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Live webchat with postnatal depression counsellor, Liz Wise, Tuesday 17th April, 1pm

(154 Posts)
RachelMumsnet (MNHQ) Sat 14-Apr-12 12:59:44

Liz Wise is joining us on Tuesday 17 April between 1 and 2pm. She was introduced to us as a possible webchat guest by a mumsnetter who described how she'd 'changed her life'. Liz is a specialist postnatal depression counsellor who has been supporting mothers with PND for the past fifteen years, Having had severe PND after both her children, she has a great deal of personal and professional experience. Liz is also the PND co-ordinator for the National Childbirth Trust and sits on the committee for The Association for Postnatal Illness. She has also produced the popular DVD, Understanding Postnatal Depression.

Postnatal depression affects approximately 20% of mothers in the UK and can be a very isolating and frightening condition. Around 10% of fathers experience paternal depression. Symptoms include, low mood, anxiety, exhaustion, inability to look forward to or enjoy anything and sometimes irrational thoughts. It is temporary condition which can be helped by the right support and/or treatment. Join the discussion on Tuesday at 1pm or send questions in advance to Liz here. For more information about postnatal depression see www.postnataldepression.com.

HJMP Sat 14-Apr-12 14:03:46

How do you think GPs/health professionals can be encouraged to take PND seriously but also appropriately?
When I was pg with dd3 I was concerned about PND after having had it twice before. GP was supportive but MW and consultant dismissed it as unlikely.
Only service offered in my area is a support group which has been unsuitable for me to attend due to a work client being in the group.

do you ever wonder if the term 'pnd' in it's medicalised glory serves to silence the social reality women face upon having children? re: it detracts attention from what it is about having a baby in our society that causes depression in many and instead plants the idea that it is just somethign 'wrong' with each of those individual women and not a pattern at all?

blue2 Sat 14-Apr-12 16:15:39

Hi Liz
I attended one of your day courses a few years ago while I was a Homestart Volunteer - it was incredibly informative, and filled in a few gaps for me as I'd had bad PND after my son was born, but only knew of "my" story.

I see that there are almost no support groups for this illness; what would I need to do to start one up? I am not a healthcare professional - but does that matter?

I'd be interested to hear your response.

Many Thanks

Great question swallowed!

Hi Liz,

I suffered from severe postnatal depression after the birth of my daughter. My husband realised pretty quickly and encouraged me to seek help but I was convinced that it was just sleep deprivation. How do you differentiate between a woman 'just' being sleep deprived and it being PND?

heather1 Sat 14-Apr-12 18:42:27

Dear Liz,
I am interested on your thoughts about a link between PND and PMT.
I had doctor diagnosed PND after the birth of both my children. Subsequently my PMT significantly worsened (also doctor diagnosed). I saw a nutritionist with a track record of helping women with PMT. Though supplements, diet and exercise no more PMT then and now 5 years from the birth of my youungest (my PMT was just like the PMD but only around the time of my period.)
The nutritionist thought there is a dietary and consequently hormonal link. I think its a shame more diet and exercise help arent given to women disgnosed with PMD.
Do you agree this could be the situation for some cases? I havent tested it out by having another child!

That's interesting Heather and links to my question.

I had PND with my DD (now 3.5) and again with my son (now 1). With my dd 150mg of sertraline worked; with DS I caught it early (6 weeks) and tried both sertraline (200mg) and mirtazapine (30mg) at different stages and altho they helped some symptoms, I was left feeling like I had pmt all the time; black moods, snapping, feeling rage. I went on the mini-pill 5 months ago and there was an overnight transformation. I am now on the mini pill and 150mg sertraline and am much better. My question is, will I have to remain on the mini pill indefinitely and is there an underlying cause of this hormonal imbalance?

Sunflowergirl2011 Sat 14-Apr-12 19:25:58

Hi Liz, I too have been through one of your support groups and it was great, thank you. Blue2 - I have set up a support group through our local nct branch, might be an route for you? ( very informal, I'm not a professional either).

agnus castus for pmt - it has done fantastically in clinical trials and is prescribed in some european countries. sorry - always want to mention it when someone says they have pmt as it really can work wonders.

HJMP Sat 14-Apr-12 20:34:49

Y to the pill. I'm on the pill for PMT and although my PND is still there I've been better since on it.

i was on the pill for pmt till we realised i can't take the combined pill due to aura migraine history and the progesterone only pill made it worse. the pill definitely helped in that at least i knew when i was going to go stark raving mad and could choose when to have the pill break and incur it. sorry for the tangent.

TruthSweet Sat 14-Apr-12 22:54:08

I am interested in the lesser known PNI - PND-OCD & PN -Anxiety. Why are they always bundled up with PND (lists of PND symptoms always seem to list 'anxiety, obsessions, intrusive thoughts, repetitive behaviours, etc...' as part of PND)? This seems to mean that mothers with non-depression based mental health problems get overlooked and not dealt with properly.

I have a friend (genuinely - it's not me though I have had PND-OCD!) that has had depression in the past (so know what it feels like) but now feels she is having OCD behaviours - her GP just keeps telling her it's PND and trying to treat her 'depression' which of course isn't working.

Non-mothers with OCD/anxiety don't get treatment for depression they get OCD specific treatment so why do mothers with PND-OCD/PNA get treated for depression?

realhousewifeofdevoncounty Sat 14-Apr-12 23:53:06

Looking back I more than likely had Pnd after dd. But I kind of agree with swallows, in that for me it kind of felt like a normal response to the massive change in my life. I was recovering from a cs, I had had no sleep for weeks and suddenly there was this thing that was so dependent on me I couldn't even go for a wee anymore, let alone eat or drink, and it wanted to suck on my boobs all the time which really hurt, but I couldn't stop doing it or I would be a bad mother. It sometimes baffles me how people DON'T get Pnd. I think it is made worse by society painting motherhood as this amazing experience - you bond straightaway, it all cones so naturally and it is all lovely. But so many people I speakto don't have that experience and feel like massive failures if they don't. For me, my love for dd has grown daily, bonding wasn't instant and the newborn phase was hard and even dark at times. I still don't know if it was Pnd or just a normal response to what is an incredibly hard and testing time of life for a lot of people, compounded by guilt at feeling that way as it is supposed to be so "magical".

peanutpie Sun 15-Apr-12 00:02:19

I spend a lot of time reading stuff about people talking about stuff like co-sleeping/bfeeding/weaning stuff. I think I genuinely feel on the outside of this. Having a baby is just about basic survival - at times it feel like just me or them. Late pregnancy and the early bits of a new child are utterly horrible. These other 'choices' are utterly beyond me. And it seems to go on for a long time, years even!
So grateful even for you to be publicsing this website.

scottishmummy Sun 15-Apr-12 00:36:30

am working but will catchup later
great choice of guest btw

WorriedBetty Sun 15-Apr-12 02:17:10

I have just had an amazing conversation with friends of mine whose dad has just died. One of these two have a child. The whole family are in love with her.

My sister had PND and is much more negative about her worth since.

In a really amazing conversation about how childhood memories come flooding back when one is linked closely to a child my friends and I wondered a) if PND research accepted/backed up the idea of a boost of childhood memories when a child is born b) if PND affects this boost of childhood memories and goes on to affects the relationship a sufferer would have with their parents and c) does an abusive childhood cause negative childhood memories to surface after childbirth and cause PND?

good q betty. because there are so many factors aren't they? yet the pnd label medicalises it under the carpet in a way. there are lots of very good reasons why a woman may experience distress and develop depression after having a child - especially when you take in that they include onset within a year as 'PN'. the childhood memory floodgates is an aspect i hadn't considered. (i applied for phd funding last year to look into this area but didn't get it sadly)

Memoo Sun 15-Apr-12 10:33:18

I developed severe pnd after the birth of my 3rd baby. I had periods of psychosis and ended up in hospital. 2.7 years later I still suffer very badly at times. I am on 5 different types of medication. I wondered how long can pnd continue? I feel rediculous that I am still struggling after all this time.

PeelingmyselfofftheCeiling Sun 15-Apr-12 12:06:30

A friend of mine suffered severe PND which came on very suddenly. She was diagnosed and put in ads, which she says worked for her, but it occured just before her first period came back and she says the more dramatic improvement was straight afterwards when she felt much less hormonal. Is there a known link between PND and pmt? And, without wanting to imply any criticsm of women who choose not to breast feed, is there any link between breastfeeding 'holding off' PND (my friend was not breastfeeding therefore her periods returned very quickly)? It's risky ground I appreciate.

dontlaugh Sun 15-Apr-12 15:56:44

Is there a link between PND and traumatic birth? Is PND actually a form of PTSD or are they related?
I definitely had PTSD after my first birth, due to terrible staff, and an OP baby. I often wonder if I would have suffered as badly and for so long in silence if the birth had gone smoothly. I didn't even have the baby blues after the second (dream birth at home, also OP but not a problem). It is something which I do think about often, and how the harsh reality of a labour/delivery ward is often shrouded in mystery - stirrups, scissors and shouting are all that spring to mind when I think of our local one, based on my own experience.
What can be done to assist women overcome the gap between their expectations and the reality?

gafhyb Sun 15-Apr-12 19:20:03

dontlaugh - my question exactly.

And also, i am watching with interest the discussions pertaining to swallowedafly's question

gafhyb Sun 15-Apr-12 19:23:24

To me, the whole area is, of course a muddle of psychological, physical and social issues. Forgive me if this sounds clumsy, but it has sometimes struck me that there's "acceptable"/understandable PND - hormonally-related in a woman with no history of mental health problems - treatable with antidepressants, and the altogether more "messy" sort. Are they 2 separate disorders

HateBeingCantDoUpMyJeans Sun 15-Apr-12 19:30:37

Mine I guess is similar to joy and swallowed... Where does'normal ' life after a baby end and PND begin?

Guess I sneak in a second seeing as my first has kind of been covered.....Is there any link regarding pre natal depression /anxiety and post natal illness? Is it a case of one or tge other or is it mix and match? And how do you think diagnosing pnd years after tge birth fits into all of this? Are pre and post natal depression just a way of saying a woman with children is depressed?

gafhyb Sun 15-Apr-12 19:33:45

I wonder if the things that make you prone to anxiety and depression, are likely to be triggered by becoming a parent (I'm speaking personally, here) - issues relating to control, perfectionism, black and white thinking. Added to by sleep deprivation, and by societal expectations.

Sorry, am wittering now.

you're not wittering at all gafhy

there's also suddenly being at home - isolation being known to be another factor, loss of status, massive responsibility etc etc etc. not to mention that the cracks in people's relationships come out and inequalities deepen.

(and social pressure comes full force with everything you should and shouldn't be/do/think/feel etc)

Barklouder Sun 15-Apr-12 22:17:12

Good reading so far.

Liz, do you have any thoughts on what can be done to educate people about postnatal depression - particularly expectant mothers - before it hits? I am sure I am not alone in having endured some dreadful dark times in silence as I believed that all mothers felt as I did (and like them I would continue to keep the secret of how dreadful motherhood was looking after a child who was like a stranger, consumed by anxiety and suicidal thoughts). I simply did not know that pnd existed and that the way I felt could be stopped! I thought I was a terrible person.

Added to this, do you have any advice on how to support friends who are new mums and encourage them to recognise if they have crossed the line from the usual challenges of a baby to becoming ill with depression?. I always ask friends if they are ok and they generally say yes fine - I would have answered 'I'm fine' too but I definitely wasn't. Is it stigma?

Just to add to some of the other comments: I was one of the mothers who had a textbook pregnancy and birth, stable family, no worries and no history of mental health problems.

StrangerintheHouse Sun 15-Apr-12 23:15:29

How can we untangle the fact that having pnd or ptsd/anxiety makes you lose your grip on reality so that it is hard to tell whether your fears about admitting to how you feel (eg they will take my baby away, people will think I don't love my baby and I'm a bad mother) are in proportion or are actually part of the problem.

(Hope that makes some kind of sense, I should be asleep!)

BellaBoo85 Mon 16-Apr-12 01:34:20

Plain and simply, how do you get over it when the guilt won't go away??
The way I see it, it's always going to be there because of how (I think) it started. And if I'd not had that one particular thought/feeling then none of it would've happened. And that thought isn't just going to disappear. Even if one day I don't believe it anymore, there was a day when I did.
And that is what I can't get out of my head.

SeverePNI Mon 16-Apr-12 09:25:50

Message withdrawn at poster's request.

apologies for posting too much on here but i'm really interested in this area. i am completing my counsellor training on an msc starting this year and i am a feminist interested in women's issues obviously. i want to develop groups for women experiencing maternal distress - i think the shared experience and understanding would be massively relieving and therapeutic for women but i also want to do antenatal counselling where women can focus on preparing - working through issues that could be a problem, looking at stuff from their own past that has come up again for them due to the triggers of approaching motherhood, relationship worries etc etc.

do you think antenatal counselling could benefit women and help prevent or at least enable women to better manage depression/anxiety/mental distress? and please if you have the time could you post links to any good materials on this subject as in therapeutic approaches to dealing with and preventing this? or perhaps you wouldn't mind someone contacting you?

really will shut up now.

ThatllDoPig Mon 16-Apr-12 09:52:51

I had pnd. It frustrates me so much that people STILL always assume that this means you don't bond with your baby.
Why is there is misconception and what can be done to challenge it? For me it was the opposite. My baby was perfect and wonderful, but I felt I couldn't protect her from this shitty world.

FourYolksAche Mon 16-Apr-12 12:22:31

Do you think the crap postnatal care women receive in hospital (very frequently bemoaned on MN) is a cause of PND?

I was v close to having some kind of breakdown on that bloody ward until DH got me out of there.

Kveta Mon 16-Apr-12 12:26:21

my mother is pretty sure she had undiagnosed PND after the birth of my younger sister - she remembers crying a lot, and trying to kill me (a toddler at the time) by beating me, throwing me in the cot too hard, at one point getting a knife out and seriously planning to use it. My sister was labelled a Failure to thrive baby, and didn't bfeed well, which mum reckons exacerbated it, and the local HV did nothing to help.

This has had 2 consequences that I can see - firstly, my sister and I DO NOT get on (and I have a somewhat prickly relationship with my parents), and secondly, I am now terrified that history will repeat itself when I have my second child in a few weeks time. I have previous history of reactive depression following sexual assault as a teen (nothing to do with parents!), so know I am prone to depression. my mother and grandmothers have all been warning me and DH to look out for it, and spent much of my older child's early life watching me like a hawk for signs of depression, which was fun... (as it was, I was never happier than after he was born!!)

So my questions are - how can my mum begin to get over this, when it was pretty clearly not 'her', it was a medical condition - she still beats herself up for my sister having various health problems nearly 30 years later, and is so overprotective of sister it's damaging her relationships with me and other younger siblings. and question 2 (sorry!) how can I avoid the same thing happening to me?

(apologies for such a personal question, I understand a single post here cannot a life time problems solve!)

just ftr kveta i think depression is a very rational response to a traumatic experience like that and i don't think it means you are susceptible to depression - i think it means that you had an extremely traumatic experience. does that make sense?

AnAirOfHope Mon 16-Apr-12 13:19:01

PND affects the whole family but its only the woman that gets counciling. What can be done to "mend" the family as a whole? or at least consider it when the women is ready.

Are there any measures that you think a woman can take during pregnancy that may lessen the chances of pnd occuring?

thunksheadontable Mon 16-Apr-12 18:41:27

Hi

I am 32 weeks pregnant with my second child and slowly coming to terms with the fact that I have mental health issues related to pregnancy and the postpartum period.

I will be very interested in what you have to say about the medicalisation of PND and how it lays the causes for maternal distress in chemical/hormonal imbalances in the mother with little apparent public recognition of the role of past experience and current social support. The preventative side seems totally absent, is this true in lots of cases?

I think my case is probably pretty typical. I grew up in a chaotic abusive (yet solidly middle-class) home with a cruel alcoholic father and a distant, neglectful mother. I have a pretty typical psychological profile of a first-born child from this type of background: I am ultra-high achieving, perfectionistic and relentlessly self-critical with a deep sense of shame and the idea I am responsible for just about everything in the world. I've had counselling/therapy on and off and more or less manage really functionally but in pregnancy my defences lower and my desire for control and certainty, plus tendency to see threat in anything I can't control, goes haywire.

There is also a family history of mood disorders, puerperal psychosis and PND.

I had antenatal OCD and depression in my first pregnancy but never sought help. All was well during labour and birth (for which I prepared as if it were a marathon) until the second stage, when my large post-dates induced baby got stuck and there was a panic and brutal rotational forceps delivery. In a state of absolute horror at his birth and how I had "failed", I went into an anxiety state and remember nothing of his first 72 hours apart from brief, brutal flashes of an incredibly nasty midwife who basically did her best to humiliate everyone on our ward (e.g. "what do you mean it hurts? Silly girl, of course it hurts, if you think this is the least pain you will feel as a mother you are very naive indeed").

Cue a very typical story of the inevitable breastfeeding problems following this type of birth leading to "intervention" from the NHS which consisted of asking me to feed 10-12 times every 24 hours, expressing and refeeding after every one: baby losing weight, immense sense of failure, battling on regardless. Distressed, hungry baby screaming 24-7. No family support other than my husband (we live abroad). No friends available (none had kids, all drifted very fast after giving initial gifts etc). A deep snowfall combined with severe postnatal perineal trauma which meant I couldn't walk also kept me housebound for nearly 7 weeks as I couldn't drive....

It's hardly rocket science that in these circumstances, and with a history that makes me prone to anxiety and depression, I started to slide... and it's hardly amazing that now, at 32 weeks pregnant, my anxiety levels about after the birth are sky-high.

And yet, despite having a label of moderate OCD and depression, there is NO plan for my labour. I have had health professional after health professional try to terrify me with stories of how badly wrong an elective section could go (despite never asking for one) and I have had several almost promise me a wonderful, calm second birth (which they can't, and shouldn't).. I had the supervisor of midwives say "listen you may think you are, but you're clealry not one of the mad ones" hmm. There is no CBT available despite NICE guidelines and my initial referral to the Perinatal Mental Health team happening at 6 WEEKS PREGNANT.

I just feel that the chances of a recurrence of PND/PN-OCD etc are absolutely MASSIVE and that there's good awareness that it might be worse this time.. and yet the whole approach is, well, let's wait and see. Go on the meds. We will just let you labour the same as any other woman despite the fact you are terrified and anxious and that doesn't augur well for your delivery, and despite the fact a poor delivery might psychologically damage me further. It's very much hands-off and "watchful waiting" just to see do I totally and utterly lose it. It's also very frustrating to have been asking for help to avoid a recurrence for this whole pregnancy and to have nothing more in place a few weeks ahead of the birth other than a handful of antidepressants. There must surely be more cost-effective ways of preventing mental health dysfunction than just letting people at it because they aren't in a total heap (yet).

I would love someone to help me plan my birth without trying to terrify me. If only they realised the extent to which I live in terror every day.. a cs is nothing in comparison but they have now successfully added it to my list of things to freak out and obsess about so that I feel totally out of control thinking of having to birth this child. Great planning, NHS.

Brandnewbrighttomorrow Mon 16-Apr-12 21:54:59

Thunksheadontable no wonder you're stressed! I've had three sections, one emergency following 35 hour labour and two elective. I think if you are that anxious about a natural delivery then an elective cs would make complete sense. It's much calmer than an emergency section, you can plan childcare for your older child and express a preference for various factors like type of anaesthetic (I'd recommend a combined spinal/epidural) discovering sex of the baby, skin to skin contact. You can find out which consultants and midwives are on for your date and express a preference for who you get. All helps to make you feel a bit more in control of the process. It's likely to take longer to recover physically though.

I'm reading with interest to see what the response is to where does normal reaction to becoming a parent end and pnd begin.

abdc Mon 16-Apr-12 22:51:15

Given that this is such a common condition, why is there not more Antenatal support for women? With a history of depression I know I am predisposed to PND, and was questioned closely by my mw at booking in. This was very reassuring at the time but since then it seems to have just been lip service - there is no actual Help that the mw can point me in the direction of. I believe I have since experienced antenatal depression, but just been told to see my gp, who I think just sees me as another hormonal pregnant woman and dismisses my anxieties. A ten min appointment is not enough time to discuss the extent of my anxieties and feelings, and so it builds up and gets worse when what I want is someone to talk to - why are there no counselling or helpline type services? Surely this could help some women to not go on to develop such severe pnd or at least know where to get help. Depression is not just tiredness, it is a mindset rut and I believe that antenatal support would help postnatally.

bjf1 Mon 16-Apr-12 22:54:53

Hi Liz
my question is, if untreated, can PND and even pre natal depression, just stay with a woman for the rest of her life? Is it possible that a mother can still be suffering from this 10 years or more after the birth of a child?
Or, over time, does it sort of dissipate of it's own accord?

Shakey1500 Mon 16-Apr-12 23:09:33

LIZ, I'd also be interested in the answer to bjf1's question.

I am certain I had PND but did not go to my GP (I'd had a bad mental breakdown the year before and the counselling I received after being discharged from the psychiatric hospital was utterly appalling so I had/have zero faith). My son is now 4, is it still possible to have PND? How is it differentiated from "depression"?

Thanks

hunkermunker Mon 16-Apr-12 23:43:03

Hi Liz

What a brilliant webchat for MN to be doing - this will help a great many women.

My question is this:

How do you cope, having had a traumatic time yourself, Liz, with being so immersed in making things better for other women? Do you ever feel like you would rather not be so close to something that was a source of such heartache in your own life? Or have you managed to work through your own issues in such a way that you use them to inform what you do, but you're distanced from the feelings you had at the time? If so, how did you go about that process?

Thank you - and thank you for what I know will be a really valuable webchat.

I'd like to reiterate puddlejumper's question. I have had very broken nights for 7 months now and my mood is often very low. My GP thinks I'm 'just' tired - how can I tell the difference? Is there one anyway?

ReallyTired Tue 17-Apr-12 09:20:00

Do you think the use of positive pychology (Ie. resilence training or the human givens theory, mindfulness, teaching of relaxation techniques) could prevent postnatal depression in at risk women?

I went to a postnatal depression group that actually made my depression worse. Do you think there should be more critical assessment to see what types of councelling/ medication works for a particular individual?

Thaleia Tue 17-Apr-12 09:33:05

Hi Liz,
Is it more likely to get PND after a c-section as it's harder to bond with the baby (lack of Oxytocin) and bfeeding might be more difficult in combination with feeling a failure for not able to do it naturally?
Thanks, Thali

lagoonhaze Tue 17-Apr-12 09:49:37

A couple of friends have suggested i have PND but I think it's just pure exhaustion as my baby has been very high need although luckily we are turning a corner.

How can you determine between the two and know when it's help you need?

Since having my first child I've become really aware of risks and sometimes don't go out as i can't bring myself to drive. This had improved but since the birth of my second has got worse again.

MrsMicawber Tue 17-Apr-12 09:59:08

Hi,

Thank you so much for doing this webchat. I had PND with my oldest quite severely, and as a result my husband was my son's main caregiver. I did not spend extended periods alone with him until he was 14/15 months old. I have a terrible feeling of needing to make up for lost time with him now that I am healthy trying to reassure him that I am 100% commited to meeting his needs even though I didn't when he was a baby.

How can I get past this feeling and do I need to be worried about 'loving him too much' and pushing him away? as in these feelings of inadequacy are mine, essentially selfish feelings. Are they harmful to him though?

MaryChalloner Tue 17-Apr-12 10:46:45

I have a question.

My relationship has broken down while I have been pregnant. I had also moved to a new city with my husband shortly before this. I am due to give birth alone and am feeling fairly isolated in my new city. I have no family support. I feel concerned that I am at risk of PND once the baby is born (coupled with sleep deprivation, no support, older children to look after etc etc) although I have not had depression in the past. I wonder if there is anything I can do to minimise the risk of being hit by PND once the baby is born. It isn't an option in the time available to move house or suddenly acquire a group of local friends!

Many thanks

GleeClubClassof2008 Tue 17-Apr-12 11:13:48

Hello Liz!!! (massive wave!!) I have name changed especially to say hello!

Wow, you are on Mumsnet, fantastic!

I came to one of your groups after the birth of my DD, I don't know what I would have done without it. Thank you.

Barklouder Tue 17-Apr-12 11:23:49

gleeclub I suspect there are quite a few of us lurking around grin

thanks Liz

JugglingWithTangentialOranges Tue 17-Apr-12 11:48:46

Hi Liz, yes I think I feel similar to saf about the name PND - feeling it may over medicalise the experience of many women and not allow much recognition of the social aspects of becoming a mother which I feel contribute to depression for a significant number of women. Possibly good though to recognise that depression is an illness. Just that "post-natal" makes it sound like it's all about hormomes which I don't think it is, though they may contribute.

I feel I've had a low level depression for much of my adult life and certainly found life more difficult to cope with especially after having my second baby when I also had a toddler to look after. I've never been diagnosed with anything relating to mental health though (although I did seek support from my health visitor and have had some counseling through GP surgery) - possibly because my experience has almost always been what might be classified as "sub-threshold depression". I still feel the DCs are a big responsibility and cause of anxiety and stress even now they're 10 and 13. Is PND an on-going experience for some ?
I'm wondering what the variations are in how different women experience it in terms of intensity and length of time they are affected by it ?

kizzie Tue 17-Apr-12 12:06:14

Hi Liz - you know me very well wink.

I just wanted to add to the thanks for Liz. She (literally) held my hand through some very very difficult times and I will always be grateful.

Swiddle Tue 17-Apr-12 12:38:01

Someone close to me has suffered long term pnd / ptsd following a traumatic birth. Her own mother had a traumatic (near-death) time in giving birth to her, way back.

I wonder if there is a connection? I don't mean genetically, but in terms of early birth trauma possibly leading to anxious parenting, leading to an anxious child, growing up to be anxious new mum... etc... ?

(I truly don't mean to cause anyone offence by this question, as I know every situation is different)

heliumballoon Tue 17-Apr-12 12:42:40

Thank you MNHQ for arranging such a useful webchat.

There are some very good questions on here already. I like strawberry's question about preventative measures in particular. I also concur with the view that it can really be kicked off by atrocious care on postnatal wards.

I had roaring PND following DD1's birth and when I (with great fear) decided to have another DC did everything in my power to prevent a reoccurence and so far (thank god) it seems to have worked. I see so many mnetters though who report just being shoved on anti depressants and receiving no other help. Surely that is not the best approach?

heliumballoon Tue 17-Apr-12 12:57:05

Upthread someone noted that she thought it was a miracle mothers avoid PND (I paraphrase). I have to say I agree with this. I meet pregnant woman after pregnant woman who tell me that they have never held a baby (or not for years). Their friends don't have babies and if they do live far away. They prepare with books called things like 'How to succeed at breastfeeding'. I looked at some baby books recently and saw they recommend things like "at 11 weeks baby needs 16 hrs 45 mins sleep a day" and a routine which starts each day with expressing at 0640. Is it any surprise that babies don't do as the books say and mothers feel like abject failures?

RachelMumsnet (MNHQ) Tue 17-Apr-12 13:01:49

Liz has joined us at MN Towers and is ready to start asking your questions. Thanks so much for joining us and welcome to Mumsnet Liz

LizWise Tue 17-Apr-12 13:02:22

Thank you very much for joining me for this webchat. I will endeavour to answer as many questions as I can in the next hour.

LizWise Tue 17-Apr-12 13:03:09

MaryChalloner

I have a question.

My relationship has broken down while I have been pregnant. I had also moved to a new city with my husband shortly before this. I am due to give birth alone and am feeling fairly isolated in my new city. I have no family support. I feel concerned that I am at risk of PND once the baby is born (coupled with sleep deprivation, no support, older children to look after etc etc) although I have not had depression in the past. I wonder if there is anything I can do to minimise the risk of being hit by PND once the baby is born. It isn't an option in the time available to move house or suddenly acquire a group of local friends!

Many thanks

I'm sorry to hear that you're feeling very isolated in a new city and don't have family support around you. I think it would be a really good idea for you to talk to your doctor about your feelings, so they can try and get you some ongoing support. I wonder if there's any practical support that a charity such as HomeStart could offer you? Again, your GP or Health Visitor should know about this. It would be a good idea to talk to someone that you totally trust about your fear of getting PND.

JugglingWithTangentialOranges Tue 17-Apr-12 13:04:59

That would make me laugh though helium - "at 11 weeks baby needs 16hrs 45mins sleep a day" grin Experience tells me babies haven't read the manual !
Of course starting your day with expressing at 6.40 am might not be so funny (I could never get used to the faff of expressing) I admit I was a sucker for the "What your baby should be doing each month" stuff though. But on the whole it made me feel proud at how clever she was ! ( Sorry, slightly tangential as is my want (sp?)) But a little humour is good, and actually might help us keep some perspective with our babies if we can hold on to it, which I know we can't always do )

LizWise Tue 17-Apr-12 13:05:24

HJMP

How do you think GPs/health professionals can be encouraged to take PND seriously but also appropriately?
When I was pg with dd3 I was concerned about PND after having had it twice before. GP was supportive but MW and consultant dismissed it as unlikely.
Only service offered in my area is a support group which has been unsuitable for me to attend due to a work client being in the group.

I think it varies greatly for health professionals as with all professions, some take it more seriously than others. I’m surprised that as you had had PND twice before that it wasn’t taken more seriously by your midwife and consultant and the only support uGu were offered was a group, not any one to one counselling. I think PND should be part of every health professional’s training and that it needs to be spoken about more to get rid of the stigma attached to it.

LizWise Tue 17-Apr-12 13:05:57

heliumballoon

Upthread someone noted that she thought it was a miracle mothers avoid PND (I paraphrase). I have to say I agree with this. I meet pregnant woman after pregnant woman who tell me that they have never held a baby (or not for years). Their friends don't have babies and if they do live far away. They prepare with books called things like 'How to succeed at breastfeeding'. I looked at some baby books recently and saw they recommend things like "at 11 weeks baby needs 16 hrs 45 mins sleep a day" and a routine which starts each day with expressing at 0640. Is it any surprise that babies don't do as the books say and mothers feel like abject failures?

Yes, I totally agree with you and think there is far too much pressure on pregnant women to become 'supermums'. We all parent differently according to how it feels for us. There is no right or wrong in how you deal with your own baby, within reason.

LizWise Tue 17-Apr-12 13:07:06

JugglingWithTangentialOranges

That would make me laugh though helium - "at 11 weeks baby needs 16hrs 45mins sleep a day" grin Experience tells me babies haven't read the manual !
Of course starting your day with expressing at 6.40 am might not be so funny (I could never get used to the faff of expressing) I admit I was a sucker for the "What your baby should be doing each month" stuff though. But on the whole it made me feel proud at how clever she was ! ( Sorry, slightly tangential as is my want (sp?)) But a little humour is good, and actually might help us keep some perspective with our babies if we can hold on to it, which I know we can't always do )

For some women, having a routine with their baby can be very helpful and may give them a sense of control and a sense of pride if their baby responds well to the routine.

LizWise Tue 17-Apr-12 13:08:16

swallowedAfly

do you ever wonder if the term 'pnd' in it's medicalised glory serves to silence the social reality women face upon having children? re: it detracts attention from what it is about having a baby in our society that causes depression in many and instead plants the idea that it is just somethign 'wrong' with each of those individual women and not a pattern at all?

That is a really good question, however there is a big difference between a mum who is finding it hard adjusting to motherhood but it isn’t making her feel anxious and or depressed. Many new mums have feelings of inadequacy, are tired, a bit anxious but with PND these feelings are very exaggerated and cause day to day problems for the mother.

FunnysInLaJardin Tue 17-Apr-12 13:09:08

Hello. I would be interested to know whether there is any link between breast feeding and PND. I felt myself slipping into PND with both my DC which only stopped when I stopped breast feeding. I think I struggled to cope with the hormonal effects. Thanks

LizWise Tue 17-Apr-12 13:09:09

Swiddle

Someone close to me has suffered long term pnd / ptsd following a traumatic birth. Her own mother had a traumatic (near-death) time in giving birth to her, way back.

I wonder if there is a connection? I don't mean genetically, but in terms of early birth trauma possibly leading to anxious parenting, leading to an anxious child, growing up to be anxious new mum... etc... ?

Yes I think there probably is a connection, as birth trauma is a possible risk factor in PND. However, if this is dealt with when the woman is feeling strong enough to address it, it should not lead to anxious parenting and an anxious child etc. etc. Again this takes me to traumas in our life that are not resolved; if we suppress them, they can raise their ugly head years down the line.

LizWise Tue 17-Apr-12 13:10:15

blue2

Hi Liz
I attended one of your day courses a few years ago while I was a Homestart Volunteer - it was incredibly informative, and filled in a few gaps for me as I'd had bad PND after my son was born, but only knew of "my" story.

I see that there are almost no support groups for this illness; what would I need to do to start one up? I am not a healthcare professional - but does that matter?

I'd be interested to hear your response.

Many Thanks

Hi, thank you for your feedback and I’m glad you enjoyed the course. There are many things to consider before starting up a support group, such as who facilitates, the venue, a room for the crèche etc. I would be most happy to have a chat with you about setting up a group; I think it’s a great idea.

LizWise Tue 17-Apr-12 13:10:37

FunnysInLaJardin

Hello. I would be interested to know whether there is any link between breast feeding and PND. I felt myself slipping into PND with both my DC which only stopped when I stopped breast feeding. I think I struggled to cope with the hormonal effects. Thanks

Hi FunnysInLaJardin,

I think there may well be a link between breastfeeding and PND, as I have known some women feel better when they have stopped breastfeeding. However, others have felt worse. We have to remember that breastfeeding can be enormously demanding, tiring, and sometimes isolating - which are factors that may contribute to PND.

LizWise Tue 17-Apr-12 13:11:45

TheJoyfulPuddlejumper

Great question swallowed!

Hi Liz,

I suffered from severe postnatal depression after the birth of my daughter. My husband realised pretty quickly and encouraged me to seek help but I was convinced that it was just sleep deprivation. How do you differentiate between a woman 'just' being sleep deprived and it being PND?

Sleep deprivation definitely contributes to PND and tiredness certainly makes it worse, however there are mums (most in fact!) who are sleep deprived but are not depressed. Sleep deprivation would not usually be a factor on its own to cause PND.

LizWise Tue 17-Apr-12 13:12:14

FunnysInLaJardin

Hello. I would be interested to know whether there is any link between breast feeding and PND. I felt myself slipping into PND with both my DC which only stopped when I stopped breast feeding. I think I struggled to cope with the hormonal effects. Thanks

(cont'd)... Hormones obviously do play a part in PND, however they're never solely responsible for it.

ReallyTired Tue 17-Apr-12 13:13:15

Do you think there is a danger with long support groups that they encourage women to ruminate on their problems and make depression worse. I had strong OCD symptoms with postnatal anxiety and I suspect that the support group I went to exasabated my symptoms.

JugglingWithTangentialOranges Tue 17-Apr-12 13:13:34

You don't think there's a complete spectrum of experience from content and happy through to seriously depressed ? As in can you really say when someone has PND and when they don't ? Aren't some people (speaking from personal experience) just either un-diagnosed or slightly sub-clinical / sub-threshold ?

LizWise Tue 17-Apr-12 13:13:45

heather1

Dear Liz,
I am interested on your thoughts about a link between PND and PMT.
I had doctor diagnosed PND after the birth of both my children. Subsequently my PMT significantly worsened (also doctor diagnosed). I saw a nutritionist with a track record of helping women with PMT. Though supplements, diet and exercise no more PMT then and now 5 years from the birth of my youungest (my PMT was just like the PMD but only around the time of my period.)
The nutritionist thought there is a dietary and consequently hormonal link. I think its a shame more diet and exercise help arent given to women disgnosed with PMD.
Do you agree this could be the situation for some cases? I havent tested it out by having another child!

There is certainly a connection between PND and PMT and it seems to be that as a mum is recovering from PND, she may find her symptoms heighten before or during her period. There is a definite connection between diet, exercise and PMT and these may help it. PMT may be a positive sign that a mum is recovering – if she’s feeling well most of the month then drops before her period it shows that her PND is becoming PMT. It can be a good idea to keep a diary of symptoms to see a pattern.

LizWise Tue 17-Apr-12 13:14:51

ReallyTired

Do you think the use of positive pychology (Ie. resilence training or the human givens theory, mindfulness, teaching of relaxation techniques) could prevent postnatal depression in at risk women?

I went to a postnatal depression group that actually made my depression worse. Do you think there should be more critical assessment to see what types of councelling/ medication works for a particular individual?

Hi ReallyTired,

I definitely think use of positive psychology and cognitive behavioural therapy (CBT) could help prevent PND in some women. However it would be important to learn this before, as getting a grip on it when you are depressed is very, very hard. I would be interested to know in what way the postnatal depression group made your depression worse? Yes, I think it is important to assess individual mothers to know what type of treatment and/or support is needed.

LizWise Tue 17-Apr-12 13:18:14

Honeymoonmummy

That's interesting Heather and links to my question.

I had PND with my DD (now 3.5) and again with my son (now 1). With my dd 150mg of sertraline worked; with DS I caught it early (6 weeks) and tried both sertraline (200mg) and mirtazapine (30mg) at different stages and altho they helped some symptoms, I was left feeling like I had pmt all the time; black moods, snapping, feeling rage. I went on the mini-pill 5 months ago and there was an overnight transformation. I am now on the mini pill and 150mg sertraline and am much better. My question is, will I have to remain on the mini pill indefinitely and is there an underlying cause of this hormonal imbalance?

For some women the mini pill can help their PND, for others it makes it worse. I would suggest talking to your GP about a possible hormonal imbalance. I wouldn’t have thought you would have to stay on the mini pill indefinitely, as I would think the sertraline is probably making you better rather than the mini pill. Agnis castus can be helpful for PMT and it is best to see a homeopath for this.

LizWise Tue 17-Apr-12 13:19:48

JugglingWithTangentialOranges

You don't think there's a complete spectrum of experience from content and happy through to seriously depressed ? As in can you really say when someone has PND and when they don't ? Aren't some people (speaking from personal experience) just either un-diagnosed or slightly sub-clinical / sub-threshold ?

Hi JugglingWithTangentialOranges,

I think in the majority of cases, you can really say when someone has PND, by assessing them from how they tell you they are feeling. I do think there's a complete spectrum of experience from content and happy to seriously depressed. There are various degrees of having post-natal depression. I think some people are slightly sub-threshold, however it is important to offer them the same level of treatment and support as you would with a woman who has been diagnosed with PND.

LizWise Tue 17-Apr-12 13:21:36

TruthSweet

I am interested in the lesser known PNI - PND-OCD & PN -Anxiety. Why are they always bundled up with PND (lists of PND symptoms always seem to list 'anxiety, obsessions, intrusive thoughts, repetitive behaviours, etc...' as part of PND)? This seems to mean that mothers with non-depression based mental health problems get overlooked and not dealt with properly.

I have a friend (genuinely - it's not me though I have had PND-OCD!) that has had depression in the past (so know what it feels like) but now feels she is having OCD behaviours - her GP just keeps telling her it's PND and trying to treat her 'depression' which of course isn't working.

Non-mothers with OCD/anxiety don't get treatment for depression they get OCD specific treatment so why do mothers with PND-OCD/PNA get treated for depression?

PND has many different symptoms including OCD and anxiety. Sometimes it may be difficult to separate OCD from PND, however it would be treated in the same way in a person who had OCD but no depression. When OCD is part of PND it tends to get better as the depression lifts, OCD in PND has a lot to do with gaining some control, as when one has PND there seems to be very little control felt.

LizWise Tue 17-Apr-12 13:22:01

Thaleia

Hi Liz,
Is it more likely to get PND after a c-section as it's harder to bond with the baby (lack of Oxytocin) and bfeeding might be more difficult in combination with feeling a failure for not able to do it naturally?
Thanks, Thali

Hi Thaleia,
Having a C-section or a traumatic birth may be a risk factor that contributes to PND, especially if it is unexpected and the mother feels that she is not in control of her birthing experience. I wouldn't necessarily say that it is harder to bond with the baby after a C-section due to a lack of oxytocin, and breastfeeding can be difficult for women who have had natural deliveries too. However it still is a risk factor for some women.

Thank you for answering my question Liz. smile

As a follow-up, what would you recommend as treatment if the usual antidepressant/talk therapy/CBT fails to effect any improvement? I had all.of.these after the birth of.my daughter but nothing seemed to.help. I was still suffering (to a degree anyway) when I.found.out I was unexpectedly pregnant with my son, and I spent the pregnancy petrified that I.would.have to do it all again, knowing that nothing had helped before. (Luckily I've had no symptoms of PND so far but we're definitely on the lookout!).

JugglingWithTangentialOranges Tue 17-Apr-12 13:22:39

Thanks Liz, Wise by name, wise by nature !

LizWise Tue 17-Apr-12 13:23:29

realhousewifeofdevoncounty

Looking back I more than likely had Pnd after dd. But I kind of agree with swallows, in that for me it kind of felt like a normal response to the massive change in my life. I was recovering from a cs, I had had no sleep for weeks and suddenly there was this thing that was so dependent on me I couldn't even go for a wee anymore, let alone eat or drink, and it wanted to suck on my boobs all the time which really hurt, but I couldn't stop doing it or I would be a bad mother. It sometimes baffles me how people DON'T get Pnd. I think it is made worse by society painting motherhood as this amazing experience - you bond straightaway, it all cones so naturally and it is all lovely. But so many people I speakto don't have that experience and feel like massive failures if they don't. For me, my love for dd has grown daily, bonding wasn't instant and the newborn phase was hard and even dark at times. I still don't know if it was Pnd or just a normal response to what is an incredibly hard and testing time of life for a lot of people, compounded by guilt at feeling that way as it is supposed to be so "magical".

I totally agree with you that there is too much pressure on mums to bond straight away, think motherhood is amazing etc etc. Not all mums take to it naturally, and often feel guilty if they don’t. However, for a mum with PND these feelings are exaggerated and make her feel negative and have an effect on her day to day life.

LizWise Tue 17-Apr-12 13:24:13

hunkermunker

Hi Liz, my question is this:

How do you cope, having had a traumatic time yourself, Liz, with being so immersed in making things better for other women? Do you ever feel like you would rather not be so close to something that was a source of such heartache in your own life? Or have you managed to work through your own issues in such a way that you use them to inform what you do, but you're distanced from the feelings you had at the time? If so, how did you go about that process?

Thank you - and thank you for what I know will be a really valuable webchat.

Hi Hunkermunker,

I think the fact that I have had such a traumatic time with my post-natal depression has been very useful in giving me greater understanding and empathy towards others going through it. No, I never feel that I don't want to be close to something that brought me such heartache. As far as I'm concerned, it's given me the best job that I could possibly have - that is one where I help other women. My PND was over twenty years ago, so I'm very far removed from it. Although I do remember it well, it doesn't have any negative impact on me now at all.

I worked through my issues when I was strong enough after my depression and also when I trained as a counsellor. Thank you for tuning in.

LizWise Tue 17-Apr-12 13:26:44

peanutpie

I spend a lot of time reading stuff about people talking about stuff like co-sleeping/bfeeding/weaning stuff. I think I genuinely feel on the outside of this. Having a baby is just about basic survival - at times it feel like just me or them. Late pregnancy and the early bits of a new child are utterly horrible. These other 'choices' are utterly beyond me. And it seems to go on for a long time, years even!
So grateful even for you to be publicsing this website.

Being a mum is one of the hardest jobs ever, and isn’t always wonderful and rosy. Not many people tell you this though and therefore it can come as a huge shock for some mums.

EG101 Tue 17-Apr-12 13:27:32

Hi Liz,

I have been receiving treatment for PND for about 6 months now, although I think I should have requested help a few years earlier. Do you think PND is ever "cured"? My GP has recommended I remain on anti-depressants for around 2 years. I have experienced a massive positive change in the last 6 months and have no problem with being on meds if they work but am also scared of becoming overly dependant.

Thank you.

LizWise Tue 17-Apr-12 13:27:53

WorriedBetty

I have just had an amazing conversation with friends of mine whose dad has just died. One of these two have a child. The whole family are in love with her.

My sister had PND and is much more negative about her worth since.

In a really amazing conversation about how childhood memories come flooding back when one is linked closely to a child my friends and I wondered a) if PND research accepted/backed up the idea of a boost of childhood memories when a child is born b) if PND affects this boost of childhood memories and goes on to affects the relationship a sufferer would have with their parents and c) does an abusive childhood cause negative childhood memories to surface after childbirth and cause PND?

For some parents, their memories of childhood will come back when they have their own children and these memories may be negative. This may bring on feelings about their own parents and yes, women who have been abused may be at high risk of having PND.

ReallyTired Tue 17-Apr-12 13:28:22

LizWise,
Thanks for answering my question. I attended an NHS postnatal depresssion group when ds was a year old and it was a disaster for me. I found that the stories of the other women increased my own levels of emotional arousal. I also made may OCD worse talking about it for 20 minutes each week.

I have been reading about human givens and it says that long term councelling can cause the same affect. Ie. with trauma people relive their exepriences and experience a rise in cortisal levels in their blood stream. The excessive cortisal makes the chemical imbalance of depression worse. According to the human givens theory depressed people have too much REM sleep which is why someone with depression so tired. People dream as a way of the brain processing stress/anxiety/ unresolved anger. The problem with too much dreaming is that people do not get restorative sleep.

With DD I went to a couple of skills based sessons run by a lady from the Herts mind network. I found that learing how to relax or looking work life balance or managing anxiety more useful than the opportunity to "talk".

LizWise Tue 17-Apr-12 13:28:45

TheJoyfulPuddlejumper

Thank you for answering my question Liz. smile

As a follow-up, what would you recommend as treatment if the usual antidepressant/talk therapy/CBT fails to effect any improvement? I had all.of.these after the birth of.my daughter but nothing seemed to.help. I was still suffering (to a degree anyway) when I.found.out I was unexpectedly pregnant with my son, and I spent the pregnancy petrified that I.would.have to do it all again, knowing that nothing had helped before. (Luckily I've had no symptoms of PND so far but we're definitely on the lookout!).

Hi TheJoyfulPuddlejumper,

I would be interested to know how long you took the antidepressants for and how long you had therapy for. From reading your post, it sounds as if your depression may have been very hormonal-related, as you have had not had a recurrence of it. How old is your baby son now?

LizWise Tue 17-Apr-12 13:30:17

Memoo

I developed severe pnd after the birth of my 3rd baby. I had periods of psychosis and ended up in hospital. 2.7 years later I still suffer very badly at times. I am on 5 different types of medication. I wondered how long can pnd continue? I feel rediculous that I am still struggling after all this time.

PND is different to postnatal psychosis and I’m sorry to hear that you are still suffering badly at times. Usually PND is a temporary episode of depression which doesn’t reoccur once it has totally lifted. If you would like to email me separately I may be able to give you some advice. We'll post the email address at the end of the webchat.

LizWise Tue 17-Apr-12 13:31:32

PeelingmyselfofftheCeiling

A friend of mine suffered severe PND which came on very suddenly. She was diagnosed and put in ads, which she says worked for her, but it occured just before her first period came back and she says the more dramatic improvement was straight afterwards when she felt much less hormonal. Is there a known link between PND and pmt? And, without wanting to imply any criticsm of women who choose not to breast feed, is there any link between breastfeeding 'holding off' PND (my friend was not breastfeeding therefore her periods returned very quickly)? It's risky ground I appreciate.

Please see my answer to Heather (1) regarding PMT and PND. Re breastfeeding – I do believe there may be a link between PND and breastfeeding, however some mums feel better when they stop breastfeeding, others not, so it does very much depend on the individual.

LizWise Tue 17-Apr-12 13:32:01

EG101

Hi Liz,

I have been receiving treatment for PND for about 6 months now, although I think I should have requested help a few years earlier. Do you think PND is ever "cured"? My GP has recommended I remain on anti-depressants for around 2 years. I have experienced a massive positive change in the last 6 months and have no problem with being on meds if they work but am also scared of becoming overly dependant.

Hi EG101,

I think the very fact that as your PND wasn't recognised or diagnosed for a few years, it would be a good idea for you to remain on meds for a couple of years. I think that is very sensible advice from your GP. There should be no reason for you to become dependent on them, as as they are working, you in turn will be getting better. As long as you don't come off them too early or too quickly, there should be no reason for you to have a relapse. I wish you all the best.

He's 16 weeks. smile With my daughter I was displaying strong symptoms within 8 weeks and put straight on sertraline, which I took for a few months. I did talking therapy for about 4 months (I was lucky that there was a centre dedicated to ante- and post-natal counselling where I lived) and did the online CBT course. After that the GP just seemed to give up on me, that was all they had to offer.

LizWise Tue 17-Apr-12 13:34:32

dontlaugh

Is there a link between PND and traumatic birth? Is PND actually a form of PTSD or are they related?
I definitely had PTSD after my first birth, due to terrible staff, and an OP baby. I often wonder if I would have suffered as badly and for so long in silence if the birth had gone smoothly. I didn't even have the baby blues after the second (dream birth at home, also OP but not a problem). It is something which I do think about often, and how the harsh reality of a labour/delivery ward is often shrouded in mystery - stirrups, scissors and shouting are all that spring to mind when I think of our local one, based on my own experience.
What can be done to assist women overcome the gap between their expectations and the reality?

A traumatic birth is a risk factor for PND combined with other factors. There is a very fine line between PND and PTSD and I do believe that PTSD can lead to PND. I wish I could answer what could be done, however we all have our own expectations about how motherhood is going to be, whether or not we are aware of the reality of it. I think it’s quite difficult to prepare anyone for adjustment to parenthood.

LizWise Tue 17-Apr-12 13:35:14

ReallyTired

LizWise,
Thanks for answering my question. I attended an NHS postnatal depresssion group when ds was a year old and it was a disaster for me. I found that the stories of the other women increased my own levels of emotional arousal. I also made may OCD worse talking about it for 20 minutes each week.

I have been reading about human givens and it says that long term councelling can cause the same affect. Ie. with trauma people relive their exepriences and experience a rise in cortisal levels in their blood stream. The excessive cortisal makes the chemical imbalance of depression worse. According to the human givens theory depressed people have too much REM sleep which is why someone with depression so tired. People dream as a way of the brain processing stress/anxiety/ unresolved anger. The problem with too much dreaming is that people do not get restorative sleep.

With DD I went to a couple of skills based sessons run by a lady from the Herts mind network. I found that learing how to relax or looking work life balance or managing anxiety more useful than the opportunity to "talk".

Hi ReallyTired,

THanks for sharing your experiences. For many women, attending a PND support group really can help, as it normalises their feelings for them and reduces that dreadful sense of isolation you can have with PND. However, it's not for all. Everyone is unique in their own experience of PND, as they will be in what will help them recover. I'm glad that you found the sessions that you had in Herts useful.

LizWise Tue 17-Apr-12 13:35:39

gafhyb

To me, the whole area is, of course a muddle of psychological, physical and social issues. Forgive me if this sounds clumsy, but it has sometimes struck me that there's "acceptable"/understandable PND - hormonally-related in a woman with no history of mental health problems - treatable with antidepressants, and the altogether more "messy" sort. Are they 2 separate disorders

I would agree a real muddle of disorders and there are many women who have PND that have no history of mental health problems. I myself was one of them. It would depend on the mental health issue as to whether you would see them as two separate disorders. Someone with bipolar or schizophrenia may well be treated with different medication and support than a mother who does not have an existing mental health issue.

foxeeroxee Tue 17-Apr-12 13:36:18

Hi liz.
I was wondering what is the difference between a diagnosis of depression and pnd?
I have had 2 episodes of depression each lasting 1-2years and 2 months ago was diagnosed with pnd, but i dont feel any different now than i did previously other than it has worsened my ocd tendencies.
Confused i guess!!

LizWise Tue 17-Apr-12 13:37:45

HateBeingCantDoUpMyJeans

Mine I guess is similar to joy and swallowed... Where does'normal ' life after a baby end and PND begin?

Guess I sneak in a second seeing as my first has kind of been covered.....Is there any link regarding pre natal depression /anxiety and post natal illness? Is it a case of one or the other or is it mix and match? And how do you think diagnosing pnd years after the birth fits into all of this? Are pre and post natal depression just a way of saying a woman with children is depressed?

Around 10% of women have some symptoms of depression/anxiety whilst pregnant and two thirds of mums with PND have had some symptoms pre-natally. However, it does not necessarily mean that if you have antenatal depression you will have PND. No, PND is depression after childbirth, NOT ongoing depression.

LizWise Tue 17-Apr-12 13:37:46

TheJoyfulPuddlejumper

He's 16 weeks. smile With my daughter I was displaying strong symptoms within 8 weeks and put straight on sertraline, which I took for a few months. I did talking therapy for about 4 months (I was lucky that there was a centre dedicated to ante- and post-natal counselling where I lived) and did the online CBT course. After that the GP just seemed to give up on me, that was all they had to offer.

It may be that subconsciously your talking therapy and CBT did work, but you didn't feel it at the time. Possibly it has been helpful to you as a preventative measure for not experiencing PND this time round. I'm really pleased that you're feeling well and hope you continue to do so.

LizWise Tue 17-Apr-12 13:39:15

gafhyb

I wonder if the things that make you prone to anxiety and depression, are likely to be triggered by becoming a parent (I'm speaking personally, here) - issues relating to control, perfectionism, black and white thinking. Added to by sleep deprivation, and by societal expectations.

Sorry, am wittering now.

Yes I do think some of those issues may make you prone to PND along with other factors, however I have known women who would class themselves as liking to be in control and perfectionists that haven’t have PND.

LizWise Tue 17-Apr-12 13:39:33

foxeeroxee

Hi liz.
I was wondering what is the difference between a diagnosis of depression and pnd?
I have had 2 episodes of depression each lasting 1-2years and 2 months ago was diagnosed with pnd, but i dont feel any different now than i did previously other than it has worsened my ocd tendencies.
Confused i guess!!

The difference between a diagnosis of depression and PND is timing. PND is a depressive episode after childbirth, whereas depression can occur at any time. As you have had previous depression, it did put you at a slight increased risk of having PND. The symptoms and feelings of depression and PND are very similar, however having a baby to look after can make the depression feel worse.

LizWise Tue 17-Apr-12 13:40:58

Barklouder

Good reading so far.

Liz, do you have any thoughts on what can be done to educate people about postnatal depression - particularly expectant mothers - before it hits? I am sure I am not alone in having endured some dreadful dark times in silence as I believed that all mothers felt as I did (and like them I would continue to keep the secret of how dreadful motherhood was looking after a child who was like a stranger, consumed by anxiety and suicidal thoughts). I simply did not know that pnd existed and that the way I felt could be stopped! I thought I was a terrible person.

Added to this, do you have any advice on how to support friends who are new mums and encourage them to recognise if they have crossed the line from the usual challenges of a baby to becoming ill with depression?. I always ask friends if they are ok and they generally say yes fine - I would have answered 'I'm fine' too but I definitely wasn't. Is it stigma?

Just to add to some of the other comments: I was one of the mothers who had a textbook pregnancy and birth, stable family, no worries and no history of mental health problems.

I think all pregnant women should be given info about PND, the facts and the figures. Not to alarm them, but to point out how common it is and that there is treatment and/or support for them and that it does go away.

there isn't any difference - it's just a label to identify a link to becoming a mum and the year thereafter. i think it's misleading and invisibilises questions of what is it about women's experiences around mothers in the context of western society that is causing them to develop depression.

the PN prefix suggests it's organically connected to the physiological experience of pregnancy and something other whereas for most it is clinical depression plain and simple that happens to have come on after becoming a mum and has the same indicators and contributory factors as any depression - re: isolation, loss of status, trauma, lots of change, sleep deprivation, changes in relationships etc etc etc. so it is the social nature of birth and early motherhood that is the issue not something inside women's bodies imo.

LizWise Tue 17-Apr-12 13:43:00

StrangerintheHouse

How can we untangle the fact that having pnd or ptsd/anxiety makes you lose your grip on reality so that it is hard to tell whether your fears about admitting to how you feel (eg they will take my baby away, people will think I don't love my baby and I'm a bad mother) are in proportion or are actually part of the problem.

(Hope that makes some kind of sense, I should be asleep!)

It is a fact that when you have PND it is sometimes difficult to untangle what are usual fears – everything seems blown out of proportion with PND and you can feel quite irrational. The best way of dealing with this is to be able to talk openly to someone you trust and someone who understands about PND, be it your GP, health visitor, a counsellor, friend etc. I have supported hundreds of women over the years and have never known anyone have their baby taken away due to PND. Health professionals want to keep families together not separate them.

LizWise Tue 17-Apr-12 13:43:38

MrsMicawber

Hi,

Thank you so much for doing this webchat. I had PND with my oldest quite severely, and as a result my husband was my son's main caregiver. I did not spend extended periods alone with him until he was 14/15 months old. I have a terrible feeling of needing to make up for lost time with him now that I am healthy trying to reassure him that I am 100% commited to meeting his needs even though I didn't when he was a baby.

How can I get past this feeling and do I need to be worried about 'loving him too much' and pushing him away? as in these feelings of inadequacy are mine, essentially selfish feelings. Are they harmful to him though?

You certainly don't need to be worried about loving him too much. I don't think you can ever give a child too much love. He won't remember that time when you weren't caring for him, although you will. Those feelings of guilt will fade. REMEMBER, you were ill and these feelings weren't your fault. They will not do him any harm.

I myself didn't bond with my elder daughter until she was 14 months old, these months were a total blur for me. She is now 26 and we are so close, she knows all about my PND and my lack of love for her at the time. She has no memories of it and it has not affected her at all. Please let me reassure you that the further away you get from your depression, the easier these feelings will be to deal with.

JugglingWithTangentialOranges Tue 17-Apr-12 13:46:40

I wonder if "maternal depression" would be a better term (though I guess PND is widely known now) - but just to give more emphasis to the tremendous social and personal changes a woman experiences as she becomes responsible for caring for a young baby ?

LizWise Tue 17-Apr-12 13:48:21

BellaBoo85

Plain and simply, how do you get over it when the guilt won't go away??
The way I see it, it's always going to be there because of how (I think) it started. And if I'd not had that one particular thought/feeling then none of it would've happened. And that thought isn't just going to disappear. Even if one day I don't believe it anymore, there was a day when I did.
And that is what I can't get out of my head.

I never thought that I would ever get over the dreadful guilt I felt about not being able to feel love for my first daughter. However, the further away you get from your PND the guilt feelings will get much easier and more often than not go. The depression sometimes hooks itself on to ‘if I hadn’t thought/felt that, then it wouldn’t have happened’, however it is the depression that makes you feel that. It may also be that having some cognitive behavioural therapy may help with these thoughts.

juggling i agree and their are researchers etc who choose to use the term maternal depression instead because of the difference it makes to how you then look at it, identify causes and seek to address it as a 'social' problem rather than just an individual woman's problem.

LizWise Tue 17-Apr-12 13:50:52

SeverePNI

Is there enough support for those experiencing very severe PNI, and who are MBU beds actually for? From reading the boards on here these places seem to only be available to mothers experiencing PN psychosis rather than severe depression.

My background to this question is that I was suicidal through my PND at the end of January and felt unsafe at home. My baby was 7.5m and BF. I asked for the Crisis Team to look into an MBU place for me; they never did. There is no unit in our area and I believe it was too expensive/too difficult and the fact that I am alone with my children and wouldn't do anything with them in the house was "used" by the team to keep me safe. Since then I have had a second suicidal episode, am habitually self harming and am possibly developing an eating disorder; these latter two were only just starting to manifest when I asked to be admitted and I believe would have been nipped in the bud by intensive intervention then. I did not even see a psychiatrist until the end of March.

Is this scenario sadly common in severe cases?

There are beds at some MBU for mums with PND not just postnatal psychosis. I’m sorry that you feel you weren’t given the help that you needed at the time, in my experience it does vary from area to area.

LizWise Tue 17-Apr-12 13:51:11

PinkFondantFancy

I'd like to reiterate puddlejumper's question. I have had very broken nights for 7 months now and my mood is often very low. My GP thinks I'm 'just' tired - how can I tell the difference? Is there one anyway?

I think you would be able to tell the difference yourself. For example, are you experiencing any other symptoms apart from tiredness and low mood? Are you able to look forward to anything and are you able to enjoy anything? Tiredness is certainly a symptom of depression, but not usually on its own.

LizWise Tue 17-Apr-12 13:52:04

ThatllDoPig

I had pnd. It frustrates me so much that people STILL always assume that this means you don't bond with your baby.
Why is there is misconception and what can be done to challenge it? For me it was the opposite. My baby was perfect and wonderful, but I felt I couldn't protect her from this shitty world.

I know I feel that too. It is a myth that if you have PND you don’t bond or love your baby. Many mums I work with have no problems with bonding even though they have PND. Unfortunately for some mums the severity of their depression doesn’t allow them to feel the bonding or feelings of love for their baby. However, as the depression lifts the feelings will start to emerge.

designerbaby Tue 17-Apr-12 13:52:54

Hi Liz,
So great that this discussion is taking place. I had PND following a traumatic birth of my first daughter, but although symptoms were there from very early on, things didn't escalate until I stopped breastfeeding when my DD1 was five months old.

Despite showing the full range of symptoms including obsessive behaviour and thoughts, suicidal thoughts (I'd planned how and when I would overdose do as not to disrupt DD1s routine - "sorry DD, your Mum's dead, but at least Your nap time wasn't disturbed" goes to show how ad things had got), hysteria, despair and anxiety when my (lovely) HV got me a GP referral I was told that he didn't think I was depressed, just stressed and tired and that I should "try and get some sleep". When referred back twice more by an outraged HV I just got a repeat diagnosis plus some hostility because I was "wasting their time". Apparently because my DD was five months old, not a newborn it "couldn't" be PND.

My HV got in touch with my husband and we managed to sort out counselling privately and I got through it (by the skin of my teeth). It was a long, hard road though, and I think ADs would have helped both ease and shorten the process. Had I not had a supportive husband and the funds to go private, I honestly don't think I'd be here now.

Are GPs routinely given training on how to diagnose PND? If a patient or HV can't get help through this avenue where else can they turn? Are there NHS/funded services that can be accessed without having to go through a GP referral? If so, are HVs aware if them? Mine was brilliant, visited me every other day and called me daily to check I was ok, and even she seemed to draw a bit of a blank when the GP failed spectacularly to diagnose/treat.

It didn't seem like there was another avenue...
Thanks,
db

LizWise Tue 17-Apr-12 13:52:58

FourYolksAche

Do you think the crap postnatal care women receive in hospital (very frequently bemoaned on MN) is a cause of PND?

I was v close to having some kind of breakdown on that bloody ward until DH got me out of there.

I think there are various different factors that contribute to PND and never just one on its own. Poor postnatal care may be one of them alongside other factors.

basically it is contentious to call it pnd. if you noted that teachers were more inclined to depression you'd say hmm what is it about teaching that contributes to causing depression and how can we make structural changes? if you call mothers getting depression depression you have to do the same. calling it PND denies that usual way of looking at phenomena and depoliticises the issue if that makes sense - it becomes your problem not a societal one.

LizWise Tue 17-Apr-12 13:53:56

JugglingWithTangentialOranges

I wonder if "maternal depression" would be a better term (though I guess PND is widely known now) - but just to give more emphasis to the tremendous social and personal changes a woman experiences as she becomes responsible for caring for a young baby ?

Hi JWTO,

I think maternal depression may be different to PND, as 'post-natal' is a short period after the birth. However 'maternal' implies that the depression is ongoing.

LizWise Tue 17-Apr-12 13:54:02

Kveta

my mother is pretty sure she had undiagnosed PND after the birth of my younger sister - she remembers crying a lot, and trying to kill me (a toddler at the time) by beating me, throwing me in the cot too hard, at one point getting a knife out and seriously planning to use it. My sister was labelled a Failure to thrive baby, and didn't bfeed well, which mum reckons exacerbated it, and the local HV did nothing to help.

This has had 2 consequences that I can see - firstly, my sister and I DO NOT get on (and I have a somewhat prickly relationship with my parents), and secondly, I am now terrified that history will repeat itself when I have my second child in a few weeks time. I have previous history of reactive depression following sexual assault as a teen (nothing to do with parents!), so know I am prone to depression. my mother and grandmothers have all been warning me and DH to look out for it, and spent much of my older child's early life watching me like a hawk for signs of depression, which was fun... (as it was, I was never happier than after he was born!!)

So my questions are - how can my mum begin to get over this, when it was pretty clearly not 'her', it was a medical condition - she still beats herself up for my sister having various health problems nearly 30 years later, and is so overprotective of sister it's damaging her relationships with me and other younger siblings. and question 2 (sorry!) how can I avoid the same thing happening to me?

(apologies for such a personal question, I understand a single post here cannot a life time problems solve!)

Hi Kveta, How awful for your mother – perhaps it would help her to have some counselling to talk through her feelings about this and to relieve her guilt. She could contact her GP for a referral. It sounds as if you are very self aware and aware of signs and symptoms which is excellent. The fact that you were fine after your first child is very encouraging. Talking about your feelings, getting as much rest as possible, eating well and exercise can all be helpful. Please feel free to email me if you would like any more information.

LizWise Tue 17-Apr-12 13:55:00

AnAirOfHope

PND affects the whole family but its only the woman that gets counciling. What can be done to "mend" the family as a whole? or at least consider it when the women is ready.

I see mums and dads together or separately depending on their needs. Most GP’s would be willing to refer a family for counselling if they think necessary. You are very right in what you say about the woman needing to be ready to address this, as she won’t be strong enough to do so when in the depths of her depression.

LizWise Tue 17-Apr-12 13:56:13

StrawberrytallCAKE

Are there any measures that you think a woman can take during pregnancy that may lessen the chances of pnd occuring?

I think awareness of how your feeling is key as well as putting support systems in place. Such as having someone that you can really talk about your feelings to, trying to rest as much as possible, eating a good diet little and often, exercise within reason, and not having too high expectations of labour, birth and motherhood.

JugglingWithTangentialOranges Tue 17-Apr-12 13:58:02

Responding to Pink Fondant though - I think sometimes we need someone else to support us in seeking help and support and recognising that something is wrong and that with that support things could get better. All the best PFF - perhaps you could get a second opinion from another doctor or seek advice from a health visitor if you find your GP's response unsatisfactory ?

Barklouder Tue 17-Apr-12 13:58:18

@swallowedafly

calling it PND denies that usual way of looking at phenomena and depoliticises the issue if that makes sense - it becomes your problem not a societal one.

Why would it be a societal problem? I just dont believe it was in my case hmm

LizWise Tue 17-Apr-12 13:58:26

designerbaby

Hi Liz,
So great that this discussion is taking place. I had PND following a traumatic birth of my first daughter, but although symptoms were there from very early on, things didn't escalate until I stopped breastfeeding when my DD1 was five months old.

Despite showing the full range of symptoms including obsessive behaviour and thoughts, suicidal thoughts (I'd planned how and when I would overdose do as not to disrupt DD1s routine - "sorry DD, your Mum's dead, but at least Your nap time wasn't disturbed" goes to show how ad things had got), hysteria, despair and anxiety when my (lovely) HV got me a GP referral I was told that he didn't think I was depressed, just stressed and tired and that I should "try and get some sleep". When referred back twice more by an outraged HV I just got a repeat diagnosis plus some hostility because I was "wasting their time". Apparently because my DD was five months old, not a newborn it "couldn't" be PND.

My HV got in touch with my husband and we managed to sort out counselling privately and I got through it (by the skin of my teeth). It was a long, hard road though, and I think ADs would have helped both ease and shorten the process. Had I not had a supportive husband and the funds to go private, I honestly don't think I'd be here now.

Are GPs routinely given training on how to diagnose PND? If a patient or HV can't get help through this avenue where else can they turn? Are there NHS/funded services that can be accessed without having to go through a GP referral? If so, are HVs aware if them? Mine was brilliant, visited me every other day and called me daily to check I was ok, and even she seemed to draw a bit of a blank when the GP failed spectacularly to diagnose/treat.

It didn't seem like there was another avenue...
Thanks,
db

Hi designerbaby,

I'm sorry to hear that you had such a dreadful lack of support for your PND. As with any other profession, GPs and health visitors do vary and I think I would have been tempted to ask to see another GP. However, I know when you're depressed, trying to be assertive can be virtually impossible. To be told that because your DD was 5 months old, it couldn't be PND, is outrageous. PND can manifest itself months after delivery.

I am aware that GPs are routinely given training on post-natal depression. However if there are no answers from the health visitor or GP, I would be tempted to change my GP practice and go somewhere else. It is quite unusual for a health visitor and GP not to offer any support. I'm so glad that you got it from your HV. I do hope you're well now.

LizWise Tue 17-Apr-12 13:59:24

thunksheadontable

Hi

I am 32 weeks pregnant with my second child and slowly coming to terms with the fact that I have mental health issues related to pregnancy and the postpartum period.

I will be very interested in what you have to say about the medicalisation of PND and how it lays the causes for maternal distress in chemical/hormonal imbalances in the mother with little apparent public recognition of the role of past experience and current social support. The preventative side seems totally absent, is this true in lots of cases?

I think my case is probably pretty typical. I grew up in a chaotic abusive (yet solidly middle-class) home with a cruel alcoholic father and a distant, neglectful mother. I have a pretty typical psychological profile of a first-born child from this type of background: I am ultra-high achieving, perfectionistic and relentlessly self-critical with a deep sense of shame and the idea I am responsible for just about everything in the world. I've had counselling/therapy on and off and more or less manage really functionally but in pregnancy my defences lower and my desire for control and certainty, plus tendency to see threat in anything I can't control, goes haywire.

There is also a family history of mood disorders, puerperal psychosis and PND.

I had antenatal OCD and depression in my first pregnancy but never sought help. All was well during labour and birth (for which I prepared as if it were a marathon) until the second stage, when my large post-dates induced baby got stuck and there was a panic and brutal rotational forceps delivery. In a state of absolute horror at his birth and how I had "failed", I went into an anxiety state and remember nothing of his first 72 hours apart from brief, brutal flashes of an incredibly nasty midwife who basically did her best to humiliate everyone on our ward (e.g. "what do you mean it hurts? Silly girl, of course it hurts, if you think this is the least pain you will feel as a mother you are very naive indeed").

Cue a very typical story of the inevitable breastfeeding problems following this type of birth leading to "intervention" from the NHS which consisted of asking me to feed 10-12 times every 24 hours, expressing and refeeding after every one: baby losing weight, immense sense of failure, battling on regardless. Distressed, hungry baby screaming 24-7. No family support other than my husband (we live abroad). No friends available (none had kids, all drifted very fast after giving initial gifts etc). A deep snowfall combined with severe postnatal perineal trauma which meant I couldn't walk also kept me housebound for nearly 7 weeks as I couldn't drive....

It's hardly rocket science that in these circumstances, and with a history that makes me prone to anxiety and depression, I started to slide... and it's hardly amazing that now, at 32 weeks pregnant, my anxiety levels about after the birth are sky-high.

And yet, despite having a label of moderate OCD and depression, there is NO plan for my labour. I have had health professional after health professional try to terrify me with stories of how badly wrong an elective section could go (despite never asking for one) and I have had several almost promise me a wonderful, calm second birth (which they can't, and shouldn't).. I had the supervisor of midwives say "listen you may think you are, but you're clealry not one of the mad ones" hmm. There is no CBT available despite NICE guidelines and my initial referral to the Perinatal Mental Health team happening at 6 WEEKS PREGNANT.

I just feel that the chances of a recurrence of PND/PN-OCD etc are absolutely MASSIVE and that there's good awareness that it might be worse this time.. and yet the whole approach is, well, let's wait and see. Go on the meds. We will just let you labour the same as any other woman despite the fact you are terrified and anxious and that doesn't augur well for your delivery, and despite the fact a poor delivery might psychologically damage me further. It's very much hands-off and "watchful waiting" just to see do I totally and utterly lose it. It's also very frustrating to have been asking for help to avoid a recurrence for this whole pregnancy and to have nothing more in place a few weeks ahead of the birth other than a handful of antidepressants. There must surely be more cost-effective ways of preventing mental health dysfunction than just letting people at it because they aren't in a total heap (yet).

I would love someone to help me plan my birth without trying to terrify me. If only they realised the extent to which I live in terror every day.. a cs is nothing in comparison but they have now successfully added it to my list of things to freak out and obsess about so that I feel totally out of control thinking of having to birth this child. Great planning, NHS.

Yes I don’t think there is a huge amount of preventative support around apart from what I have mentioned above. Howver if you have had PND before you should be given some extra support by your GP, midwife and possibly a referral to a counsellor and or the community mental health team if necessary. I would really like to see antenatal screening for every woman to assess their risk of PND as we do know that past experiences and their current social circumstances can certainly be risk factors for PND. From your description of your childhood and family history yes you may have been more at risk for PND and certainly the very traumatic birth you endured and a lot of other factors you have described. To be totally honest sometimes there is nothing you can do to prevent a reoccurrence, however as mentioned before putting support in place may well help. In your case you say you have no family support of friends to talk to about this so I feel that if you and your husband could try and insist on having some form of prenatal counselling. Have you told your GP? /midwife how terrified you are feeling? I have known many women have severe PND after their first child and have had no PND with subsequent babies. I wish you all the best.

LizWise Tue 17-Apr-12 14:01:03

Brandnewbrighttomorrow

Thunksheadontable no wonder you're stressed! I've had three sections, one emergency following 35 hour labour and two elective. I think if you are that anxious about a natural delivery then an elective cs would make complete sense. It's much calmer than an emergency section, you can plan childcare for your older child and express a preference for various factors like type of anaesthetic (I'd recommend a combined spinal/epidural) discovering sex of the baby, skin to skin contact. You can find out which consultants and midwives are on for your date and express a preference for who you get. All helps to make you feel a bit more in control of the process. It's likely to take longer to recover physically though.

I'm reading with interest to see what the response is to where does normal reaction to becoming a parent end and pnd begin.

Thank you for your very helpful response to thunksheadontable. I think the line between normal reactions to becoming a parent and PND is in how the Mum is feeling in herself. Most of us have anxieties adjusting to becoming a parent but not all of us have symptoms of depression, eg, low mood, inability to sleep( although the baby is sleeping), obsessive thoughts, panic attacks which affect the day to day life of someone who is depressed. I use two questions when supporting mums with PND are you able to look forward to anything and are you enjoying anything? If these are both answered with a no then discussion around other feelings and thoughts needs to take place. There are mums that have similar thoughts and feelings as mums with PND but they are not causing problems for them and they are able to look forward to and enjoy things. I hope that answers your question?

LizWise Tue 17-Apr-12 14:04:45

abdc

Given that this is such a common condition, why is there not more Antenatal support for women? With a history of depression I know I am predisposed to PND, and was questioned closely by my mw at booking in. This was very reassuring at the time but since then it seems to have just been lip service - there is no actual Help that the mw can point me in the direction of. I believe I have since experienced antenatal depression, but just been told to see my gp, who I think just sees me as another hormonal pregnant woman and dismisses my anxieties. A ten min appointment is not enough time to discuss the extent of my anxieties and feelings, and so it builds up and gets worse when what I want is someone to talk to - why are there no counselling or helpline type services? Surely this could help some women to not go on to develop such severe pnd or at least know where to get help. Depression is not just tiredness, it is a mindset rut and I believe that antenatal support would help postnatally.

Yes I totally agree with you, see my reply to thunksheadonthetable. I really don’t know why there aren’t any counselling services offered for this and I would certainly like to see these in place as well as more counselling support for PND. I’m sure this could be very useful as a preventative measure.

bark - things like the nature of the isolated nuclear family, the fact that all the responsibility falls on the woman solo (no paternity leave), the exhaustion of doing it in isolation without the support of extended family, the loss of status and identity incurred by giving up work (for those who do), the level of pressure put on mothers about who they are supposed to be/what to feel/what is a 'good' mother etc incurring guilt and shame in those who can't fit it, economic stress, poor post natal care and no opportunity to rest (women used to be kept in hospital and in other cultures women get special support in the weeks following birth so they can recover physically and mentally) etc etc etc.

not saying that everybody would have these factors or that all depression would be due to them and others - some depression that occurs immediately after birth may well be to do with hormones but like with all depression there is the environmental triggers and set ups that can cause a susceptibility to develop illness.

LizWise Tue 17-Apr-12 14:05:37

bjf1

Hi Liz
my question is, if untreated, can PND and even pre natal depression, just stay with a woman for the rest of her life? Is it possible that a mother can still be suffering from this 10 years or more after the birth of a child?
Or, over time, does it sort of dissipate of it's own accord?

That really depends on the individual and own circumstances. I have met women in their 50’s and 60’s that say they had PND that was not treated or supported and they have gone on to sometimes have more depressive episodes. However I have also met women that have not had any treatment/ support and they have made total recoveries. In my experience mums that have it recognised and treated/ supported recover quicker and more fully, it’s like any trauma we go through, sometimes if we suppress it and don’t deal with it at the time, it can resurface later on in life. I have worked with many mums that had PND first time that was not recognised and resolved, have felt better during their next pregnancy then have PND, this is quite common.

LizWise Tue 17-Apr-12 14:06:40

Shakey1500

*LIZ*, I'd also be interested in the answer to bjf1's question.

I am certain I had PND but did not go to my GP (I'd had a bad mental breakdown the year before and the counselling I received after being discharged from the psychiatric hospital was utterly appalling so I had/have zero faith). My son is now 4, is it still possible to have PND? How is it differentiated from "depression"?

Thanks

It may be that you are still experiencing some depression left over from your PND if it was never totally resolved. The difference between PND and depression is the timing of it; PND is a depressive episode after childbirth which usually is isolated and temporary. Usually after a couple of years if having being treated and supported the depression will be better. It may be a good idea for you to talk this through with your GP if you haven’t done already so you can get some support.

LizWise Tue 17-Apr-12 14:09:22

PinkFondantFancy

I'd like to reiterate puddlejumper's question. I have had very broken nights for 7 months now and my mood is often very low. My GP thinks I'm 'just' tired - how can I tell the difference? Is there one anyway?

I think only you will be able to tell the difference by asking yourself if you are able to enjoy things when you’re not so tired, if you have other symptoms of PND and feelings of feeling very different to before you had the baby. Please do email for further advice on this if you wish.

LizWise Tue 17-Apr-12 14:10:31

hunkermunker

Hi Liz

What a brilliant webchat for MN to be doing - this will help a great many women.

My question is this:

How do you cope, having had a traumatic time yourself, Liz, with being so immersed in making things better for other women? Do you ever feel like you would rather not be so close to something that was a source of such heartache in your own life? Or have you managed to work through your own issues in such a way that you use them to inform what you do, but you're distanced from the feelings you had at the time? If so, how did you go about that process?

Thank you - and thank you for what I know will be a really valuable webchat.

I think the fact that I did had such a traumatic time with my depression has enabled me to understand far better and allowed me to help others. No, I never feel like I would rather not be close to this, I feel I have one of the best jobs ever helping mums who are going through such a dreadful time. I am very far away from my own experience of PND; it was over 20 years ago, so although I remember it, it doesn’t give me any heartache or negative feelings when discussing it with others. Yes I have worked through my own issues and I guess that happened as I moved away from my depression and felt strong enough to look at them. Also I had to look at issues when I trained to become a counsellor. I have met so many mums that although have had PND, have said how much stronger, compassionate, patient and able to relate to others better since having recovered from it. So from something so negative at the time, can come positive from it.

FunnysInLaJardin Tue 17-Apr-12 14:11:54

Many thanks for answering my question Liz. What a good webchat and excellent guest!

Message withdrawn at poster's request.

RachelMumsnet (MNHQ) Tue 17-Apr-12 14:13:45

That brings us to the end of the hour. Thanks SO much to Liz for joining us today for this invaluable discussion and for answering so many questions. Thanks to everyone for joining in the discussion.

LizWise Tue 17-Apr-12 14:13:52

Thank you for your questions and for sharing your experiences. If you have any further questions, please feel free to email me at lwise@talktalk.net.

yeah thanks liz.

JugglingWithTangentialOranges Tue 17-Apr-12 14:22:02

Seems Liz gave much valuable support to many posters but wasn't particularly keen to be drawn into any political or feminist aspects of the debate. That's a slight shame I feel - you asked a couple of excellent questions I thought saf
Perhaps Liz just didn't have time to answer everything, guess that's possible ?

I feel it would often be easier to recover from PND if there was more help and support available in looking after the baby !

designerbaby Tue 17-Apr-12 14:59:27

Thanks for answering my question Liz...

I do think from what I've read here that some profile-raising stuff about PND and it's various manifestations, plus some myth-dispelling stuff might be long overdue – both for the medical professionals (I'm thinking of GPs an HVs as they're usually the first port of call) and the general public...

I don't think I was aware of much about PND at all - I certainly didn't know it could present months after the birth...

Great webchat though. Mumsnet and mumsnetters at their collective best.

db
xx

it can present months after the birth because it's just clinical depression (not 'just' as in unimportant but just as in the same as, not unique or differentiated from for most people).

factors around becoming a mother and having a young baby predispose you towards falling ill with mental health problems. pnd sounds a lot more sanitised than admitting that the conditions of motherhood in our society make women prone to develop mental health problems.

it's in looking at those factors that we will be able to move towards preventative measures and tangible ways of helping women avoid becoming ill under the strain of them imo.

JugglingWithTangentialOranges Tue 17-Apr-12 16:42:54

Interesting that you applied for PhD funding to explore some of these issues saf - I hope you might have the opportunity to pursue that at some point.

i start an msc in autumn and will probably do my dissertation around this area - i'd like to do some antenatal counselling and groups voluntarily and follow up with the people involved after they have their babies as part of the qualitative research. hopefully will be interesting.

Thank you for answering my question Liz.

I have really enjoyed reading all of this thread especially your posts saf I am due in December and had pnd with my first so I'm really trying to prepare myself for this one.

JugglingWithTangentialOranges Tue 17-Apr-12 17:24:15

That sounds like a great area to look into saf - I think you have some very strong points to make which I'm sure will be validated further when you speak to more women about their experiences. smile

kizzie Tue 17-Apr-12 19:53:20

Re. the causes. Im sure there are a great number of mothers with pnd whose illness is either caused or increased by 'the conditions of motherhood in our society'. I cant remember which culture it is - but there is one where early parental support is prioritised and the cases of Pnd are very low.

In my own case however I am sure as I can be that it was a hormonal response to an IVF / twin pregnancy.

For the first six weeks after birth I felt mentally great. Then I needed to stop breastfeeding. A couple of weeks later my period returned and I became very ill.

heliumballoon Tue 17-Apr-12 21:08:58

Thank you MNHQ and Liz for an excellent webchat. If it helps even one woman suffering with this wretched condition, then it will have been very well worth it.

peanutpie Tue 17-Apr-12 22:46:36

Thank you. Reading these responses has been very supportive.

agreed kizzie - i do think for some it is very much hormonally linked - i for one have had hormonally triggered episodes of depression and major agitation following hormonal events and have had awful trouble with pmd at times (particularly in the months after a big hormonal event). like you though i think there's a lot of cases that aren't that and i also think that that plus the conditions and cultural set up probably makes for bigger and more prolonged problems than that plus good conditions and cultural set ups. itms!

i am curious to know if anyone else had a bit of the opposite and felt quite manic in the weeks following birth. i was very happymad for quite a while.

CagneyNLacey Wed 18-Apr-12 09:14:49

In retrospect I'd say I was manic in the few months post birth. I was constantly making lists of things to do, the house was spotless, I'd take dd out every day at least once. I kept a diary of what I had done or wanted to do. I couldnt rest and was constantly planning even the smallest of things. When I look back now to that time, only 15 months ago, I wonder if it was motivated by a sort of terror that I'd be a shit mum and everyone would see through me.

ReallyTired Wed 18-Apr-12 09:20:21

I think that breastfeeding can have strange affects on mental health. I am a prolactin junkie and I found I had a drop in mood when I started weaning / gave up breastfeeding.

I was every elated both times after the birth.

JugglingWithTangentialOranges Wed 18-Apr-12 09:24:57

Hmmm, pmd ? sounds very familiar - I take it that's pre-menstrual depression saf ? - I think I've suffered with that for a long time. Maybe I should go and have another talk with my nice doctor as long-standing grumbling depression isn't great fun to live with ! And maybe if my mood lifted a bit higher I'd feel up to doing more interesting things. Feeling particularly pee'd off ATM as DH is away for a week with work, and it's peeing down outside - though wondering actually if the rain can be quite comforting when you're safely inside with a nice brew - and the company of some lovely MNers smile

JugglingWithTangentialOranges Wed 18-Apr-12 09:29:40

Both pregnancy and breast-feeding hormones were wonderful for me - I've really never felt better since childhood.

Think I was a bit of a prolactin junkie too ReallyTired grin
- in any case I managed to breast-feed every day for 8.5 years on the strength of only two children grin Oh and I'll do a shock for you all !!

all4u Wed 18-Apr-12 10:37:49

Only just logged on today and found this - MN being wonderful again! As they said in Life of Brian - yes we are all different - but by heck we have a lot in common too!
I had PND after my two all wrapped up in having really felt fantastic and happy during the pregnancy (yeah I know it is the wrong way round and sad really...) and having painless deliveries in under two hours but then finding that my body had just given way and I was like a carrier bag inside and out!

After being told by a consultant 'What did I expect I had just had two big babies?' and nearly crashing the car driving away because of the tears - my Mum paid for me to go privately and have an internal repair op. (I exploded when she was critical of a cousin for opting for a CS and burst into tears!) I will advise my daughter that if she has my genes ie stretch marks during pregnancy to be sure and have CS.

But I know I could never embark on another relationship as I am now - that part of my life is over.

So it is about coming to terms with whatever your kit and caboodle is and having kindness and support from others to adust - that's where MN can come in! Before MN we had to be silent or dared not risk speaking up for fear of alienating our precious friends (my best friend cannot have children as she married a man who had a family and whose first wife persuaded him to have a vasectomy so I don't like to discuss this with her and my other BF had two non-progressing labours that ended in CS so is now abfab down below).

Time passes too girls - but I am glad I had them late!

post menstrual dysphoria juggling. seriously recommend the agnus castus - you don't need to see a homeopath (despite the advice on here) just to make sure you get the right standardised extract and daily dose - the website healthspan sell a good, standardised one a day pill at a reasonable price. disclaimer: other websites may do this too obviously wink

i also had spikes of weird stuff around ovulation too. my doc made me right it all down and track for a few months (this after periods returned after having ds and things going very whacky) and it was absolutely clear that it was around ovulation and in the pre menstrual period every time. she put me on the pill and it helped but as i think i mentioned we then found i shouldn't be taking the combined pill (and the mini pill made things worse for me) due to aura migraines and stroke risk. i do recommend the agnus castus - take it every day for a few months and see what effect it has had for you.

i was crazy high after birth - i remember standing in the middle of the room having gotten up to make a cup of tea for visitors and then babbling away about something, then forgetting what i'd stood up for, then giggling like a loon about it. things like that. i was non stop iykwim.

JugglingWithTangentialOranges Wed 18-Apr-12 12:27:33

I was tremendously happy after the birth especially of my first, dd.
But I think that's all good ! Nice to be happy sometimes - I kept a diary of everything we did together and was in ecstasy looking at the beautiful spring blossom that April !

I hope everyone reading can have happy moments with their babies too - it is an amazing thing you've all done to create a new little person smile

i was beyond happy i think - reckon i'd have met the criteria for clinical hypomania. seem to recall reading about a push for pnd to be renamed to reflect the fact that actually it seems to have more in common with bipolar than unipolar depression. don't know what became of that.

Andrewmackembailey Tue 17-Sep-13 14:54:33

As a concerned parent/grandparent how can I best help my Daughter through what appears to be PND?

RachelMumsnet (MNHQ) Mon 30-Sep-13 12:08:40

Andrewmackembailey

As a concerned parent/grandparent how can I best help my Daughter through what appears to be PND?

Hi there
As this discussion thread hasn't been active for quite some time, you will probably get a better response if you post your question on the antenatal/postnatal depression board where lots of people with experience of PND are posting every day. You may also want to look at our Post-natal depression content page which has information provided by Liz Wise.

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