Postpartum Depression & Anxiety Q&A

It's Maternal Mental Health Awareness Week, and we've teamed up with two experts, midwife Tessa van der Vord (@mentalhealth_midwife) and clinical psychologist Dr Tess Browne (@drtessbrowne). We've put together their expert advice to help inform our community and offer support for parents who are suffering from symptoms of postpartum depression and anxiety. 

According to Dr Tess postpartum depression and anxiety are two of the most common Perinatal Mood and Anxiety Disorders (PMAD), so if you identify yourself in any of the symptoms listed below then you're not alone. 

One in five new mums and one in ten new dads experience a PMAD during pregnancy or within the first year postpartum.

What's the difference between postpartum depression (PPD) and postpartum anxiety (PPA)?

 

Postpartum or (postnatal) Depression refers to the experience of having a clinically low mood during the first year of parenthood (although in reality, it can exceed this period).

Symptoms of postpartum depression may include:

• Consistent low mood
• Guilt, shame or hopelessness
• Lack of interest in your baby
• Loss of interest and joy in your usual activities
• Crying more than usual
• Changes in appetite or eating
• Sleep difficulties (aside from sleep deprivation as a result of your baby)
• Thoughts of hurting yourself or your baby

According to midwife Tessa, "postnatal depression has very similar symptoms as 'typical' depression, but there is usually a focus around the baby or capability to parent. For example, the parent may not feel a sense of attachment to their baby or they may feel they’re not good enough to be their parent. The parent can feel very low, tearful, little energy, trouble sleeping, change in eating habits, low libido and feelings of helplessness. Some parents often feel very little or no enjoyment whatsoever."

Postpartum Anxiety (PPA) refers to the experience of feeling highly anxious during this period. Midwife Tessa says when postpartum anxiety sets in, "there can be a lot of excessive worry surrounding the baby’s health and well-being, or indeed their own."

Symptoms of postpartum anxiety typically include:

• Extreme amounts of worry and fear, often about the health and safety of your baby
• An urge for reassurance or avoidance of anxiety-provoking situations
• Acute physical sensations, such as chest pain, heart palpitations, shallow breathing, muscle tension, dizziness or headaches.

Is PPD the same as the 'baby blues'?

 

Midwife Tess reminds us that "it's important not to confuse postnatal depression with baby blues", which is thought to affect that up to 80% of mothers in the initial days and couple of weeks weeks following birth.

Dr Tess explains the cause of 'baby blues'; "The heightened emotional state known as 'baby blues' is caused by hormonal changes, and also because once the initial 'high' of birth is over, fears may start to set in. A degree of heightened anxiety is also completely normal and to be expected in motherhood."

However, if symptoms of either persist over many weeks, are severe and have a significant impact on your day-to-day functioning, it’s worth speaking to a qualified health professional about them. Both midwife Tessa and Dr Tess agree that while baby blues usually appears and resolves itself within weeks, postpartum depression will often appear after a couple of weeks and is likely to persist until help is sought.

 

What causes PPD and PPA?

 

According to midwife Tessa, perinatal anxiety and depression does not discriminate - anyone can become unwell with it.

She says "those who are more likely to suffer are typically parents who have experienced perinatal anxiety or depression before, those who may have a history of anxiety and depression (or other mental illness) and those who discontinue medication for their mental health abruptly without supervision. Nonetheless, even those who have no history of mental illness can still develop symptoms."

While it is agreed that there is no one cause for PMADs but according to clinical psychologist Dr Tess Browne there are some factors which can increase a person’s vulnerability. These include biological, hormonal, psychological and environmental factors.

• Biological factors can include a family or personal history of mental ill health, a traumatic fertility, pregnancy, labour or delivery, and general physical ill health.
• Hormonal factors include the changes and fluctuations in hormones during and around pregnancy and childbirth.
• Psychological risk factors include personality characteristics such as perfectionism or excessively high standards.
• Social or environmental risk factors include previous experiences of trauma, lack of social support, significant life events or transitions, and financial, health or other significant stressors.

According to Dr Tess, "it's important to bear in mind that experiences are all relative and vary from person to person. A delivery which was perceived as relatively straightforward from a medical perspective may have a long lasting impact on the mother. Similarly, a medically traumatic childbirth experience may have had less of a lasting mental impact on another person."

Where can new parents who are struggling with PPD or PPA get help?

 

Midwife Tessa urges parents who are struggling with their mental health to seek help; "unlike baby blues, perinatal anxiety and depression rarely goes away on its own. It’s highly likely the parent will need help with talking therapy to overcome it. Sometimes, medication is required but not always.

If you think you’re suffering from perinatal anxiety or depression, please speak to your midwife, GP or health visitor in the first instance who can have a more in-depth conversation with you around how you’re feeling. Following that, they will make a bespoke plan to support you going forward. Often, seeking help can feel like the hardest bit. However, it’s the first step towards returning back to a happier and more enjoyable life again. Your healthcare providers are there to support you, so it’s important you confide in them when needs be."

Dr Tess also urges parents "don't suffer in silence. There are an abundance of effective, evidence based treatments available which can truly transform your life and experiences as a parent."

She encourages parents who are concerned about their mental health to get in touch with the PANDAs Foundation and The Maternal Mental Health Alliance which both have online resources about PMADs and are a great source of support for anyone concerned about mental health during pregnancy or postpartum.

Read our blog How To Support A Partner With Postpartum Depression or Anxiety.