P OSTNATAL D EPRESSION

References * Mental Health Foundation (2002) Postnatal Depression Mental Health Information New Zealand (MHINZ) *Boath,E. & Henshaw, C. (2001) The treatment depression: a comprehensive literature review, Journal of Reproductive and Infant Psychology, Vol. 19, No. 3, p The Royal College of Psychiatrists. Postnatal depression. Postnatal depression Postnatal depression

Post natal Depression The term postnatal depression refers to a number of emotional changes which may occur after childbirth. These include -the “baby blues”, -postnatal depression -postnatal psychosis content/uploads/2011/04/postnatal-depression1.jpg

Postnatal or maternity (baby) blues -very common – up to 80% of women experience -typically peaks 3-5 days after birth -brief period of mother feeling down and tearful and a feeling of not coping. -feeling passes after a few days -regarded as a normal reaction resulting from hormonal changes after birth.

M ANAGEMENT OF “ BABY BLUES ” - reassurance - practical help - rest, - healthy nutritious food - - education - -

Postnatal depression (PND) -more serious than baby blues -10–20% of women experience PND -may occur any time during the first year after childbirth and may continue for as long as 1-2 years. Can affect anyone. -combination of physical, emotional and environmental factors can trigger PND.

Associated risks of PND -the question as to the impact PND has on the mother-baby relationship is unproven. Some suggest it may affect infant cognitive and emotional development. However it is unlikely where there are other people around the baby and child. -adverse effects on family as a whole.

Risk factors – before pregnancy and birth -past history of depression or mental illness. -relationship difficulties. -little social support. -onset of depression during pregnancy. -stresses – financial/housing problems.

Risk factors related to birth -birth complications resulting in caesarean delivery. -birth experience not living up to expectations. -birth of a baby with a congenital abnormality or a baby who is ill following birth.

Risk factors after birth -persisting postnatal blues. …prolonged or continuing….. -not wanting to hold her baby, or feeling detached or negative about her baby. -sleep problems (mother). -fussy baby, problems with feeding, colic. -lack of support. -ongoing social problems.

Physical symptoms of PND -change in sleeping patterns -change in appetite -decreased energy, tiredness and fatigue -physical slowing or agitation

cognitive symptoms of PND -thoughts of worthlessness and inadequacy -thoughts of hopelessness and death -difficulty thinking clearly -anxiety symptoms – very common -thoughts of loneliness.

Symptoms – mood symptoms of PND -persistent low, sad or depressed mood -loss of interest and pleasure in usual activities -irritable mood 2.jpg

Outlook for PND -without treatment may last 6 months or more -with treatment, 70 – 80% of women will recover much sooner. -majority of women will have a complete recovery. -20 – 30% will improve but still have some symptoms persisting for months later. -for a minority, 5 – 10%, no improvement and will remain unwell for two or more years.

Help and support -General practitioner -Plunket nurse / family centres / plunket line -Family-Counsellor/psychologist -Parent Help -Maternal mental health services at local hospital -Iwi health services -Other mothers

Treatment -Counselling – supportive listening, practical problem solving and information giving. -Medication: antidepressants -Combination of both. Key : mother acknowledging that she needs help and sensitive, non judgmental help being available. Often mothers with PND find the greatest support from mothers who have had PND.

Postnatal psychosis -rare – one or two per 1000 births. -usually within 1 – 3 weeks of delivery. -prompt diagnosis and expert treatment is critical. -risk factors similar to those of depression. -history of mood disorders. -no previous history

Signs and Symptoms Mood disturbance – depression or mania or both, with symptoms of psychosis at the same time. Symptoms of psychosis -delusions (unusual or altered belief) -thought disturbances -hallucinations (occur when someone hears, feels, sees, or smells something which is not there)

Treatment-Hospitalisation. -Crisis intervention. -Medications: anti-psychotic medication or mood stabilizer. -ongoing support …….

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In an attempt to try and identify women with PND early there are various questionnaires available. One that has been commonly used is the Edinburgh postnatal depression scale.