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

[RachelMumsnet]

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.

[LizWise]

@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]

@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]

@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.

[JugglingWithTangentialOranges]

Thanks Liz, Wise by name, wise by nature !

[LizWise]

@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]

@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]

@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]

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]

@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]

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]

@TheJoyfulPuddlejumper

Thank you for answering my question Liz.

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]

@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]

@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]

@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.

[LizWise]

@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]

@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]

@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]

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]

@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]

@TheJoyfulPuddlejumper

He's 16 weeks. 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]

@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]

@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]

@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.