Recognising the signs of postnatal depression and anxiety

This post was contributed by Diabetes Educator and Registered Nurse/midwife, Jenny van Gemert MNurs GDipMid GDipEd (Facebook and Insta).

What is postnatal depression and anxiety?

Postnatal depression or anxiety refers to depression or anxiety that develops in either the mother or the father within a year of giving birth.

The symptoms of postnatal depression and anxiety are the same as those experienced when depression and anxiety occur at any other time in life. Depression is characterised by a low or depressed mood for most of the time for two weeks or more. In addition to a depressed mood, those with depression may lose interest in activities they previously enjoyed, experience changes in their sleep or appetite, feel fatigued or agitated, and lack concentration. They may also experience feelings of guilt, shame or worthlessness.

Anxiety is characterised by excessive worry for most of the time for two weeks or more. The worry is difficult to control and may be accompanied by fatigue, restlessness, difficulty concentrating, irritability, muscle tension and sleep disturbance. Some individuals with anxiety may also have panic attacks, where an abrupt surge of intense fear and discomfort is experienced. This manifests with a range of physical symptoms, including sweating, trembling, palpitations, nausea and chest pain.

Postnatal depression and anxiety may occur together, and the symptoms of each condition can overlap. In more severe cases of postnatal depression and anxiety, people may experience thoughts of suicide or harming themselves or their baby.

While postnatal depression and anxiety are the most common mental health conditions that occur in the period surrounding a baby’s birth, postnatal psychosis (puerperal psychosis) can also occur. This serious mental health conditions affects 1–2 in every 1000 mothers. It leads to marked changes in a mother’s behaviour and a woman with postnatal psychosis may experience symptoms such as delusions and hallucinations.

How do I know if I have postnatal depression and/or anxiety?

Diagnosing postnatal depression and anxiety can be difficult. Firstly, it must be differentiated from the ‘baby blues’. The ‘baby blues’ refers to a common experience of many women, where they may feel teary, overwhelmed and fatigued for a number of days following birth. These symptoms resolve within two weeks of onset and can be managed through support and care from loved ones, as well as extra sleep. While it’s not certain why the ‘baby blues’ happens, it may be partly attributed to the hormonal changes and exhaustion that occur before and after birth.

Postnatal depression must also be differentiated from the normal reality of becoming a new parent. During this time, the immense life changes and the lack of sleep can leave anyone feeling exhausted and overwhelmed. However, those who are coping can still maintain a positive outlook on life, still experience joy and acknowledge that things will improve. In contrast, those with postnatal depression can’t recognise the temporary nature of their situation, can’t experience joy and will see no light at the end of the tunnel.

If you’re consistently feeling down or anxious, or feel like you’re not coping, you may be experiencing postnatal depression or anxiety. Furthermore, if your loved ones are concerned, this may indicate it’s time to seek help – sooner rather than later.

What should I do if I think I have postnatal depression and/or anxiety?

Initially, there are a number of people you can talk to. You can raise how you’ve been feeling at your regular appointment with your Maternal and Child Health Nurse, or make an appointment with your GP. Alternatively, you can discuss how you’ve been coping with your obstetrician – by contacting them directly or at your six-week check-up. These healthcare professionals will likely ask you to complete a questionnaire about your mental health, most commonly the Edinburgh Postnatal Depression Scale.

Talking to a healthcare professional can feel daunting, or intrusive. However, you shouldn’t feel embarrassed or ashamed to be honest with your feelings. They encounter people in your situation more often than you’d think. Furthermore, it’s best they understand how severe your postnatal depression and/or anxiety is in order for them to give appropriate guidance on your next steps.

If you don’t wish to talk to someone face-to-face, there are also a number of organisations that provide a phone service (see the list provided at the end of this article).

What are the treatment options for postnatal depression and/or anxiety?

Upon a diagnosis of post-natal depression and/or anxiety, there are a number of different treatment options.

Firstly, it’s important to ensure that you have sufficient emotional and practical support. Following this, your doctor may recommend psychological therapy (counselling). This may be provided by a psychiatrist or a psychologist. If you decide to see a psychologist, your GP can create a Mental Health Plan for you. This allows you to receive a Medicare rebate for ten appointments, meaning your appointment will be bulk-billed or subsidised, depending on who you are referred to.

In many cases, psychological therapy is sufficient. However, some patients may require medication to feel better. There are a number of medications that are safe to use when breastfeeding, and your doctor will advise which medication is right for you. Your GP may prescribe the medication, or they may refer you to a psychiatrist (mental health specialist). The length of time you need to remain on this medication will depend on your own situation and will be determined with your doctor. When the time is right, they’ll talk to you about the safest option for discontinuing therapy.

Lastly, for very severe cases of postnatal depression and/or anxiety, or cases of postnatal psychosis, you may be referred to a mother-baby unit in a hospital. This allows your baby to stay with you at hospital while you are treated as an inpatient. This may occur in a public or private hospital. However, if you have no private health insurance, a stay in a private hospital will incur a cost.

Will postnatal depression or anxiety occur again if I have another baby?

If you’ve had postnatal depression or anxiety in a previous pregnancy, or experienced depression or anxiety during another stage in life, you do have a higher likelihood of experiencing it again with your next baby. However, it’s not a given. It’s important to let your doctor know early in your next pregnancy, so steps can be taken to help prevent it from reoccurring. If you do experience postnatal depression and/or anxiety again, your previous experience will ensure you’re better prepared for it and have greater insight into the condition.

Where else can I seek help?

As well as your Maternal and Child Health Nurse, GP and obstetrician, there are several organisations that can help you. These include:

• Perinatal Anxiety and Depression Australia (PANDA):
  • www.panda.org.au
  • 1300 726 306
• Beyond Blue:
  • www.beyondblue.org.au
  • 1300 224 636
• Maternal and Child Health Line:
  • 13 22 29 (24hr telephone service)