Signs Of Postpartum Depression: How To Tell If You’re Suffering

The time immediately after giving birth is a time of monumental change. Now, faced with a brand-new baby, society tells us this is meant to be the good part, which comes naturally, but we know this is often not the case. It’s no wonder that many new parents experience some form of anxiety or depression

As professionals we know that the new-born period can be the most challenging time of all; where the physical changes for a new mother after birth are still resounding, the changes in day-to-day life are incomprehensible and the lack of sleep is like nothing the body has experienced before.

It is not uncommon for new parents to be struggling with their emotional wellbeing at this time. However, it is difficult to know whether your mood is constantly low because you are physically exhausted or whether your feelings of worry are normal and due to a lack of sleep. Amplified emotions and fear are typical as a first time parent, as you are so focussed on how to care for this vulnerable brand new human which came with no instruction manual. But how do you know when there is something more going on?

How do new mothers, or birth parents, know whether your struggles are due to a traumatic birth that did not go to plan, or a longer than expected hospitalisation due to complications, changes with your hormones or issues with trying to breastfeed?

How do you know as a new father, or the non birth parent, whether your fears are related to challenges with the birth or a brand new baby and feeling helpless around supporting your partner in the best way, such as with things like breastfeeding?

It can be difficult to face unexpected challenges as new parents together. You may realise you have different views about caring for a baby, alongside less energy, which can result in difficulty communicating easily. Due to this, you are more likely to experience relationship problems at this time. On the other hand, it can be terrifying to face these new challenges alone as a single parent.

In this blog we are going to explain perinatal depression in more detail, to help parents understand what might be part of the typical emotional upheaval associated with a new baby, or what might be postnatal depression and how you can get support.

It is important to understand that postpartum depression treated means more positive future outcomes, particularly if this is picked up early before things become increasingly difficult.

Postpartum depression symptoms

You are likely to hear lots of labels for perinatal depression as an expecting or new parent, including perinatal depression or anxiety, postnatal depression, postpartum depression or even the ‘baby blues’. ‘Perinatal’ includes the whole of the pregnancy and up to when your baby is one year old, so perinatal depression is referring to this timeframe.

Postpartum depression or postnatal depression are diagnosed when symptoms are experienced during the period up to 6 weeks after birth, but (confusingly) these labels are often used to describe longer periods of time, sometimes up to 6 months post birth.

Postpartum anxiety is referring to the same timeframe, but where symptoms present more like fear, worry or panic than depressive symptoms, which are more likely to include sadness, hopelessness and feeling unworthy.

Experiencing symptoms of postpartum depression or anxiety are more common than you might think, with 1 in 5 mothers or birth parents affected and 1 in 10 fathers or non birth parents affected. We often explain this to parents to reassure them that these symptoms are valid, happen frequently and unfortunately can reflect how difficult this time can be.

We recognise at ForWhen that perinatal depression doesn’t necessarily fit into neat timeframes, which is why we are available for support from conception up until the first year for your baby.

Early Symptoms of postpartum depression

The first few weeks post birth are likely to be emotional for most women, with the physical effects and hormonal changes of giving birth combined with the stress of caring for a new-born often resulting in symptoms similar to those of postpartum depression.

Look out for the following symptoms: depressed mood, constantly feeling depressed, extreme sadness, frequent crying spells or excessive crying. You may also experience negative thoughts, lose interest activities previously enjoyed, feel as though nothing can cheer you up, lack hope for the future and feel completely overwhelmed by everyday tasks.

Other indicators of postpartum depression might include severe mood swings, anger or frustration, feeling disconnected from your partner or your baby and changes to your functioning, like changes to appetite, stomach problems and issues with sleep (when the opportunity presents) including insomnia.

While it can be usual to feel some of these things briefly, especially with the added pressure of a new baby, if things are not getting easier and these symptoms are disrupting daily life, it might be time to consider seeking some support.

It is not uncommon to have trouble sleeping with a new baby, including broken sleep due to caring for your baby, struggles with falling asleep and trouble with staying asleep as you are worried your baby may disrupt you at any time.

While postpartum depression and anxiety are separate diagnoses, both are very common in the perinatal period and it is also common to experience both together. Symptoms associated with anxiety include excessive worry or fear, constantly feeling on edge or hypervigilant and can also result in experiencing panic attacks.

Panic attacks are likely to be terrifying the first time one is experienced and many people believe they are experiencing a heart attack or a fatal health condition. Panic attacks can feel different for different people, with some describing shortness of breathe, chest pain, nausea, sweating, trembling or a racing heart. It is easy to see why people might mistake these symptoms for a heart attack!

If you experienced antenatal depression or anxiety, then it can be especially important to monitor how you are feeling in the postnatal period. Being diagnosed with antenatal depression or antenatal anxiety can increase the likelihood you may also have postpartum depression diagnosed.

It may be difficult to recognise postpartum depression and anxiety, or whether you are just feeling sad or anxious managing this huge change in your life. If you are unsure whether your feelings may require further assessment or support, it is always best to reach out for support sooner rather than later – your emotional health is important! We know from supporting people in this space that early detection and intervention have the best outcomes for both you and your family members, helping you to get back to pre pregnancy levels of functioning.

There are various ways to treat depression in the perinatal period and treatment options should never be ‘one size fits all’. Some people feel uncertain about what a postnatal depression diagnosis may mean or be worried about admitting they are experiencing mood issues.

To these people I would like to reassure you that you are not alone, it is far more common than you might think, and seeking support is one of the bravest and best pathways forward you can take at this time, to help yourself and also your family members.

I would also like you to know that you don’t have to do walk this postnatal depression pathway alone and even if you don’t feel comfortable talking to friends, a support person or family straight away, there are professionals available who are there to listen and support you.

Severity of postpartum mental health illness

Baby blues

You may have heard the term ‘baby blues’ and may (like me) feel it doesn’t quite cut it to describe the level of emotions experienced during postpartum depression. So when do the baby blues become clinical postnatal depression and what can you do about this?

Postpartum depression

Postpartum or postnatal depression may be diagnosed by a Psychologist or a Psychiatrist or sometimes even just your GP and is longer lasting, with more severe symptoms than baby blues. Which of these options is suitable for you will depend on a range of factors, such as whether you already have any of these professionals involved. It is likely that when there is severe postnatal depression or additional mental illness, you may need more specialised support.

Severe PPD

I want to acknowledge firstly that both being a new parent or experiencing a mental health condition can be incredibly difficult experiences and the combination of these can result in more extreme issues. These next paragraphs talk about suicide and suicidal thoughts, so please be aware this may be triggering.

So what are signs of severe postpartum depression? When we talk about severity of postpartum depression we are talking about significant and harmful symptoms which occur more frequently and have a higher impact on day to day life. It is likely in severe cases that screening tool scores; like the Edinburgh Postnatal Depression Scale, will be higher.

These symptoms may still be sadness, anger, hopelessness and despair but are likely to be more frequently occurring and longer lasting than in milder cases of postnatal depression. In severe cases these symptoms are likely to cause feelings of wanting to give up, run away or even contemplate self-harm, harming others, death or suicide as a way to escape.

Sadly, suicide can be the result of these extreme cases where parents do not get the right support and where symptoms remain untreated. This does not have to be the outcome, as even for severe postnatal depression there are treatments which are effective and can help.

Postpartum psychosis

There is increased risk in the postpartum period for birth parents to experience psychosis, regardless of whether there is a history of this, although the risk is higher with previously diagnosed mental illness.

Postpartum psychosis or puerperal psychosis is less common than postnatal depression, impacting 1-2 in 1000 birth parents and is defined as occurring within days to one month following birth. While less frequent, postpartum psychosis is associated with more severe consequences, including negative outcomes for infants as well as parents and including a higher risk of suicide. Due to this, it is critical to recognise and manage symptoms for postpartum psychosis through a health care professional.

Risk factors:

Increased risk means higher level or more risk factors are present, which may contribute to the likelihood or severity of postnatal depression. It is important to know that while risk factors can contribute to postpartum depression, the presence of these does not automatically mean this will be diagnosed.

A woman’s risk for experiencing postpartum depression is increased with; a history of mental health issues, whether the pregnancy was hoped for, complications with conception, pregnancy complications, birth or your new-born infant’s health and a lack of personal and professional support.

To understand mental health, it is helpful to understand any family history of diagnoses, as this can be a risk factor for perinatal depression. Previous diagnoses of Bipolar Disorder, Postpartum Depression or Postpartum psychosis are especially important to consider.

While somewhat limited information exists for perinatal bipolar disorder, an existing diagnosis is more likely to result in a relapse of symptoms during pregnancy and untreated, can cause complications for pregnancy and birth. It is especially important for this reason that symptoms are managed throughout pregnancy, to promote positive outcomes for both parents and the baby.

Women who experience postpartum depression during a previous pregnancy have an increased risk for experiencing postpartum depression during future pregnancies or following your child’s birth. As a result, it is important to seek proactive treatment from a mental health professional in these cases to ensure appropriate support is in place.

Pregnancy or birth complications are also important factors to consider. This could include concerns about the development of the unborn child or medical issues for the mother or baby during pregnancy or at the time of birth.

Poor physical health of parents is a risk factor for poor emotional health, so it is really important to prioritise this from conception to post birth. As your baby grows, it is also really important to role model looking after your overall health – this is how they best learn these skills which can last the lifetime.

Stressful events in your environment, such as a history of trauma or the presence of family violence, are also risk factors for perinatal depression. Less obvious stressful events might include big life transitions, like changing jobs, financial changes or moving house.

The good thing about understanding risk factors for perinatal depression is that you have control over some of these – not all, but some! Which means you have the ability to improve certain factors which may result in improved outcomes for your family.

Managing The Symptoms of postpartum depression

Self care is important when managing symptoms of perinatal depression &/or anxiety. This may include making sure you shower, keeping a healthy diet, regular sleep, and doing something you enjoy; watching your favourite TV show, reading a book, exercising or spending time with family and friends. Prioritising yourself will ‘fill your cup’ a little each and every day to continue caring for your baby.

Mindfulness is another helpful tool for managing postnatal depression symptoms, which is intentionally paying full attention to the ‘here and now’ and slowing down to notice your feelings, thoughts and body sensations. This tool can be learnt by using an App on your phone, completing a course, or each day taking time to pay full attention to the here and now. Reaching out to a friend, one that is supportive to

Mindfulness and self-care (why not use both?) can make a world of difference to coping each day as a new parent. Becoming a new parent, you may need to adjust previous thinking and learn to lean on others, whether family, friends or professionals. Asking for help can be difficult but can support you to manage the symptoms of depression by offloading some tasks or having time to rest or sleep.

Diagnosis:

Understanding diagnosis assists with getting treatment and professional help can be important for managing symptoms of postnatal depression. Attending your local GP for screening, assessment and possible diagnosis is a starting point. A blood test may also be suggested to assess hormone levels, as some physical health conditions cause mood fluctuation or similar symptoms to postnatal depression.

Contacting a helpline for support and guidance, such as ForWhen, may be another part of your recovery journey. This can even be before you see a GP if you’re not sure where to start.

Speaking with your Child and Family Health Nurse can also provide support options including suggestions for local support groups and online resources.

You may be asked by any of these professionals to complete screening tools which assist with identifying postpartum depression. Professionals may also ask other psychosocial questions to assess your specific circumstances and provide recommendations around treatment options.

Referral pathways may include accessing a Mental Health Care Plan from your GP, to get Medicare rebates for psychology sessions or being referred to a psychiatrist. Other pathways may include referral to hospital outpatient or inpatient services, depending on your need and what you would like to access.

While postnatal depression can be diagnosed formally by a Psychologist or Psychiatrist, other mental health professionals or GPs can also provide a level of screening, assessment and treatment suggestions.

Treatment Options

A combination of options may be best to treat postpartum depression, including various types of therapy, support group options and/or the prescription of antidepressant medications. Social workers, psychologists or counsellors can provide specialised therapeutic support in the perinatal period for parents diagnosed with postnatal depression.

A couples approach to treatment, acknowledging joint experience of postpartum depression symptoms has been shown to help families better adjust to parenthood as mothers and fathers both experience postpartum depression and anxiety in different ways.

There are a range of therapeutic interventions available to treat perinatal depression; cognitive behavioural therapy approaches or psychotherapy options are just some. The approach will be tailored to suit your individual needs, in collaboration with you.

Keeping baby in mind when suggestions are made for treatment is an important part of promoting perinatal mental health. A new-born baby is very connected to you as their parent, so your emotional wellbeing is closely linked with that of your baby.

A GP or psychiatrist will prescribe medications such as an antidepressants. They are used to stabilise low mood and reduce anxious feelings. Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), are the more commonly prescribed antidepressants during the perinatal period. A range of factors are considered when prescribing the type of antidepressants for example whether you are breastfeeding, on other medications or are struggling with other symptoms postpartum.

Different medications may be recommended for managing symptoms associated with less common or more severe perinatal mental illness and it is important to consult with your GP or psychiatrist for prescription, monitoring and management of these.

Support groups

Support can be sought from family and friends, or through formal groups such as online, in person or community groups. These groups can provide emotional support, connection to others and help you feel less alone in experiencing this hard time in becoming a new parent and experiencing postpartum depression.

Your Child and Family Health Nurse can suggest some support groups available in your area, there are always playgroups in each community.

The risks of untreated postpartum depression

We may not usually associate irritability, anger and frustration with perinatal depression, but these issues can certainly present where postpartum depression remains untreated.

Untreated postpartum depression can cause a deterioration of mental health and even eventually lead to psychosis without intervention. Psychosis in the perinatal period is related to poorer maternal and infant outcomes and even self-harm, harm to others or suicide.

Untreated postpartum depression is also associated with poor infant mental health, which is not the best start to life for our new baby. This can in turn be related to issues with global health and development and cause problems with cognitive, emotional, motor or language development into the future.

Pregnancy and the new-born phase are likely to be the most difficult times for a couple, where relationship issues are very common. Untreated mental illness may cause further issues with your significant other and at a time where you need them most.

Intervention for postpartum depression works best if your partner and family are involved with treatment planning and can provide support. It is not the time to isolate yourself from your support networks, it is the time to include them.