Postnatal depression (now often termed perinatal distress, as it can start during pregnancy), affects 10 to 15% of South African women, according to the South African Depression and Anxiety Group (SADAG).
Journalist Lauren Shapiro was one of these women. She was delighted when she discovered she was pregnant with her third baby. “I’d had two already and had loved being pregnant, so I didn’t think this time would be any different,” she recalls. “But I couldn’t shake this feeling of deep, heavy oppression.”
Normally sunny and optimistic, she became withdrawn and edgy. “I would want to scream at strangers in shopping centres. I flew into disproportionate rages with my husband and children. I feared going to fetch my kids from preschool because of the supposed judgment of other parents.”
The symptoms were not only psychological, but physical too. “My heart would race – sometimes for no apparent reason. I had trouble breathing. My mind would fog over, and I’d start sweating and shaking.”
Family and friends encouraged her to seek professional help, but she resisted. “There’s a huge stigma attached to mental illness,” she admits. “I was terrified of being judged an unfit mother; that my children would be taken away from me.”
However, when she started to have dark thoughts of self-harm and death, she consented to being treated. Even before her baby was born, she was hospitalised and put on medication to control the symptoms as well as the causes of her condition. “It was overwhelming and scary, for me and for my family,” she recalls.
I wish I’d known then how common and treatable postnatal depression is
Fortunately, she was stabilised by the time her baby was born, and after many months of medication, therapy and support, Lauren made a full recovery. “I wish I’d known then how common and treatable postnatal depression is,” she confesses. “If I’d sought help sooner, I may not have gotten so bad.”
Recognising Postnatal Depression (PND)
Although PND is highly treatable and curable, it is generally under-diagnosed, which means that many women struggle unnecessarily, with repercussions that can negatively affect marriages, families, careers and communities.
One of the reasons for the fact that it is commonly under-diagnosed is because so many of the symptoms of postnatal depression/perinatal distress (PND) could also be attributed to tiredness or to an emotional response to a massive life change with new demands and extreme new levels of responsibility. We spoke to Dr Sarah Howard, a psychiatrist in private practice, about how to identify PND and seek help for this condition.
“Postnatal depression can occur at any time in the postnatal period, which is defined as the first year after birth,” she says. “The symptoms are feelings of hopelessness and guilt, a low mood, anxiety, lack of energy and agitation. This can be accompanied by changes in sleep patterns – either not sleeping very well or waking in the early morning – and changes in appetite resulting in weight loss or in comfort eating.”
PND is more likely to occur if the new mother already suffers from depression or if she has a first-degree relative who suffers from depression, and there are other factors that can contribute, such as a vitamin B deficiency.
Sarah says it’s important to distinguish between PND and “the baby blues”, which often occur in the first week after your baby is born as a result of the massive hormone change in going from being pregnant to not being pregnant. “You can feel tearful, anxious and quite down. But only after the symptoms are prolonged for a period of longer than two weeks, one would consider the diagnosis of depression.”
Treating Postnatal Depression (PND)
If this is the case, Sarah says your first step should be to talk to a friend or family member. “Acknowledging the fact that you are struggling is important – especially as mothers often feel guilty that they are not overwhelmed with happiness. And remember that PND can come on at any point in the first year of your baby’s life, so don’t ignore your feelings because they didn’t come on in those early weeks,” Sarah says.
The next step, she says, is talking to a healthcare professional, like your GP, gynaecologist, clinic sister, or a psychologist for their help in getting the counselling that you need. There are also many different NGOs, including SADAG, FAMSA and the Parent Centre, which offer postnatal support such as support groups for mothers as well as other resources. Many private clinics also offer mother and baby groups, where new mothers can get support and share experiences.
However, if therapy and support are not helping, or if the mother is severely depressed, considering suicide or having thoughts of harming the baby, then an appropriate course of medication will be prescribed.
Sarah says, “Mothers in this situation should definitely not be reluctant to medicate if necessary. Many antidepressants are safe to be used in breastfeeding, and not treating the depression or distress can result in difficulties with childcare, mother-and-child bonding, and overall quality of life and relationships.”
Sarah points out that when a mother is being treated with an antidepressant, she should continue treatment for two years after the point at which her symptoms go into remission. “If she goes off the medication before that, there is a higher probability of a relapse,” she explains.
You may have heard of Eglonyl, which is frequently prescribed by gynaes and GPs for women battling the baby blues. It has a helpful side effect of stimulating breast milk production. However, Sarah says that if you have been diagnosed with a major depressive disorder, an antidepressant such as an SSRI would be your first line of treatment.
Even if the mother is taking medication for her PND, Sarah advises that she continues with therapy as well.
What about postnatal psychosis?
In very rare cases, a mother might develop postnatal psychosis, a condition in which she has auditory hallucinations and delusions. Sarah says that this extreme condition can put the mother and baby at risk, and the mother should be admitted to hospital – preferably along with her baby.
“However, if there is a supportive and available family structure, the condition can be managed at home,” she says.
The good news
For mothers battling with anxiety, distress or depression around the birth of their baby, it is reassuring to know that these conditions are largely treatable. The most important message to take-away from reading this is to seek help as soon as possible. Don’t wonder, “Is it or isn’t it?”. Rather speak to a healthcare professional, as early intervention can stop it from getting a whole lot worse.
Remember, you owe it to yourself and your baby to be the best and happiest mother you can be.
Book special offer
Lauren Shapiro has written a book Through the Window: How I Beat PND about her experience, in the hope that promoting awareness will prevent others from suffering as she did. 1Life Blog readers can use the discount code “1Life20” when purchasing a copy.
Frequently asked questions
Postnatal depression, now often termed perinatal distress, can occur during pregnancy or within the first year after birth. It affects 10 to 15% of South African women, according to the South African Depression and Anxiety Group (SADAG).
The symptoms of postnatal depression include feelings of hopelessness and guilt, low mood, anxiety, lack of energy, agitation, changes in sleep patterns, and changes in appetite. It can be accompanied by physical symptoms like a racing heart, trouble breathing, sweating, and shaking.
The "baby blues" typically occur in the first week after childbirth due to hormone changes. While feeling tearful, anxious, and down is normal during this time, if these symptoms persist for longer than two weeks, it could be an indication of postnatal depression.
If you suspect you have postnatal depression, the first step is to talk to a friend or family member about your feelings. Don't ignore your emotions just because they didn't arise in the early weeks after childbirth. Seek help from a healthcare professional such as a GP, gynaecologist, clinic sister, or psychologist for counselling. There are also support groups and resources offered by NGOs like SADAG, FAMSA, and the Parent Centre.
Yes, in severe cases or if therapy and support are not sufficient, medication may be prescribed. Many antidepressants are safe to use during breastfeeding, and treating depression is essential for the well-being of the mother and the baby. Continuing treatment for about two years after remission of symptoms is often recommended to reduce the risk of relapse.
Postnatal psychosis is an extreme and rare condition where the mother may experience auditory hallucinations and delusions. Unlike postnatal depression, postnatal psychosis requires urgent medical attention and may necessitate hospitalization to ensure the safety of both the mother and the baby.