An experienced Psychiatrist answers our questions about postnatal depression symptoms, stigma and misconceptions.
Postnatal depression can be a terribly isolating and crushing time for a parent. It’s made all the worse by the fact that so many people don’t want to talk about it. Hushed tones and obvious, visible discomfort makes those with postnatal depression feel less inclined to talk and to reach out for help. Yes, it’s a difficult topic — but it’s one that deserves more discussion, regardless.
In an attempt to keep the discussion going, I reached out to Doctor Victoria Khromova, Child and Adolescent Psychiatrist. Dr Khromova was kind enough to answer my questions about postnatal depression symptoms, myths and misconceptions. Fellow bloggers have also chipped in with some great questions.
You can find links to Khromova’s social media profiles and website at the bottom of this post — be sure to follow her for more insights.
While you’re here, you might want to check out my interview with Dr Sarah Mundy on the topic of Coronavirus and how it is impacting children.
We don’t hear much about antenatal depression. Is it common for postnatal depression start before the baby is born? If you catch it before the baby is born, is it easier to treat? — Lauren from Sahara Splash
You’re right, for some reason we do hear more about postnatal depression, but at the
end of the day antenatal, postnatal – they’re just terms indicating when the depression starts. The depression itself is still a similar illness whether you get it antenatally, postnatally or completely unrelated to childbirth. In the charity I volunteered with supporting parents – we tended to use the term ‘perinatal’ mental health trying to capture the whole time of pregnancy and post child-birth – which does tend to be a higher risk time for parents to develop mental health difficulties.
There are a number of estimates for how common antenatal depression is, a rough average from the research is that 1 in 6 mums will get this. Of those, just over a third will go on to have postnatal depression too.
Identifying the illness earlier just means that treatment can be started earlier and hopefully this will reduce the period of time that Mum is experiencing the illness, which will be good for both her and her child. And, certainly, national guidance encourages early detection and treatment including in pregnancy.
Sometimes when postnatal depression symptoms are left unchecked for longer periods of time, they can become harder to treat. But it’s worth keeping in mind that depression, at any time in life, is generally a self-limiting illness, so it would eventually resolve, but the person would have been suffering from a longer period of time. In pregnancy and childbirth this also has an impact on the baby, because it’s such a crucial time for development, so shortening the period of illness is very worthwhile for all involved.
Does postnatal depression relate to existing mental health conditions or are all mothers are susceptible to it? — Eileen from Crooked Flight
This is a bit of a controversial topic as the research done in this area has varying results. Though it seems like an obvious link, most studies have not found that any mental health difficulties postnatally can be predicted by previous mental health difficulties alone. The only exception being – where a mum has a diagnosis of bipolar disorder – she is more likely to have a relapse of this during perinatal period, which could be a depressive episode.
But there are many other social factors (such as poor relationship with a partner, having hostile in-laws, not having enough practical and social support) that do predict postnatal depression and can also be linked to mental health difficulties prior to becoming pregnant. So, if these are present the risk does increase.
Can fathers get postnatal depression, too? Is it common? If so, are the postnatal depression symptoms the same as those experienced by women? — Rebecca from Keene on Travel
Absolutely! And I am very keen that this is fully recognised, because I do think many Dads go unnoticed. During my volunteering work I have supported some dads, though they did not tend to access this kind of service nearly as much as mums.
Much less research has been done on dads, unfortunately, and the estimates they have come up with in terms of how many dads suffer with postnatal depression vary from around 1 in 100 to around 1 in 4 (which is more than mums!).
What we do know is that the mum’s postnatal depression is a huge factor in predicting paternal postnatal depression and some studies have shown that up to half of men whose partner has postnatal depression also develop postnatal depression.
Dad’s mental wellbeing is so important, not just for them, but also because their support is a vital factor for Mum’s mental wellbeing and the child’s development, and we know that Dad’s postnatal depression has an independent effect on the child’s wellbeing.
There is very little research into the symptoms of postnatal depression in dads and there is no separate checklist for Dads. What we do know is that it tends to develop slower and kicks in later on in the first year, rather than straight after birth.
From having supported dads with postnatal depression – they can get the usual symptoms of poor sleep, feeling like life is unlikely to get better, like there is nothing to look forward to and really struggling to enjoy anything. Often, they talk about:
- Feeling like an incompetent parent (often because they aren’t able to be as involved, or can feel pushed out in a mum-centric baby world)
- Disconnection from the child, and a feeling of failure over this
- Not being sure what their role is
A great resource I have found which I know Dads have appreciated and which I think describes all those feelings so well is the honest and poignant photobook called The Reluctant Father – created by a photographer who became a dad and didn’t love the experience (straight away).
What are some misconceptions you hear about postnatal depression?
That it’s all to do with hormones and it is somehow a completely different illness to ‘normal’ depression. The exact role of hormones in postnatal depression is still not fully understood and it is only one of the factors. Postnatal depression is not really a different entity to ‘normal’ depression and is treated in similar ways.
Another misconception is that one of the signs would be a mum who is not coping. So if a mum is getting up, getting her baby sorted out, attending to their needs, then she can’t be that depressed. That’s not the case – many, many mums with postnatal depression do just that, they may well get out the house and attend baby groups, but everything is twice as hard as it is for a mum without postnatal depression. Plus, it feels like something you do just because you do it. Not because you enjoy any of it.
Another common misconception surrounding postnatal depression is that most mums get it when they’ve just had a baby. Straight after having a baby you have all this support and check ins and everyone just swirls around you to support you, because you’re up every couple of hours and you’re exhausted. But for many people the depression can come later, at 6 months or 9 months, when support has very much subsided, there’s an expectation that you should now know what you’re doing because you’ve been alright for a few months and when you may well have to be returning to work.
Are there lesser-known postnatal depression symptoms you feel should be discussed?
Often people imagine that depression is being tearful, feeling like you’re not coping, feeling like a rubbish mum. But some symptoms are less obvious, but just as powerful.
Terror that you will harm your baby inadvertently – many mums describe very intrusive thoughts about what harm they might cause accidentally – they have images of dropping their baby, or falling asleep on the couch with them, or doing something else, which leave them feeling like awful mothers (even though they are not actually doing any of those things)
Emptiness is a common depressive symptom – where you don’t feel sad, you just feel … nothing. Initially this can be okay because you have that much to do, there might be not much room for feeling, but over time this becomes a very unpleasant experience as you just can’t connect with life or the people around you.
Thinking that nothing good can happen in the future – again this is a very core depressive symptom – hopelessness. And as a postnatal depression sufferer myself, this is something that hit me hard. I felt like my life was over, and I could not imagine that I would ever enjoy anything again. This is actually very worrying, because if you can’t even imagine that things might change for the better – what is the point in living?
If postnatal depression persists for years, at what point do we stop calling it ‘postnatal depression’ and start calling it ‘depression’?
As I said in the first answer – the words postnatal or postpartum just give an indication of when this particular depressive episode started. There isn’t anything ‘special’ about postnatal depression in terms of how you treat it.
Sometimes people think that postnatal depression is all about the hormonal changes, but studies show that though this is a factor, there’s a plethora of other factors, many of which are also factors for non-pregnancy related depression.
The World Health Organisation identifies the postnatal period as the first six weeks after birth, but most mental health clinicians would consider this to be longer e.g. until the child’s 1st birthday, though, the charity I volunteered for, for example, worked with parents until their child was 2 years old and considered any of their mental health difficulties perinatal.
Just under a third of women who have had postnatal depression continue to do so beyond the first year after birth. 1 in 4 women who have had depression in the first year will also have a subsequent relapse of depression.
Am I more likely to get postnatal depression with my next child if I’ve already experienced it?
Anecdotally I have heard many people discuss this possibility, and certainly as a clinician I would want to consider it. However, there isn’t a lot of hard evidence for this and there are no recommendations for specific follow up of mums who had postnatal depression in the past.
The factors that have consistently been shown to predict postnatal depression across a number of countries are:
- Poor partner relationship and support
- Poor wider network and support (both practical and emotional)
- Experiencing violence from your partner
- Having hostile in-laws
- The pregnancy not being intended
- Being a younger Mum
- Being unmarried
If these factors were present in the first pregnancy when postnatal depression was experienced and are still there during the second pregnancy then of course the risk remains high. But if they have changed (e.g. new partner, planned pregnancy later on in life, moving closer to supportive family) then the risk is lower.
I was diagnosed with postnatal depression, but I always felt a strong connection and love for my child. Sometimes I think people assume I didn’t bond because I had postnatal depression, is this a belief you come across often?
Often, I think we have quite an extreme view of what a depressed mum looks like. Often this involves ideas about not being able to meet the child’s needs, or maybe not feeling much love for the child or, as you say, somehow not bond with the child. But I think the reality is much more subtle, which is why a lot of mums with postnatal depression get missed.
When I suffered with postnatal depression what I found that is of course I knew I loved my daughter, and I was also very keen to meet her needs both physically and emotionally because I knew how important it was. But what I found was that it was hard. It felt like I had to really concentrate and so much of the time I felt overwhelmed by all the needs she did have.
I think that’s the difference, it’s not that mums with postnatal depression don’t feel love for their child, or don’t bond, it’s just that meeting their emotional needs takes more emotional work than it is for a mum who doesn’t have postnatal depression. And it’s often accompanied by not liking yourself, feeling like a failure because it is so hard.
It is worth noting that mum’s postnatal depression can affect what attachment style the baby develops in the first year, though it doesn’t affect it in all children.
Forming a secure attachment is a complex business and there are so many factors involved, but we do know that a mum having postnatal depression is one of them.
A huge thank you to Dr Victoria Khromova, who took time out of her busy schedule to talk about this hugely important topic. Dr Khromova is founder of Emerging Parent — visit this website for some really valuable resources and insights. You can also follow her on Facebook or on Twitter. Do you have any questions about postnatal depression symptoms or myths that weren’t explored here? Let me know and I might be able to explore them with another mental health professional in the coming months.