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.

I think for some of us it is a bit more like an adjustment disorder. For me I hated it for the most part, have only now (18 months) started not completely dreading a day alone with DD (I do love her, and would feel like dying if anything happened to her, I spend hours everyday reading and playing with her).

But the adjustment form being relatively carefree to the relentless demands of being a parent made me quite depressed. We are very isolated (expats) so no-one to just hand the baby to for half an hour.

I do think PND is a catch all term, could be sleep deprivation, could be hormonal, could be depression etc.

I think I got quite angry about the PND suggestions because I thought many people would probably be quite depressed having to be on 24 hour call with little respite. Tbh though I probably should have still got some anti-depressants.

The way we raise children in small nuclear families is really quite unnatural and the expectation is no longer that you just keep them alive, loved and fed, you must stimulate them, you must feed them a certain way you must do loads of things or you will impair your childs development (thats how I felt anyway). No wonder so many women are depressed.

It's taken lockdown to make me realise how awful it all is. Not only do you raise your child in a closed nuclear family and no support from friends thanks to social distancing but you've also got to be a non-stop entertainer and educator. It's unsustainable bollocks.

Absolutely. I had a similar experience to the OP but wasn’t diagnosed with PND. At the time I was having practical help on weekends from a relative who works in mental health and she said I was just having a normal reaction to extreme sleep deprivation and I should get some help by way of having someone take the baby and feed expressed milk so I could get a minimum 6 hour solid stretch of sleep - I did that and everything lifted. Obviously within 48 hours I was back to feeling terrible again (my baby cried all day and all night!) but the fact that sleep semi fixed the problem for me essentially proved that sleep deprivation was the cause.

There is no help out there for people with extremely needy babies. You can feel really alone and desperate.

Honestly I think a lot of the time women get diagnosed with depression when in reality they're dealing with a really shit situation.

My wonderful grandmother was desperately trying to get the GP and social services to provide greater support for my grandad who had severe dementia. She said she wasn't coping and they tried to put her on antidepressants. As if anyone would cope with having sole care of a much stronger adult who forgot who you were, was prone to violent outbursts and kept nearly burning down the house at midnight.

It's just cheaper and easier to chuck tablets at the woman to get her back to functioning in her socially expected role, than to actually provide the necessary support.

I think it’s under diagnosed as sleep deprivation.

Exhaustion can cause depression so they can go hand in hand

I agree with you

@peachgreen

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

This

I agree that for many women their PND is caused by environmental issues e.g. no support. But for some women (like me) it's purely a chemical reaction. I had a huge amount of support from DH and my Mum, plenty of sleep, a cleaner twice a week, food delivered. I barely had to lift a finger, but I still went to pieces.

Interestingly I read Brooke Shields book 'Down Came The Rain' about her experience of PND, and our experiences were almost identical.

I'd agree with the 'no support' idea.

I was diagnosed with PND when ds was 5 months. I was waking at 3am even though I was exhausted, and not getting back to sleep. I went to the GP, tried hard not to weep on him while I explained. He gave me some ADs.
I took them home, thought very hard and realised that I wasn't depressed, I was unhappy.
My then-DP had morphed after DS was born, into a bigoted git with distinctly 1950s ideas - childcare is woman's work, housework is a woman's work etc.

But it wasn't the GP's fault. I hadn't explained.

I took the ADs back to the surgery, applied for some jobs, eventually left & moved home with DS.

I was diagnosed with PNA. 80% of my symptoms lifted on days when I had had a minimum of 5 hours of sleep.

My 'recovery' from PNA went hand in hand with my child's sleep improving.

I honestly think if you took a person at random off the street, put them through a medical event, then deprived them of sleep for months while expecting them to keep a fragile being safe and alive 24/7 - then yes they're going to feel a lot of bad stuff.

Society needs to provide more actual support from the start, not just throw pills at women in the aftermaths

Lavinia1 that's a very pertinent post!

I think so too. In my experience the GP and HV were almost trying to convince me I needed to stay on the anti depressants I'd been on during pregnancy because I would "probably" have PND as a result of having had depression previously. I was at the (forgotten how many weeks) check, I was feeling great, baby was sleeping well, I was really happy, no physical issues from labour, etc etc. Telling the GP that I was feeling ready to come off anti depressants - I just wanted to check how best to do that as I was EBF so obviously DD was getting a bit of that drug too. I had to really fight my corner to say I didn't want to keep taking them when I was feeling so good! For me, depression was triggered by doing a stressful job I hated. Being on mat leave with no intention of returning was the best treatment ever! But they really didn't want me stopping the ADs "in case" I developed PND.

I agree that supporting women is definitely harder than giving them pills.