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The aftermath, The National, 03.03.2009

Despite its prevalence, post-natal depression often goes undiagnosed or untreated. Jo Wadham reports

Imagine an illness that affects one in 10 women, that impacts their ability to eat, sleep and function at the most basic level, and, in extreme cases, can be fatal to mothers or their children. And despite the fact that it is treatable, few women understand the illness or receive timely medical help, suffering alone instead. This is the story of post-natal depression.

Many women experience a period of feeling unsettled and unhappy after giving birth. The baby blues, as it is commonly known, affects around 50 per cent of mothers and usually begins about two to four days after birth. It is so common that most medical practitioners consider it a normal part of the post-natal experience. The mother may find herself crying frequently, have difficulty eating and sleeping, and may also feel anxious, sad, guilty or afraid. In most cases, the blues will last just a few days, but if it persists, medical help should be sought as this can develop into post-natal depression.

Post-natal depression (PND) can affect a woman any time in the first year after the birth of her child, irrespective of her age, background and whether the baby is her first. The cause of PND is thought to be a mixture of hormonal upheaval (levels of progesterone plunge dramatically post-birth) and external factors such as the lack of a support network, a traumatic birth experience or a family history of mental problems combined with sleep deprivation and post-labour exhaustion.

One of the difficulties in diagnosing PND is that the usual markers of depression, sleep and appetite disturbance as well as fatigue are common even in non-depressed mothers of young babies. Other symptoms include crying frequently, the inability to concentrate, anxiety about themselves or the baby’s health and panic attacks. Some women have obsessive and inappropriate thoughts, fearing they will harm their babies, but this rarely happens. If a woman exhibits any of these symptoms for a period longer than two weeks, she should seek medical help.

Such is the stigma attached to mental illness that all of the women I spoke to requested to remain anonymous, and their names have been changed accordingly. Polly developed post-natal depression six weeks after the birth of her first child. There was no obvious cause: her pregnancy and the birth went smoothly and she has a very supportive family. This only made her feel worse: “It makes you feel more guilty. You think: ‘There is no reason I should be feeling like this. Other people cope, I must be doing a terrible job.’ Then, you feel worse and just spiral down to feeling like a useless, worthless mother.”

Polly’s illness crippled her ability to function normally. “I couldn’t turn the steriliser on, or even write my own name.” The memories of this dark period of her life are still too raw for her to talk about in any detail, but she identifies one overwhelming feeling: “I was utterly convinced I couldn’t do it, that the baby would be better off with someone else looking after her.” Every normal new mother fear was magnified in Polly’s head. “If you have post-natal depression, your child vomiting after a feed is the most traumatic thing in the world. It just convinces you that you are a terrible mother.”

Polly left the UAE to be with her family while she received treatment. “The illness lasted five months. After six months, I was back at work,” she says. Treatment was a mixture of practical support, psychotherapy, alternative therapy and medication. “I was prescribed sleeping pills to help me sleep. Once you sort the sleeping bit out, you can get the psychological bit sorted.” She also took antidepressants for just under a year.

Polly clearly remembers the day when her baby was four months old and she knew she was on the road to recovery. “I just looked at her, sitting there gurgling at me, and I thought: ‘For someone who doesn’t know what to do, your baby looks all right!’ It was like a cloud lifting. I felt that I was looking at her properly for the first time and a bucket full of love exploded inside me.” Now fully recovered and thinking of having another baby, Polly still feels sad about the time lost when she was ill. “It’s a shame when I see photos of her during that gap, because I wasn’t there. Physically I was, but mentally, emotionally, the love was not there. I was just going through the motions.”

Post-natal depression can last weeks or months, but the earlier a sufferer receives treatment, the shorter and less severe it usually is. “We treat post-natal depression the same as we would treat any depression. The only difference is that this is triggered by the birth of a child, and because it has an impact on the mother’s relationship with the child, there is a great deal of concern about it,” says Dr Yousef Abou Allaban, the consultant psychiatrist and director of the American Center of Psychiatry and Neurology in Abu Dhabi. “The condition must be treated, but not necessarily with medication. For mild to moderate depression, we can treat it with psychotherapy alone. However, severe depression really needs to be treated with medication as well as psychotherapy.” Around three per cent of PND sufferers develop severe depression and require antidepressants. There are many antidepressants which do not affect breast milk, so feeding can continue during treatment.

A more severe form of post-natal mental illness is puerperal psychosis, which affects one in 1,000 mothers. It occurs very suddenly, often within the first 10 days after delivery, and can be life threatening for both the mother and the child. This illness is similar to manic depression or bipolar disorder, and is characterised by erratic behaviour. The symptoms include restlessness, excitement, elation and insomnia. This can develop into general confusion and disorientation. A woman suffering from puerperal psychosis may find it difficult to relate to her environment, and fail to recognise family members. She may even suffer delusions or hallucinations. A mother who is exhibiting any of these symptoms needs urgent medical attention, as there is significant risk of suicide or harm to the baby.

Sarah, originally from the UK, was living in Dubai. “I was living the picture postcard life. I was so happy,” she remembers. She had married her husband on a Dubai beach in 2005, and a year later her son was born. However, a couple of months after the birth, external stresses started to take their toll. Her husband started a new job involving long, unsociable hours and they struggled to move from a one- to a two-bedroom apartment at a time when rents were increasing by thousands of dirhams.

At the same time, Sarah was increasingly isolated from her friends, none of whom had children, and her family was not nearby. She became very depressed. “I’m not a depressive person, but I felt sad and very lonely. I was having panic attacks at very small things. Things gradually got worse, and I stopped sleeping. Then things rapidly spiralled out of control.” After struggling for four months, Sarah’s depression got so bad that she had barely slept at all for a period of six weeks. She eventually visited a psychiatrist and was advised to return to the UK for treatment immediately. “When he said that, my world fell apart. I felt I had let everyone down and it was all my fault. I just shut down and couldn’t carry on.”

By the time she arrived in the UK, Sarah had developed full-blown psychosis. She was sent to a mental hospital where she was given medication and, initially, slipped further into psychosis. “I had delusions. I was hallucinating. I thought the nurses and doctors were trying to kill me.” The turning point was when she was admitted to a specialist mother and baby psychiatric unit. After six weeks there, she was discharged from the hospital and had daily, then weekly, check-ups, followed by cognitive behavioural therapy once a fortnight for the next two years.

“My son lost his mum for 12 months. It was 10 to 12 months before I felt I could be OK again,” Sarah recalls. “I will never be the same again, but life’s worth living now and I never thought I’d say that. The key is to take it one step at a time.” Sarah’s illness might not have become so severe had her PND been identified and treated. At her six-week check-up in Dubai, a nurse had asked her a series of questions about her mental state. “I answered ‘yes’ to all the questions but nothing ever came of it. The gynaecologist put my feelings of anxiety and lack of sleep down to new mother nerves and said: ‘You’ll be fine, don’t worry’.”

Despite the prevalence of PND, there is little education about it or post-natal monitoring of mothers. Sarah agrees that the stigma of having a mental health problem would in itself prevent most women from seeking help. “I’d never even heard of post-natal depression before I got ill. I thought people who were depressed should just pull their socks up.” She adds: “Women should know about it. It can just happen. It can be anyone.”

Sarah is pregnant again, news which was greeted with delight and apprehension by her family, but she is very positive and has a great support network in place. “The most important thing to know is that it does end. When you are ill you feel it is for life, that you will never feel better, that there is no hope. If I can come back from that, pregnant again, then there is light at the end of the tunnel.”

Useful websites: The Association for Post Natal Illness (www.apni.org); The National Childbirth Trust (www.nct.org.uk); Post-partum Support International (www.postpartum.net); Mind, a mental health charity (www.mind.org.uk); general depression advice www.depnet.ae


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