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This Month's Feature Article seriously blue WITH AS MANY AS ONE IN FIVE WOMEN SUFFERING FROM POSTNATAL DEPRESSION, IT’S ESSENTIAL TO BE AWARE OF THE SYMPTOMS WORDS JODIE THOMSON

There was a distinct moment in the weeks after my twins were born when everything felt black. Alone on the couch one night, exhausted and aching from the rigours of twin breastfeeding, I listened with dread for any sounds of them waking. I was anxious about the night ahead, the pain of it all and the worry. I started crying, and admitted to myself with some shock, ‘I’m not enjoying this, it’s too hard, I don’t want to do it any more.’
Luckily for me, that was one of only a few blue moments, most likely fuelled by tiredness and post-birth hormones. It was gone the minute
I clapped eyes on my two little girls’ tiny faces.
Most new mums report some degree of baby blues because, let’s face it, having a baby is one of the most physically and emotionally difficult things you’ll ever do. But what happens when that sadness doesn’t stop and the bleak thoughts lead you into a downward spiral of unhappiness? It’s called postnatal depression, or PND, and is more common than you might think. Officially, one in seven Australian women suffer from PND, according to Beyond Blue, the national depression initiative. That’s about 14 percent of new mothers, or 50,000 Australian women a year.
But it’s thought PND could affect as many as one in five new mums, because some women are reluctant to admit they’re not well. Recent research at the University of Adelaide found that many women are hiding their depression behind the ever-smiling mask of “supermum”. ‘The mask is often worn because of cultural ideologies and media-created images concerning the need to appear perfect in the role of mother,’ says Victoria Williamson, who conducted the study.
Some women see having PND as being a failure, a terrible mother, says Dr Nicole Highet, deputy chief executive officer of Beyond Blue. ‘There seems to be some competitiveness, and pressure to be seen as coping, and to show that everything’s going smoothly,’ Dr Highet says.
When new mums don’t acknowledge the fact that they may be suffering PND, symptoms can become severe, making treatment more difficult. Most women don’t seek help until they reach crisis point, according to a study conducted by Dr Michelle McCarthy at Sydney’s Macquarie University. ‘For some this meant not being able to look after their baby or no longer wanting their baby, while others became suicidal, requiring hospitalisation,’ says Dr McCarthy.
Family doctor and well-known media commentator Dr John D’Arcy agrees that letting PND go without treatment can be dangerous. ‘Because there’s no help, no discussion about it and no cognitive support, the mums go deeper and deeper into it,’ Dr D’Arcy says. ‘They hate the baby, their partner, their life and their personality, feel totally inadequate and drift into this incredible pit of depression.’

WHO GETS POSTNATAL DEPRESSION?
It can strike any new mother, but PND can be triggered by certain events or circumstances. A history of depression, difficult pregnancy or labour can all kick-start an episode. Other life issues, such as relationship troubles, the death of a loved one, moving house or financial strife can also be the cause. Or it may be prompted by the practical realities of looking after a new baby: exhaustion, a baby who won’t stop crying or the isolation of being at home all day.
‘Biochemically, a mother’s hormones are very different after the birth,’ says Dr D’Arcy. ‘The endorphins that get pumped out at the time of the delivery drift away and you feel lousy. Lack of sleep makes you down-in-the-dumps. There’s this whole crescendo of factors that lead to it.’
A history of depression can make PND more likely. ‘If the mum has suffered bad premenstrual tension there’s a greater incidence of postnatal depression,’ adds Dr D’Arcy. It’s also important to understand that PND is just a form of depression. ‘It’s not a different illness to depression at any other time,’ says Dr Nicole Highet of Beyond Blue. ‘It’s just that the events of having a baby make it more likely to occur at that time.’

DO I HAVE POSTNATAL DEPRESSION?
At what point does a normal dose of the baby blues develop into postnatal depression? Simply, when it goes on for more than a week or two. Some form of baby blues affects around 80 percent of new mothers, usually between the third and 10th day after giving birth. But PND can also hit women up to a year, or even more, beyond that. ‘It’s most common in the first six weeks, but can occur after that,’ says Dr Highet.
Symptoms can include low moods, exhaustion, anxiety or panic, feeling sad or tearful, having sleep troubles such as insomnia or nightmares, or believing you’re not a good mum. More severe symptoms can include an inability to cope with a daily routine, or thoughts of suicide.
One way to confirm if you’re suffering PND is to fill out a depression self-assessment checklist, such as those available on the Beyond Blue or the Black Dog Institute websites. ‘If you’re feeling like that for over two weeks, go to your GP and take along the checklist,’ says Dr Highet.

TREATMENT OPTIONS
Treatment will depend on the severity of the symptoms and the individual circumstances. ‘For mild depression, exercise and support groups can be effective,’ explains Dr Highet. ‘More severe cases affect all areas of your functioning and there’s a greater likelihood of needing medical intervention and a longer road to recovery.’
Treated early, PND can be dealt with effectively. ‘In general, if it’s not entrenched or profound depression, women do really well if it’s picked up early,’ says Lisiane La Touche, director of social work/psychology at Tresillian. ‘Usually we find a combination of individual and group therapy will work and there’s no need for medication. There is only a small percentage of people who do require medication.’
Tresillian offers an eight-week program to treat PND, incorporating specific therapeutic support groups. In more severe cases, medical intervention can involve anti-depressant medication, and/or more intensive therapy, such as cognitive behavioural therapy. ‘This really targets people’s thinking or behaviour and can be very powerful in terms of the person coming back from the depression,’ says Dr Highet.
Only a doctor can determine whether anti-depressant medication is required. There are certain classes of medication that can be taken while still breastfeeding.

HOW TO STAY HAPPY
First of all, be mentally prepared that having a baby can be tough. ‘Factor it into your plot and plan,’ says Dr D’Arcy. ‘Appreciate that it will be hard, and have a plan to deal with things if it’s crook. The most important thing is to be aware, and if you have a hard time, understand it doesn’t mean you’re not an adequate individual.’
Learn as much as you can about dealing with a newborn while you’re pregnant and preparing for the birth. ‘So much care and attention is placed into the getting pregnant and the antenatal period,’ says Dr D’Arcy. ‘The same care needs to be put into the postnatal period. It’s a crucial time for the early development of that child and the bonding between mother and baby.’
Once the baby arrives, get out every day, even just for a walk around the block. ‘Exercise is essential and there’s evidence that it increases levels of serotonin in the body and reduces the incidence of depression,’ says Dr D’Arcy.
Dr Highet advises seeking out other mothers who are willing to be honest. ‘If you’re in a mothers’ group where everyone’s saying things are perfect, you won’t relate to them. Seek out like-minded women. If one person says they feel they’re not coping, it gives permission for other people to speak out too,’ she says.
When my twins were born, my daily walks with the double pram in the winter sunshine were when I felt happiest. The girls slept soundly and I always felt really energised. My other sanity-busters were my regular meetings with the local mothers’ group. Luckily, they were more than happy to whinge and share their horror stories, with plenty of good humour. Many a morning I staggered along to my mothers’ group, feeling wrecked after a rough night, only to find half the group in an even worse state. Over coffees, we would end up rolling our eyes at what our tiny offspring were putting us through.
Looking back, I realise how lucky I was that my blue moments were just that – moments. But for the many other mothers whose sad moments slip into depression, be assured it’s got nothing to do with your ability as a mother and there’s lots of good help available.

MY STORY
After the birth of her first daughter 15 years ago, Michelle Fletcher suffered postnatal depression for two-and-a-half years before being diagnosed. Then, when her third child was six months old, she was hit with it severely. Now fully recovered, Michelle is the national chair of the Beyond Blue postnatal depression consumer reference group.
It took me four years to fall pregnant with our first child and after a very difficult birth she was a very difficult baby. She never slept, ever, and cried a lot. I was teary, angry and frustrated. Out of desperation I went to a playgroup, hoping other mothers would say, ‘It’s awful for me too,’ but none of them did. I’ve since found out a lot of them were putting on this brave facade.
When Stephanie was two-and-a-half, I was asked to run a parenting course. One session was on postnatal depression, which I’d never heard of and when I saw all the symptoms, I realised what was wrong with me. It was such a relief. I then plugged myself into a therapeutic group and that was enough to work through my depression.
My second daughter Alexandra was a dream baby and I had no troubles. But Jonathon, my third baby, breastfed every hour around the clock. By the time he was about six months old things started to cave in. Suddenly, I went from holding it together to being really sick. I was curled up in the foetal position and couldn’t bring myself to touch my baby. I was a wreck, rocking backwards and forwards, and at one point felt suicidal. After seeing a psychiatrist I took anti-depressants for a while. It took me three months to fully recover.
Now those days are so far behind me, I can see some good came out of it all. I wish I’d been more relaxed about things but I’m a much better parent now. Mums need to know it can be treated effectively. They just need to get help early.’

RESOURCES
FURTHER READING
• Postnatal Depression by Paula Nicolson (John Wiley & Sons, $23.95).
• Postnatal Depression: Families in Turmoil by Lara Bishop (Halstead Press, $22.95).
• Beating the Blues by Susan Tanner and Jillian Ball (Susan Tanner and Jillian Ball, $29.95).
• Postnatal Depression and Breastfeeding Produced by the Australian Breastfeeding Association, $4.99. Available online at www.mothersdirect.com.au.

USEFUL CONTACTS
• www.beyondblue.org.au Information about issues associated with depression.
• www.blackdoginstitute.org.au Research and educational information on depression.
• Karitane Comprehensive services for mothers and babies. www.karitane.com.au.
• Tresillian Family Care Centres Practical advice on caring for babies. www.tresillian.net.
• Lifeline 24-hour counselling on 13 11 14.