Saturday, 28 February 2015

Why post natal depression is no different to any other depression

Up to 15 percent of women develop depression after giving birth. In the case of one or two percent of women, the depression may become psychotic - taking the form of hallucinations and delusions, which can put the baby's life, as well as their own, at risk.

Postnatal depression (or postpartum depression, as doctors may call it) is often viewed as a biologically based condition, attributable to a high level of hormonal imbalance after childbirth.

In fact, surprising as it may sound, there is no evidence that the majority of postnatal depression is due to hormonal imbalance. Indeed, the depression tends to develop weeks or months after the birth, by which time hormone levels are likely to be back to normal. ('Baby blues', on the other hand, a brief period of becoming over-emotional and tearful for no clear cause, which may occur a few days after a birth, is indeed hormone-induced and passes extremely quickly.)

'Postnatal' depression
However, the fact that depression after childbirth is given the name 'postnatal' depression creates the impression that it is a distinct entity, just as would be the case if doctors commonly diagnosed 'redundancy depression' or 'bereavement depression' or 'being jilted depression', or even 'not winning the lottery depression'. Quite obviously, of course, these are simply circumstances that may trigger depression, and childbirth, in this respect, is no different.

(There is one important exception, however. In a very small proportion of women who suffer serious postnatal depression, the trigger is a disorder in which the body makes anti-bodies against its own thyroid gland. About 11 percent of women are thought to make thyroid antibodies and this puts them at particularly high risk of postnatal depression, as well as damage to the thyroid gland. A simple test can detect whether this is the cause and treatment with the thyroid hormone thyroxine should resolve both problems. If women are found, during pregnancy, to be producing thyroid antibodies, treatment with thyroxine after the birth may prevent the development of depression altogether.)

It's not the situation, it's the attitude
Women who are the most likely to develop depression after childbirth are those who have little support from a partner, family or friends and who are managing in highly stressful circumstances. For instance, a women who is coping alone with a baby and three other young children is at high risk of depression. However, as we said earlier, it is attitude and response to circumstances that determines whether a person sinks into depression, rather that those circumstances themselves. A woman could be in a happy relationship, living in a lovely home, enjoying a fully-paid career break and with her mother on hand to offer help, and still experience depression if she hasn't come to realistic terms with the big changes in life that a baby brings.

Inevitably, motherhood creates enormous changes that are demanding to cope with. (So does fatherhood - fathers may also suffer from depression after childbirth, particularly if their partner is depressed, but the problem often goes unrecognised.)

The impact of sleep deprivation
As we have seen, sleep deprivation, which is an unavoidable part of new motherhood, will lower resistance, physically and emotionally, and increase vulnerability to low mood. And even when they are asleep new mothers tend not to sleep deeply (as they are subconsciously keeping an ear open for their baby) and therefore they often miss out on the important restorative Stage 4 slow wave sleep (as is often also the case with doctors and nurses who are on call).

So not only are new mothers getting less sleep than usual, the sleep they do get is unbalanced, with proportionally more REM sleep and less restorative, slow wave sleep. This lack of balance invariably leads to brain exhaustion (itself another cause for worry) which, in turn, both makes it harder for the new mothers to think clearly about the emotionally-arousing concerns they have about their new life changes and increases their vulnerability to these worries. Thus their disrupted sleep can be both a symptom and a partial cause of any resulting depression.

Once they have established a routine and life settles down more, most new mothers recover quickly and are soon enjoying their new lives. However, others may find it harder to do so and the depression can become prolonged - many new mothers, for instance may be at home during the day for the first time in years and therefore have all the more time to give way to any emotionally-arousing introspections and worries that they might have.

The impact of thinking styles
Women who tend towards having an emotionally driven black-and-white thinking style will find it more difficult to come to terms with the major changes and uncertainties that becoming a parent entails - "Can I cope or can't I?"

Concerns are likely to include worries about the baby's health and safety but equally powerful is the psychological shock of new motherhood and the realisation of its full implications. It may be difficult to reconcile fantasies of a life wonderfully transformed by the addition of a child with the reality of pacing the floor with a colicky, crying baby, worrying about being a failure as a parent. New mothers may feel consumed by their baby's needs and that they have lost their sense of identity, as a working woman or as an independent person, and consequently their standing or status in the eyes of others.

High expectations
As might be expected from what we've explained so far, women who become depressed after childbirth commonly have unrealistically high expectations of themselves. They think they should be able to meet all their baby's needs, without resentment or frustration, keep the home as clean as it used to be, cook meals for their partner and be loving, attentive - and perhaps even look sexually alluring, too - when their partner returns from work. It is such perfectionism and all-or-nothing thinking, which exacerbates the likelihood of depression.

Getting needs met
If new mothers cannot easily, or are too despondent to, get out and spend time with other people, the important need for social connection, a human given, will not be met. (Also, those who meet other new mothers in support groups are likely to feel far less isolated and become more confident of their own anxieties and learning new skills.)

Sometimes, in meeting a new baby's demanding schedule, new mothers may have little time to take care of their appearance in the way that they used to, and may snatch unhealthy snacks instead of eating properly. A lack of certain nutrients, especially omega-3, can also make new mothers vulnerable to depression.

Considering themselves unattractive or overweight can easily lower self-esteem further. Worries about whether they are still attractive to their partners or about why they don't want sex (a common problem when exhausted), add to the other ruminations likely to be going round and round in their heads and further disrupt sleep.

Postnatal depression can recur, after another birth, for the same reasons that any depression recurs: the psychological response to the circumstance (feeling anxious, isolated, and worrying about it all) is the same. If, however, a mother feels more confident and has more of a 'life' in place by the time the second baby arrives, postnatal depression is less likely.


This is excerpt taken from the book: How to lift depression... fast.

How to lift depression shatters many myths. It provides clear guidelines, with case histories, for helping people get out of depression, even those at high risk of committing suicide. Without ‘psychobabble’, false sentiment or jargon, this book makes it easy to understand the causes of depression and why so many of us are so vulnerable to it. More importantly, it describes how to overcome it.

For more information about how to beat depression, including postnatal depression, see the site

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