Postnatal Depression
- About postnatal depression
- Getting help
- Helping yourself
- More information
- Professionals: some tips
- Supporting sufferers
Related Articles
Related Local Information
Related National Boards
Getting help
Quicklinks
Seeing your GP or Health Visitor
The first thing you should do, if you haven't already, is see your GP or health visitor as soon as possible. Tell them all the symptoms that are troubling you. Even if you are having scary thoughts about harming yourself or your baby, tell your doctor. Many women fear admitting these thoughts in case they are judged unfit mothers but your doctor will not judge you. This is a well recognised symptom of postnatal illness and doctors know that these thoughts are rarely, if ever, acted upon
It may be an idea to write your symptoms and feelings down before you go, or print out the list above and underline or tick the ones that affect you. Or take a friend or your partner with you. Many mums find the relief of admitting their feelings causes them to break down in tears when they start talking to their doctor. This is good - the doctor needs to know how you are really feeling to know how best to help you.
You may be prescribed antidepressants and perhaps suggest counselling. If you saw your doctor first, they will also want (with your permission) to tell your health visitor. Health visitors are often better trained in postnatal depression and counselling, they can give you extra support and an increasing number of health visitors now offer counselling for postnatal illness themselves. Your doctor will also probably ask to see you at regular intervals.
A very few people find their doctor to be unapproachable or unhelpful. If you find this, then go to a different doctor. If you are prescribed antidepressants, but then decide you really don't want to take them, go back and discuss this with your GP. Don't just put them in the cupboard and walk away. Talk about all the possible alternatives - some GPs are now prescribing 'exercise' - they are sending mothers along to exercise classes, because it is known to help.
Footnote: While you are there, if you are up to it, it may be a good idea to discuss contraception. It is generally felt that women with postnatal illness should not take the pill as it can aggravate the condition and whilst contraception may be far from your priority you don't really want to get pregnant again right now, especially if you are taking antidepressant drugs (although it wouldn't be the end of the world - if really necessary you can take anti-depressants while pregnant).
The Role of Health Visitors
Your health visitor has responsibility for taking care of your health as well as that of your baby's. In many areas of the country they will arrange to see you when your baby is about 6 weeks old, and they should talk with you to see if you are suffering from postnatal depression. In many areas, health visitors use the EDPS, or 'Edinburgh Scale' as a basis for the discussion. It is a short series of question where you are askied to rank you feelings over the past week. If you are asked to fill this in, try to be honest about your feelings - health visitors know that postnatal depression is very common, and that it's NOT anything to do with a failure to cope of being a bad mother. If you find that it doesn't fully cover what you are going through, make sure you say so as well - the scale is designed for those with depression, but doesn't cover the anxiety end of the spectrum so well.
If you don't feel able to talk about how you are feeling at that time, ask if you could have a go at a later date and make an appointment to see her again - perhaps she could visit you at home if you are currently at the clinic.
Netmums Parent Supporters
As part of our Parent Support Programme, Netmums are working in association with Unite/CPHVA (association for health visitors) and we have four health visitors on our forums ready to listen and offer practical and emotional help, advice support and guidance. Click here to find out more about the service. Click here to go straight to our PND and Depression Support Forum.
Counselling
Some people find counselling hugely effective. It can be especially useful if there is something in your life that you haven't dealt with, or if you haven't anyone to talk to about how you are really feeling. Most women acknowledge that their partners can be great with practical help but aren't so good at listening to lots of emotional waffle! And it is great to have someone completely focused on you where you don't have to worry about "going on about yourself".
It is widely acknowledged that something called Cognitive Behavioural Therapy (CBT) has good results for mums with postnatal depression. Ask if your doctor can refer you for counselling and ask if it will include CBT
Cognitive Behaviour Therapy will encourage you to challenge the way you are thinking. With postnatal depression, your thought processes become less rational - you may become anxious or depressed in situations that wouldn't have affected you before. For example, try to stop every time you feel particularly anxious or unwell, consider what thoughts are going through your head and then challenge them. The table below gives a few examples.
|
How you may be thinking |
How to question it
|
|
Trying to predict |
Am I predicting the future instead of facing it as it happens? |
|
Thinking in extremes |
How would someone else looking in view the situation? Would they see a failure? Or a mum with a nice house, lovely, clean happy baby and good relationship. |
|
Using the words "Should", "Ought" and "Must" a lot: telling yourself how you ought to behave |
Why should you? What will happen if you don't? |
|
Considering the worst case scenario, |
What is the evidence to support the thought? Did you make a total fool of yourself last time? ... and in whose eyes? Did anyone really notice? Does it really matter? |
The counsellor will encourage you to write down what you were
thinking about and you may start to see if a pattern emerges in terms of the
types of thoughts and the time of day at which you feel worst. By actively challenging
your thoughts regularly, eventually you start to do it automatically, and you
start to feel better.
If this sort of advice seems useful to you, ask your GP or Health Visitor to
refer you to a counsellor, indeed an increasing number of health visitors are
now trained to offer counselling themselves. If the waiting list is too long,
your GP may know of free services offered by the charities working in our area
that could help. If you can afford it, maybe even pay for private counselling...you
can't spend money on anything more important than your health. But get a recommendation
from your doctor even for private counselling and DON'T spend money on counselling
provided over the internet.
Antidepressants
You may not need or want antidepressants. Many mums, particularly those with
milder symptoms, recover without them but they are very effective for postnatal
illness. Drug treatment for depression and anxiety has come a long way. You
might be surprised to know there are nearly 9 million people in the UK taking
antidepressants.
A little bit about them, there are 3 main types:
- tricyclic antidepressants (TCAs) and related drugs,
- selective serotonin re-uptake inhibitors (SSRIs), and
- monoamine oxidase inhibitors (MAOIs).
Antidepressants work by changing the level of certain chemicals in the brain called neurotransmitters. Normally, these chemicals pass signals from one brain cell to another, but in depression, some of them don't work properly. Antidepressants increase the level of active neurotransmitters.
Treatment with antidepressants usually starts with a TCA or SSRI. It takes about 10 to 14 days for the drugs to start working, and six to eight weeks for them to fully take effect. If you don't feel the benefit within that time, see your doctor again and he may try a different type - different people respond better to different drugs.
When you first start taking them there can be some side effects including a dry mouth, drowsiness and feeling slightly sick but this usually settles down after a week or two as you get used to the drug.
Antidepressants often have to be taken for a long time - at least 6 months and it’s important to come off them slowly to prevent side effects.
Can I breast feed my baby?
All antidepressants are secreted in breast milk but the amount that actually
gets into your breast milk is low: about 2%. Generally, there should be no reason
why you should stop breastfeedin g. Your doctor will be able to advise which
type and dosage are best for breastfeeding mothers.
Can I take them during pregnancy?
Of the modern drugs fluoxetine (or Prozac) has been most studied. It has NOT
been shown to cause congenital abnormalities or neurobehavioural effects in
children whose mums took it in pregnancy. In summary, there is no evidence of
it causing any harm to babies. *
* This information has been taken from 'Drug and Therapeutics Bulletin' in May 2000. Your GP's surgery should have a copy somewhere if you want to know more.
Local
help and support
Click here for local PND support groups
Health visitors
Health visitors are there for the welfare of babies and children under 5 and their mothers. They are trained to understand postnatal illness and they are there to support you in whatever way they can. Make an appointment to see your health visitor. Most will pop round to see you and you can tell them about how you are feeling. Your health visitor's contact details should be in the Red Book you have for your child. If you don't know how to reach your health visitor your doctors surgery will be able to tell you.
You can also ask your health visitor whether she might be able to put you in touch with another mother who suffered from post-natal depression locally. Some health visitors are happy to ring up people they've known and ask, and it can really help to just have a chat with someone else who's been through what you're going through. They might also know about a local postnatal depression group that you can attend.
Homestart
Phone the national Home-start line on 08000 68 63 68 or click
here to find details of your local Home-start
Home-Start is a charity which helps parents with young children by providing families with volunteer support. Whether you are struggling to look after several young children, or are suffering from postnatal illness, loneliness, children’s behavioural problems, disability or ill-health, Home-Start are there to help.
As the UK's leading family support charity, Home-Start has 337 local offices,
known as Schemes. Through these more than 10,000 volunteers help over 60,000
families each year.
Home-Start provides an informal, friendly family support. Very simply, volunteers offer regular support, friendship and practical help to young families under stress in their own homes. The idea is that your Home-Start volunteer visits you regularly, in your own home, usually once a week for between two and four hours. The visits are flexible and you decide together what to do during that time.
Sometimes you may want someone to listen, someone to talk to about your concerns or problems or sometimes just someone with whom to share an adult conversation! At another time you may want some more practical support such as help to play with the children or to get the family to the shops. Volunteers are not babysitters or home helps so any practical help is given as a friend would. For many families, this simple type of support makes a world of difference. While Home-Start does not have a magic formula to take all the problems away, parents say that having a friend to confide in, to cry with, to laugh with, to talk to, can make all the difference.
Here are the experiences of two Netmums members, Sally and Tania, who found Home-Start a great source of support.
Sally writes
'I had no problems after the birth of my son James, but six weeks after my daughter Charlotte was born, I was already starting to suffer from depression. I just didn't seem to have the energy to do anything, and would just sit around the house feeling guilty for not keeping on top of things. After my maternity leave finished I returned to work, but was eventually signed off sick. The doctor was sympathetic, but I was put on a long waiting list for counselling and given anti-depressants.
Learning to look after two small children seemed like the most difficult thing in the world and as we'd recently moved house, I didn't have many friends locally. I asked my health visitor for ideas and she suggested Home-Start - I wasn't really interested in 'therapy'... and couldn't afford to pay for counselling anyway, but I thought that having someone to talk to once a week would be nice...
I can't tell you what a difference it made. Wendy came round each week and we played with the children. Occasionally she'd ask how I was feeling - but really, it was just someone to share the children with, and to chat to. I would always look forward to Thursday mornings. Over time, I found I gained confidence, and started to make new friends and gradually recovered from the depression. When I was happy to go it alone, Wendy stopped visiting and is now helping other families - I owe her so much. Home-Start really is about being a friend to you - it's for 'normal' people who need some extra support... after all, for many people, bringing up young children can be the most difficult time in our lives.'
Tania's story:
'I had two sons aged five and three and Home-Start was initially suggested by
my health visitor following the birth of my second son when I experienced severe
post-natal illness.
I was very nervous when Jackie first came but we hit it off very quickly. The first eight months following Luke's birth were really, really hard but Jackie was always there. I suffered from hallucinations and Jackie was often with me when this happened. I'd feel too guilty to tell my family and believed I was going mad but Jackie would comfort me and reassure me that things were OK and it would pass. I was suicidal at times and I'm sure she saved my life on a number of occasions by just being there.
The children know and love her and now see her as part of our family. She was also wonderful with my husband and was really the only person to ask how he was through all of this. There are not many people you can bare your soul to and really trust that they won't let you down. Jackie was always honest with me and provided me with lots of reassurance.
I'm so much better now. I am off anti-depressants and Jackie no longer visits but we do keep in touch. I am now a member of Home-Start's management committee and try to help in any way I can, because of what they've done for me.
Phone the national Home-start line on 08000 68 63 68 or click here to find details of your local Home-start
Other national groups
The Association for Post-natal Illness
This a registered charity established in 1979 to provide support to mothers suffering from post-natal illness, increase public awareness of the illness, to encourage research into its cause and nature. They have a helpline and a network of telephone supporters.
www.apni.org
PNI-SHA
Post-natal illness - Support & Help Association
This charity has a national telephone and message board support service for those suffering with post-natal illness. They are based in Derbyshire and also offer local support and home visiting for sufferers of post-natal illness and their families in and around Ashbourne in Derbyshire.
http://www.pnisha.org.uk
Post natal Depression Project
If you live in Scotland, this wonderful support organisation has been running for 12 years and offers a telephone helpline and one-to-one and family counselling
Helpline 0131 538 7288
The Birth Trauma Association
Supporting women with post-natal Post Traumatic Stress Disorder (PTSD) or birth trauma.
www.birthtraumaassociation.org.uk
Also remember if you are looking for further information visit our.... Library and Self-help pages.
