seek appropriate support from others and professional help.

Some women may have experienced similar difficulties in the past or have already started to have these symptoms in pregnancy but for others it may occur for the first time after the baby is born. Symptoms may occur any time in the first postnatal year but many women may only seek help later as they expect things to resolve when the baby grows and they are getting more sleep. This is also a significant rate of recurrence with between 20-40% of women who have PND relapsing after the birth of a subsequent child. Men are also at risk of anxiety and depression in the postnatal period.

There are a number of risk factors that can include: past personal or family history of depression and /or anxiety, relationships difficulties, lack of social support, stressful events (may include a complicated or traumatic delivery), past history of abuse/dysfunctional family, health complications, preterm/ sick baby and breastfeeding difficulties. There can be particular issues for single or adolescent mothers, and women from indigenous or other cultural backgrounds who may be even more isolated or there may be cultural beliefs about mental health that can make it even more difficult for these women to seek help.

It is vital to seek help early as if symptoms persist it will not only impact on your quality of life but can significantly affect relationships with your child, partner, friends and family. There are many different treatment options and medication will not always be required. Many women are fearful to use medication when pregnant and /or breastfeeding but there is now evidence of the safe use of many medications and the benefits of prompt recovery can far outweigh the side effects. However, medication should always be utilised in conjunction with psychological treatment for the best outcome, as this helps you to understand the factors involved for you, develop strategies to manage the symptoms more effectively and improve your enjoyment of parenting and quality of life. Many women also find it helpful to join a support or treatment group as this allows them to meet other mothers who are experiencing similar problems.