Do you think PND is over diagnosed when parents are in fact just exhausted?

[cheeseismydownfall]

Our DS1 was a terrible sleeper as a baby. A classic case of feeding hourly during the night, not settling, dreadful at napping. He was hopelessly overtired and as a result he was a pretty miserable all the time and parenting him was hard. For me, motherhood started with a 48 hour induced labour, culminating with a middle-of-the-night emergency CS, so I was already exhausted before I started, and I found breastfeeding excruciatingly painful.

By around 10/12 weeks I was on my knees and clearly struggling to cope. I was worried about bonding with DS and basically hating being a mother. My midwife referred me to my GP, who didn't take long to diagnose PND and Sertraline. Somehow the diagnosis of PND made me feel even worse - yet another thing that hadn't gone according to plan. The Sertraline made me feel horrific initially, and didn't seem to help once things had settled down. As weeks turned into months I still felt awful.

When DS was around 10 months old DH and I couldn't take it any more and sleep trained DS - something we had never, ever thought we would do. It was surprisingly painless and within a few days he went from waking every half hour to sleeping through the night (note - this isn't about the pros and cons of sleep training! - I'm just explaining my experience).

As we slowly began to catch up on sleep, it was like a fog lifting. Everything became easier and more hopeful. DS was more settled, and even when he wasn't, I felt more able to cope. I began to enjoy him, and enjoy being a parent, for the first time. Those dreadful dark days slipped into the past, and we went on to have two more children.

I've been thinking back on my experience, and I do question how new parents, and particularly mothers, are supported with what can be quite horrific lack of sleep. I feel that health professionals are very quick to diagnose PND when in fact it isn't necessarily accurate or helpful. I'm not saying that there is anything that a GP could have done, but simply having someone acknowledge that I was utterly exhausted and that of course it was directly affecting (and possibly entirely responsible for) my mental health would have actually really helped and made me feel that I wasn't going mad.

Clearly I am not for a minute saying that PND isn't very, very real for many mothers, and that correctly diagnosing and treating it is incredibly important. But it just seems to have become so easy to 'blame' PND for anything and expect anti depressants to compensate for getting two hours of broken sleep for months on end, and that a mis-diagnosis of PND is actually quite harmful.

Probably. My ex partner was psychologically abusing me and took me to see the GP and told him I was depressed - he was in the room with me - the GP prescribed antidepressants, but I was too scared to say anything. Ex then used it against me when he took me to family court. Told them I was on tablets and was an unfit mother etc.

There needs to be a proper assessment, not five minutes with a GP.

It does sound like a bit of a catch all diagnosis when in reality there are probably subtypes with different causes like hormones, prior mental illness, birth trauma as well as sleep deprivation.

I wasn't diagnosed for months because I thought it was just sleep deprivation, so you maybe are correct for your experience, but definitely not mine and I could be dangerous telling women that they just need more sleep.

By 11 months old DS was sleeping much better, I was enjoying being back at work, but I still felt empty. Like there was nothing to live for, no point in booking holidays or buying new clothes that I desperately needed because I couldn't see a future behind that very day. Citalopram gave me my joy back.

I had what felt like PNA which stopped as soon as DD started waking just once a night - thankfully she did this at about 3 months. In my case I'm pretty sure it was just lack of sleep meant I wasn't thinking straight so was worrying about everything.

But I do agree with the PP that this is not the case for everyone, and there is such a thing as PND, separate from sleep deprivation.

I do think it’s an easy term to fob new parents off with - have some tablets and off you go. Once ‘diagnosed’ that’s basically it.

However, sleep deprivation can cause depression (it’s a form of torture for a reason!) so I wouldn’t want a new mum to just think it’s because she’s tired and not seek help.

I relate to what you are saying but I think sleep deprivation can lead to depression so I'm not sure you can easily separate the two. I think that GPs should talk to parents about how much sleep they are getting and discuss strategies to get more rather than reaching straight for the medication. Unfortunately many women are left to cope with very little support from partner or wider family so there is no practical way for them to get more sleep.

The other problem is even if you were to confirm that it's definitely sleep deprivation related it's not like they can really do a lot for that. Unless they were to fork out for night nannies you can't make a baby sleep even if mum is suffering.

I agree. I was on my knees with exhaustion (baby waking up very regularly, refusing to have a bottle do exclusively breastfeed so all up to me). I asked health visitor to help with getting baby on bottle and sleep and was told to get medication from gp.

A friend spent about two years feeling awful being told the anti depressants would kick in soon - it did affect her marraige and her and her DH split up for a while.

She by chance saw a locum who asked her what the plan was about her goiter - which was a shock turned out she had been sent for blood test for thyroid and been very low but no-one had checked and not questioned anything once pnd was diagnosed. Took a couple of months with proper treatment for her to feel better.

We had a lot happen around every pg and birth - I always felt in one area we lived the HV were always annoyed with me that I didn't seem to have pnd - the questionaire was obviosuly very leading and I did once get accused of lying - took my Mum along to one appointment and with no input from me said the same.

I don't doubt PND is real and sadly prevalent but I do think it can be to swiftly diagnosed when perhaps other things need to be looked at.

I agree somewhat. Our NCT teacher told us the number one cause for PND was sleep deprivation, second was hormone imbalance that causes PND.

I think I now have PND due to sleep deprivation. DD is 7 months and wakes every 2 hours. No evening. No adult time.

Who would enjoy this?!

Mental health can be so closely linked to sleep I think its hard to seperate.

Yes, this probably is true in some cases. I reckon they should teach combi feeding (by this I mean a baby that is both breastfed and bottle fed) as standard, then the dads could share the load at night, the mums wouldn't be so exhausted, and things would be much better.

Sleep deprivation is played down and actually talking about it after the baby is no longer newborn becomes somewhat taboo among some groups of parents. People think that their experience is universal - they think thst if their baby woke 3 times per night, fed, went back to sleep, then that's all you mean when you say your child doesn't sleep.

Nobody wants to hear that your 8, or 18, or 30 month old still barely sleeps (as in 45 minutes at a time and only if in physical contact with you) and that as a consequence you feel physically broken, with every joint painful and constant brain fog.

Also there's a "rod for your own back" parental blame game from the smug and the unknowingly ignorant - not all babies can be painlessly sleep trained.

I think that its like the side effects and risks of hormonal contraception being played down. Its very politically correct to say parents are exhausted, but women carry 90% of this burden, especially as we're encouraged to breastfeed and mentioning that this means mothers end up doing almost all the night waking is disapproved of.

When I was diagnosed with PND I remember thinking exactly this when the GP asked me the questions in the little questionnaire - every single question seemed to me to be easily explained by fatigue and lack of sleep. Do you just want to sleep/stay in bed all day, are you very tired, do you feel on the verge of tears, etc. I responded to all of them "yes but I have a toddler and a newborn, of course I feel like that, doesn't everyone!?"

The thing that convinced me that it could be something beyond sleep deprivation and to at least try sertraline was that I had stopped feeling anything at all, including any positive (or negative) emotional response to both kids and DH. I knew that times in the past when I had been sleep deprived I hadn't felt completely dead or numb, especially towards the kids, so there must be something else going on. But who knows - maybe I just hadn't been sleep deprived enough before. Also I don't know if it was sertraline that sorted me out, or whether just through passage of time DS2 started sleeping and I got more sleep - it's so hard to disentangle.

I think you’re probably right but I’m not sure there’s an easy (expensive) fix. I do wonder if mothers did better when it was standard to be in hospital for a week after giving birth. Don’t get me wrong, the thought of being an inpatient for a week makes me shudder, but as you say a lot of women are starting from a place they’re physically exhausted with no chance to recover. As PP have pointed out exhaustion and depression are linked so it seems madness that it isn’t addressed.

My DP recently had urology surgery and it’s taken all my willpower to not constantly point out that when I was recovering from birth with stitches in my crotch and the general battering my body took I didn’t get the option of a week off all responsibilities, in fact I took on a load of new ones!

Yes i think you probably have a point. PND is pretty much unheard of in cultures where women are properly supported after birth and allowed to rest and recover properly.

I gave birth in an Asian country and a week in hospital afterwards, in a private room with 3 meals a day provided and nurses and midwives on call constantly, is completely standard. They were horrified by my UK experience of my first birth (out in 24 hours despite a very long labour and some tearing, and time on a busy post natal ward).

I actually didn't mind the quick discharge from hospital as just wanted to get home but i can't deny my mental health after birth was far, far better with some time and space to adjust, get to know my baby, process the birth and rest.

Yeah I think so. I was hallucinating with tiredness with dts who didn't ducking sleep. I wasn't depressed, I was just exhausted.

Without a doubt. I had very severe PND (narrowly avoided hospitalisation and survived a suicide attempt) and the mental health team's most vehement recommendation was that I move DD into her own room and prioritise my own sleep. I refused for quite a while because it went against safe sleep guidelines but after 4 months of barely sleeping (she had baby grunting syndrome so was never quiet) I had gone genuinely and truly insane, and my mental health team, DH and even my health visitor begged me to agree to it. I did, both she and I started sleeping a lot better and I slowly regained my sanity. There's no doubt that the medication and the treatment played a huge part in my recovery but none of it worked until I started getting some sleep.

The demonisation of sleep training makes me so angry. You see these poor mothers who are on their knees with exhaustion and yet the world is telling them that sleep training is selfish and will damage their baby irreparably. And recovery time post birth and paternity leave isn't nearly long enough. If we want to reduce rates of PND I think we should:

• have mothers stay in hospital in a private room with proper support from midwives 24/7 for at least a week
• extend paid paternity leave to 2 months
• encourage gentle sleep training from 6 months
• educate women about mixed feeding

I refused for quite a while because it went against safe sleep guidelines

This was my problem too. I remember feeling at the time that I had to choose between not getting much sleep, or my baby being at a higher risk of SIDS so of course the baby's safety came first.

I definitely think that sleep deprivation can be enormously more damaging than people admit, and it's not taken seriously enough.

But, my experience was that when I raised the possibility of my DP having PND (because I was worried), the response to tick us both off because we should be 'thinking about the baby'. So I don't feel PND is readily diagnosed; I think sometimes medics refuse to even consider it.

I reckon they should teach combi feeding (by this I mean a baby that is both breastfed and bottle fed) as standard, then the dads could share the load at night, the mums wouldn't be so exhausted, and things would be much better.

I bf and co-slept - spoke to really good community MW with first who told us how to do it safely - think that made things barable - and sleeping in afternoon till eldest outgrew naps.

But co-sleeping is very controversal and in end it was like a dirty little secret.

I also found wider family very unsympathetic to tiredness - timing visits and phone calls to times I was known to be trying to sleep - and having almost higher hosting expecations from me than prior to kids. DH had to play being buffer a lot.

Yes, over diagnosed and under supported.

Two parents need a team around them. It takes a village etc.

And definitely increase paternity leave to two months

Most definitely ! I was horribly sleep deprived and very low....I had a long painful labour and suffered severe birth injuries. Struggled with feeding etc I really didn’t want another ‘Label’ Put on me as I already felt like a massive failure (i am not for a second saying PND makes you a failure, just saying that is how I felt at the time) and never got a diagnoses but they were dark times. And like you once the sleep came , the fog and darkness lifted and I felt human again. I had/have to live with the birth injuries unfortunately (5 years later) so there was more going on after that around ptsd from the birth and acceptance etc
Since then I’ve had another child and can absolutely see much more clearly the link between my mental health and lack of sleep. I used to say there should be a service where someone can come and walk your baby to sleep in the buggy so you can catch up on sleep (we have no family in the country that we live in so had no support like that)