All you need to know about Peri-Natal Anxiety and Depression: A Q&A with our peri-natal mental health therapist
Janelle Lusty, senior Mental Health Occupational Therapist here at Little Window, is passionate about working with new and expectant parents and their baby. Recently, we sat down with Janelle to find out a little more about peri-natal mental health and all that it entails.
How did you become interested in working with peri-natal mental health?
My original interest is actually from my work in infant mental health. This is a specialised area where the infant’s emotional development and the formation of a secure attachment in the context of the parent-child relationship is the focus. I’m passionate about infant mental health as I believe investing in the 0-3 age group has the best potential to prevent and protect against mental health concerns in later life.
How do you know the difference between normal anxiety/depression, and peri-natal anxiety/depression?
The symptoms are the same ~ the difference lies in the time of onset. Ante-natal is before the birth, postnatal is after the birth and perinatal includes from conception up until the baby is 12 months old. Perinatal anxiety and depression are given special attention because it is a time of increased risk and it can also be harder to recognise due to the symptoms overlapping greatly with the emotional experience of pregnancy, birth and the arrival of a new baby.
Naturally there is anxiety caused by this huge change to your life and for the mother there are multiple hormone changes. The lack of sleep alone can also mimic the symptoms of depression. It can be hard to know if it is depression or sleep deprivation. When everything is new, it is a challenge. This can leave people feeling inadequate and self-doubting. If the situation persists as overwhelming for an extended period of time this adds to the risk factors that can lead to depression or anxiety.
What are the most common symptoms of post-natal depression?
The symptoms of depression are persistent low mood, loss of energy and motivation, negative thinking pattern, feeling hopeless that nothing will get better, increase or decrease in sleep and appetite and lack of enjoyment. The lack of enjoyment can be particularly distressing if this is related to the baby. Many mothers feel guilty about their negative feelings towards their baby. There may or may not be thoughts to harm the self or the baby, if this does occur it is important to seek help immediately.
What are the kinds of thoughts people have when they're experiencing PND?
There are many and various negative thinking that can occur with depression. Common ones include feeling like a bad mother, not doing good enough, should be doing better, feeling hopeless about the future. Sometimes the thoughts may be directed toward the baby, feeling like the baby does not like me, feeling like the baby is controlling or manipulating me, thinking there is something wrong with the baby. A baby’s cries can be very powerful and without support this can be very distressing for a parent. It can lead to feeling irritated and frustrated with the baby.
For anxiety there may be specific worries and fears related to the baby, such as not wanting to go out with the baby, not wanting to be alone with the baby, fear of the baby being unsettled. There can be anxiety about keeping the baby safe and not wanting other people to touch the baby, fear of germs, not wanting to separate from the baby.
How common is PND in modern society?
1 in 7 women are affected by PND and men are also at a higher risk of depression, especially if their partner has PND.
How do you distinguish between the "baby blues" and post-natal depression?
Baby blues typically starts between the 3rd and 10th day post birth and is due to changes in hormones. Usually it is experienced as feeling tearful and overwhelmed. This passes after a few days. PND is different in that the symptoms are persistent in nature (more than two weeks), it can start before the birth and can occur any time during the postnatal period. PND requires more support and there is an impact on the baby and partner.
What typically causes the occurrence of PND?
There is not one cause for PND, and it can happen to anyone. Generally, it develops due to a combination of increased risk factors and a reduction in protective factors. You will notice that a lot of the risks naturally occur and protective factors are reduced when having a baby.
Risk factor include lack of sleep, changes to nutrition, lack of exercise, lack of social supports. Risks related to the perinatal period include unplanned or difficult pregnancy, premature birth, difficulties with breastfeeding, traumatic birth. A baby with feeding, sleeping or settling difficulties.
Other risks include a past history of mental illness, drug and alcohol use, family history of mental illness, violence, multiple stressors, loss and grief.
Some of the protective factors that people lose at the time of having a baby is their social network, ability to exercise, changes in diet and sleep, major changes to your role and ability to do previously enjoyed activities, change in identity.
What guidance can you share about how to get through PND if you are experiencing it?
Be aware that you are not alone and there is support out there, I would urge you to reach out, even if you aren’t sure if it is PND or not, check with your GP or child health nurse, this is important because there is an impact on the baby and the family.
Social and therapeutic support are vital. If you can join a group or gather your supportive network who can give you practical support and company this will be helpful. A therapist can provide a safe place to talk through any worries and make an individualised recovery plan. Focus on building up protective factors for example self-care basics such as sleep and nutrition. If you can do gentle exercise get out into nature, practice mindfulness and if possible, have some time just for yourself. Monitor triggers such as social media and comparing your piles of laundry with the airbrushed images on Instagram. I have helped mothers who have felt nothing for their baby or had thoughts to harm their baby. This does not make you a bad parent, this is the depression and with support this can be healed.
How can you help someone you know who has PND?
If you know someone who is struggling, it may be hard for them to tell you. Let them know that you are glad they could tell you. Avoid the generic “let me know if there is anything you need”, this kind of offer is difficult to take up. Think about what you could do- can you make dinner once a week, do some laundry, hold the baby, go out for a coffee. Offer to arrange to do this task, this is a very practical way to give support.
~ Janelle Lusty, Senior Mental Health Occupational Therapist, Little Window