Psychotherapist Dr Amanda Jones explains what postnatal depression is, why it occurs and how it can be treated.

Depression is an emotional response to loss. The dominant symptom is a lack of joy or pleasure in anything because of feeling sad, lost and angry. Anxiety is also a horrible feeling that something terrible is going to happen, as if there is no protection, and the body can have all sorts of panicky symptoms. If either of these feelings takes over a person's life, it can be hard to manage and it might be necessary to seek help. In effect, anxiety and depression can make someone feel very ill: stressed and hopeless. Depression and anxiety are common in the general population (10 – 30%). But if experienced during pregnancy and the postnatal period, it is especially hard. Fortunately there are effective ways to help a mother make sense of what’s making her feel vulnerable and to help her feel better.

Imagine needing to become responsible for the development of a baby when you can't stop crying, you don't want to get out of bed, or you feel surges of panic and palpitations and racing thoughts that disaster is unavoidable?

For anyone, becoming a parent is a time of momentous change. Having feelings of loss of freedom and anxiety about the responsibility of looking after a baby are normal and hopefully can be helped by feelings of pleasure and pride in the development of your baby. It is much harder to cope if a mother doesn't have practical and emotional support, or if she’s prone to feeling self-critical. Research suggests that between 10 – 30 % of mothers experience pronounced feelings of depression and anxiety during pregnancy and postnatally. This figure is the same as the general population at other times, but the major difference is suffering from an emotional illness whilst having to care for a dependent baby. This figure is also higher for adolescent mothers and here are some ideas as to why.

A hard fact many adolescent mothers often face is that here in the UK, there is an expectation that adolescence should be a time during which success at school is promoted above all else. There is a pressure to learn and achieve qualifications to help youngsters become employable. But adolescence is also a time of other irreversible changes that can be both exciting and frightening. As the body changes, sexual feelings can compete with cultural and family views. There is a need to find the right group of friends to fit in with. Other things may be going on at home that are worrying. So many things happen all at once, and one thing that is typically disapproved of is a 'teenage pregnancy'. This loss of approval within the family and from society is an important risk factor for adolescent mothers and can trigger depressed and anxious feelings. Young mothers may also criticize and blame themselves and their self-esteem can suffer, especially if a mother feels her own plans and ambitions are wrecked.

In the programme, Stacey’s story is a good example of this and how a traumatic birth can also contribute to an emotional breakdown: if a young mum feels her body and sexuality have been ruined during birth, it is understandable to almost blame her baby for her pain. There is also the issue about the baby’s father: is he supportive or has he left? Stacey had to cope with both, a traumatic birth and no partner to help.

If a young mum has also had an insecure childhood and not got on well with her own parents, it can be especially lonely and hard. The programme looks at the life of Jessica who had lived in 21 foster care placements and experienced emotional and physical abuse throughout her childhood. Her depression during pregnancy with her third daughter was linked to her two previous daughters being taken into care and her anger about everything she’d been through. With the right psychological treatment and support though she showed how she could turn her life around and social services could move out of her life because she showed that she could get better and become a loving mum.

The case of another young mum in the programme highlights how some mothers can experience what are called ‘psychotic symptoms’. She described hearing a voice telling her to stab her baby boy. This is the most dangerous form of emotional illness that a mother can silently suffer from. Ideally, if a mother describes such feelings, she should be referred to a Consultant Perinatal Psychiatrist, or her GP should refer her to an Early Intervention in Psychosis Team, with additional community support such as the Family Nurse Partnership intervention described in the programme. Medication may or may not be suggested but close monitoring of the mother’s mental health by a responsible perinatal consultant would be best. Unfortunately in the UK, it depends on where you live as to whether such specialist services exist.

If a young mother is feeling overly anxious or depressed she should let her GP, midwife or health visitor know. Shame can make it hard to speak out but there is nothing to be ashamed of. Strong emotional responses to big changes are understandable, and pregnancy and becoming a mother is one of the biggest changes a human can go through. It is important that an experienced professional can assess how serious the problem is and recommend a treatment plan to help the mother and baby.

There are different kinds of help available for young mums with postnatal depression. For those with mild symptoms, support groups, online sites, forums and local children’s centres can be of great help. Those who have more deep rooted issues could benefit from counselling, especially counselling that can include their baby. For those mums who need to see a consultant perinatal psychiatrist, medication and/or more intensive counselling are options.

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