When Rachel* gave birth to her second child, Zach, she expected to feel much like she had after the birth of her daughter. But, instead of the intense emotion she had experienced the first time around, this time she felt nothing at all. As the steady stream of visitors told her what a beautiful baby she had, Rachel smiled and agreed. “But inside, I was just numb,” she says.

When she went home from hospital she got herself into a routine with the baby and her older child. She appeared to be coping well but she couldn’t help feeling that something just wasn’t right. “I became convinced that there was something wrong with my baby,” Rachel says. “Even though he fed and slept well and was content most of the time, I just couldn’t shake the feeling that Zach was going to die.”

She became fearful of everything that could possibly happen to her baby “… illness, SIDS, choking, drowning, being in a car crash”. Yet Rachel still believed she was OK. She reasoned that all new mums worry about their babies. It wasn’t until her fears became scarily irrational that she realised something was very wrong.

Rachel went from being afraid something bad was going to happen to being terrified that she herself would harm her child. “I became obsessed with the fear that I might drown the baby in the bath or throw him out the window. I didn’t understand where these thoughts were coming from and I couldn’t tell anyone about them.”

She began to suffer constant anxiety and acute panic attacks, especially when driving. She often cried uncontrollably and was scared of being left alone with her children. She even fantasised about suicide. “I thought maybe Michael and the kids would be better off without me. I was in a dark, dark place.”

Finally, in desperation, Rachel told her doctor how she was feeling. “I was ashamed and terrified someone would take my kids away and lock me up,” she says. Instead, she was diagnosed with postnatal depression. With a name for what was happening to her, support from her husband and family and a combination of treatments, Rachel gradually began to regain control of her thoughts and her life.

Rachel’s story is not uncommon. It’s now believed that about one in seven new mothers in Australia will suffer postnatal depression (PND). Not all will feel as bad as Rachel, and some will feel worse, but all will be affected by the illness. It robs women of the joy of having a new baby. Left untreated, it can ruin relationships, shatter families and destroy lives. While there is a greater awareness of PND now, sadly, many women still suffer in silence, afraid of being judged or deemed a failure as a mother.

A matter of degree

Postnatal mood disorders exist on a scale. At one end is the “baby blues”, experienced by up to 80 per cent of new mums and occurring in the first week after birth. The baby blues is generally mild and transient, disappearing within a week or two. At the other extreme is postpartum psychosis (PP), a rare but serious acute mental illness that almost always requires hospitalisation.

Somewhere in the middle is postnatal depression, generally characterised as a depressed mood or feelings of anxiety lasting more than two weeks and occurring in the first year after having a baby. Common symptoms include tearfulness, anxiety, unexplained or irrational fears, lack of interest in the baby, listlessness, irritability, loss of confidence and inability to cope, memory problems, loss of appetite or marked increase in appetite, sleep disturbances and obsessive morbid thoughts.

Not all women with PND will experience all these symptoms or to the same degree. Symptoms can appear immediately after the birth, suddenly in the first few weeks or gradually over a period of weeks or months. Most women with PND will be aware that something is wrong but may be reluctant to admit it to others and may find it difficult to accept a diagnosis of depression.

Why so blue?

It’s not known exactly what causes PND but several things are thought to contribute. Hormonal changes after childbirth are often cited as a factor, as are lack of sleep, sudden social isolation, predisposition to depressive disorders, stressful life events coinciding with the birth and, less commonly, thyroid disorders and vitamin or mineral deficiencies. Some psychologists believe childhood trauma may also contribute.

The good news for women with PND is they will recover. You’re not the only one asking how to overcome postnatal depression how to overcome postnatal depression. While almost all sufferers will get better with time, recovery is generally faster and the illness less destructive when it is treated promptly. Recognising there is a problem and seeking help are the first steps towards recovery and, the earlier treatment is sought, the better.

Often a woman will confide in her partner, a family member or close friend before seeking professional help. While this can be very helpful, it’s essential to see a professional healthcare practitioner. GPs and early childhood nurses are trained to look for signs of postnatal depression; mums will often be asked to fill out a depression questionnaire when taking their baby for health checks.

For those who prefer natural therapies, most naturopaths, homoeopaths and herbalists can help, although if a woman seems severely depressed, they may suggest she sees a doctor. GPs may want to prescribe antidepressant medication, but antidepressants need to be taken for at least six months and they can have unwanted side-effects, including difficulty weaning yourself off them. They can also make some people feel worse. Many women, particularly those with mild PND, will prefer to try natural therapies first and there are several to consider.

Healing without drugs:  home remedies for postpartum depression

Help for PND

• Counselling
• Sleep
• Diet
• Exercise
• Meditation
• B vitamins
• Fish oil
• Magnesium
• SAMe
• 5HTP
• St John’s Wort (Hypericum perforatum)

Counselling

Nearly everyone with PND will benefit from seeing a psychologist. Both natural and pharmaceutical treatments work best when combined with counselling on how to overcome postnatal depression. A comment often made about antidepressants is that they simply elevate a person’s mood enough to enable psychological work to be done, but it’s the therapy that actually cures the depression.

Counselling is particularly effective when there are identifiable psychological factors contributing to the depression, such as post-traumatic stress, feelings of social isolation or lack of control, unresolved childhood issues or relationship problems. Cognitive behavioural therapy (CBT) is a popular and effective therapy for PND and some women will get better with this alone.

CBT “retrains the brain” to think in more constructive ways, which makes the patient feel happier and more able to cope. As the woman feels better, the physical symptoms of PND start to disappear. There are lots of psychologists trained in CBT and if a GP provides a referral as part of a mental health care plan, up to 12 sessions with a qualified psychologist are covered by Medicare. If seeking a psychologist without a GP referral, it’s important to find one who has experience in treating PND.

Sleep

Sleep deprivation affects the way you feel and your ability to think clearly and rationally. All new mothers are sleep-deprived to a greater or lesser extent. Seeking help from family and friends to allow the mum to get some rest can be a powerful weapon against PND. Some studies suggest that up to one-third of women with early symptoms of PND will recover if they get three consecutive nights of good sleep.

Most newborns will happily take a bottle of expressed breastmilk or formula and if breastfeeding is well established, a night or two of bottles from Dad or Grandma shouldn’t upset the breastfeeding relationship. If a woman is reluctant to allow bottles, then even having someone else do the burping, changing and resettling will help. Rest during the day is important as well. Stress about housework, washing or caring for other children can be alleviated if there is someone available to help.

Diet

Diet is important for mental health as well as general health. Poor eating habits and excessive consumption of sugar, caffeine and alcohol tend to make depression worse. Maintaining a healthy diet will increase energy levels, making it easier to cope, and will provide adequate vitamins and minerals for healthy brain function. Good nutrition is particularly important for breastfeeding mothers as their bodies are working harder than normal to produce milk for baby. Breastfeeding mothers need, on average, an extra 1000 calories to ensure both they and their babies are adequately nourished.

Exercise

Exercise is one of the best natural antidepressants. Exercise produces endorphins, your body’s natural mood boosters. It also uses up excess adrenaline that is produced when you feel anxious. Being active during the day makes it easier to relax in the evening and produces better-quality sleep. Exercise is also a good way to get a new mum out of the house. Walking to the park to meet up with a playgroup, going to mother and baby yoga classes or a local gym with a crèche can have the added benefit of providing a social network of other new mums. Exercise will make it easier to shed the excess weight gained during pregnancy, which can help a new mother feel good about herself.

Meditation and deep breathing

Meditation and deep breathing can be very useful in combating anxiety. Many of the physical symptoms of anxiety such as tightness in the chest, dizziness and headaches are a result of hyperventilation, or over-breathing. Learning to recognise over-breathing and anxiety triggers and focusing on slowing-down breathing when starting to feel anxious can head off a full-blown panic attack. Daily meditation, particularly done in the morning, can help create a relaxed and calm state of mind for the rest of the day.

Vitamins, minerals and fish oil

Vitamins can be helpful, particularly when diet is inadequate. The B group vitamins are known to help the body cope with stress and anxiety and vitamin B deficiency is commonly associated with depression.

Calcium and folic acid have also been found to play a role in regulating moods and controlling stress. Breastfeeding can be very demanding of a woman’s body and can lead to various vitamin deficiencies. A good multivitamin supplement will ensure a woman is getting all the necessary vitamins for optimum health.

Magnesium is essential for normal muscle function and acts as a relaxant on all muscles, including the heart. Magnesium supplementation can significantly improve symptoms of anxiety. Recent research has shown a link between magnesium deficiency and depression or anxiety, and found magnesium supplements to be significantly more effective than placebo in treating depression and anxiety disorders where magnesium deficiency is present.

Fish oil is believed to promote healthy brain function and there are indications it may be helpful in treating depression.

Bach Flower essences

Many people swear by Bach Flower essences, which can be used safely while breastfeeding. Some of the more commonly used for PND are aspen, white chestnut, rock rose and cherry plum. These can be added to a bottle of water and sipped throughout the day. Rescue remedy is also popular for acute anxiety attacks. Healthfood stores and herbalists sell Bach Flower essences and staff should be able to advise which are most appropriate for particular symptoms of PND.

 

Herbal remedies

St Johns Wort (Hypericum perforatum) is a commonly used herbal antidepressant. There’s a large body of evidence that suggests St John’s Wort can be as effective as pharmaceutical antidepressants in treating mild to moderate depression and anxiety. Both Vitex agnus-castus (Chaste Tree) and Dioscorea villosa (Wild yam) are herbs used to regulate hormones. They are particularly effective for correcting oestrogen dominance and stimulating the production of progesterone. For women whose symptoms worsen around the time of their period, Vitex and wild yam may be helpful. NOTE: St John’s Wort, Vitex and wild yam are not recommended while breastfeeding.

5-hydroxytryptophan (5HTP)

5HTP is an amino acid that is a precursor to serotonin and works by increasing the levels of serotonin in the brain. Low serotonin levels have been identified as a factor in depression and most of the modern pharmaceutical antidepressants work by inhibiting the re-uptake of serotonin, thereby increasing the available serotonin in the brain. 5HTP is not available in all states of Australia but can be bought online. International studies have shown it to be very effective in treating depression. A professional alternative healthcare provider should be consulted before taking 5HTP.

S-adenosyl-methionine (SAMe)

SAMe, pronounced “Sammy”, is a chemical that occurs naturally in the body and is used in a process called methylation, whereby it assists in maintaining cell membranes, removing toxins from the body and producing mood-enhancing neurotransmitters. Studies have shown it to be equally effective in treating depression as pharmaceutical antidepressants. SAMe has been used extensively in Europe for some time as a successful treatment for both depression and osteoarthritis.

It has no significant reported side-effects, though like other antidepressants, it can cause episodes of mania in people with bipolar disorder and its safety for breastfeeding remains unproven. Your body makes SAMe provided you have adequate levels of the amino acid methionine, folic acid and vitamin B12. So if your diet is poor, SAMe supplements can really help.

 

PND Resources

Post and Anti Natal Depression Association (PANDA): T: 1300 726 306, W: www.panda.org.au

Beyond Blue: T: 1300 22 4636, W: www.beyondblue.org.au

 

Seek help fast

Post-partum psychosis (PP) is the most severe form of PND and is a serious mental illness that requires urgent intervention. Around one in 1000 women will develop PP. Many will have a history of mental illness and it is most common with a first baby. Onset is usually sudden and severe and the woman will be obviously unwell. It’s often a family member rather than the woman herself who seeks help on how to overcome postnatal depression . Symptoms include rapid mood swings, mania, delusional thoughts, hallucinations and sleep disturbances. The woman may appear confused, say peculiar or nonsensical things or respond to her baby in a strange way. It’s essential that anyone who suspects a family member or friend is suffering PP seek medical help as the safety of both mother and baby may be at risk.

 

The PND crowd

If you have PND you’re in good company. This illness is indiscriminate, affecting women of all backgrounds, cultures and ages. Some well-known sufferers include Elle McPherson, Princess Diana, Courtney Cox, Rachel Hunter and Jerry Hall. Brooke Shields, who preferred the pharmaceutical route and wrote a book about it titled Down Came the Rain: A mother’s Story of Post-natal Depression, said, “I just felt as though I would never be happy again, as if I had fallen into a big black hole.”