Depression

Updated 23 June 2014

Happy event? When motherhood hurts

Between 10% and 40% of women develop Postnatal Depression (PND). If one takes the lowest figure of 10%, there are at least 50 000 new cases of PND per year in South Africa.

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Between 10% and 40% of women develop Postnatal Depression (PND). If one takes the lowest figure of 10%, there are at least 50 000 new cases of PND per year in South Africa.

A recent study in Khayelitsha showed that more than 30% of new mothers in that community are suffering from PND. This is according to the Post Natal Depression Support Association (PNDSA).

What are the three types of postnatal emotional disorders?
According to the PNDSA, PND can present in three ways. These vary in time of onset, duration of illness, and severity of symptoms.

  • Postnatal “Blues”
  • Postnatal Depression (PND) & Anxiety
  • Postnatal Psychosis or Puerperal Psychosis

The Blues
Blues are commonly described as weepiness and emotional fluctuations that begin shortly after childbirth, and continue for only a few days. The onset is typically three to five days postpartum. The most commonly reported symptoms are tearfulness, tiredness, anxiety, over-emotional reactions, up and down mood swings, feeling low, and muddled thinking. The Blues affect between 30-80% of women – mean incidence across studies is 55.75%.

Research has shown that severe Blues may be predictors of PND. Usually re-assurance and sympathetic management is sufficient treatment. It is generally thought that the causes of the Blues may be associated with the changes in hormonal levels associated with childbirth.

Postnatal Depression and anxiety (PND)
Postnatal Depression is a more serious illness than the Blues, and the symptoms are more severe and last longer. The disorder is insidious and debilitating, and can develop at any time during the first year postpartum. Antenatal Depression is often found during pregnancy (10%), and is a good predictor of subsequent PND.

Between 10-40% of women develop Postnatal Depression. The range of these prevalence figures may partly be due to differences in diagnostic measurement and in differences in definition of the depression. Duration is a minimum of two weeks, but usually much longer. (It is thought that it may continue as a low-grade chronic depression if left untreated, becoming more severe with each subsequent pregnancy).

Symptoms may include tearfulness, despondency, feelings of inadequacy, numbness, suicidal ideation, sadness, reduced appetite and interest, insomnia, over-sensitivity, feelings of helplessness and hopelessness, excessive dependency, anxiety and despair, intense irritability, irrational fears and fantasies about her self or baby, feeling out of control.

A relationship has been found between the Blues and later-developing PND. This suggests that for some women there may be a hormonal component of postnatal depression and anxiety. Many of the symptoms of the Blues are also found in Postnatal Depression, but in a more severe form. Full recovery may take a long time, as the causes for the depression may lie in deep-seated past psychological traumas.

Treatment may require medication, and professional advice needs to be sought regarding what drugs can be safely taken during breastfeeding. “Talk therapy” is extremely helpful, and almost all women find great comfort in attending support groups, where they can share their painful feelings with others, knowing that they will not be judged as bad mothers.

Postnatal Psychosis
Postnatal (Puerperal) Psychosis is the most severe of the postpartum illnesses. Onset is typically within two to four weeks, but may be as late as eight weeks postpartum. Duration depends on speed of diagnosis and appropriate treatment. Symptoms include heightened or reduced motor activity, hallucinations, marked deviation in mood, severe depression, mania, or both, confusion, and delirium. Incidence is one or two per 1 000 postpartum women. The three most common diagnoses are unipolar depression, bipolar depression and schizophrenia. Treatment usually requires hospitalization and medication. The prognosis is generally good, and Postnatal Psychosis appears to respond well to anti-psychotic medication.

For more information on PND, visit the website of the Post Natal Support Association or contact the Mental Health Information Centre (021) 938 9229.

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Depression expert

Michael Simpson has been a senior psychiatric academic, researcher, and Professor in several countries, having worked at London University in the UK; McMaster University in Canada; Temple University in Philadelphia, USA.; and the University of Natal in South Africa.

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