Postpartum Depression & Anxiety
by Amanda Attfield

Anger, guilt, numbness, sadness, panic and anxiety are only a few of the symptoms of postpartum depression and anxiety (PPD/A). Between 10 to 28 per cent of women will experience PPD/A in the first year after their baby is born. Postpartum depression and anxiety often begins six to eight weeks after giving birth, but may also occur during pregnancy or later in the baby’s first year. The thoughts and feelings of PPD/A can be persistent and overwhelming for the woman and her family. You may be wondering how PPD/A differs from the “postpartum blues.” The “blues” affect up to 80 per cent of women within days of giving birth. Some of the symptoms are similar such as crying, mood changes and anxiety, but the “blues” do not last, and usually get better within a few days.

What Does Postpartum Depression and Anxiety Feel Like?
Postpartum depression and anxiety looks and feels different for every woman. However, there are some symptoms many women share. They may feel tired, forgetful, angry, guilty, numb, sad, panicky, scared and/or lonely. They may cry a lot, experience changes in their eating and sleeping habits and may have scary thoughts of harming their baby or themselves.

Often women going through PPD/A realize that something is wrong and feel that they are “not themselves.” For other women, it could be their partners, a family member, or friend who notices a change. Some women are able to reach out and ask for help, but many others suffer in silence. They may fear being labeled with a mental illness, how others will react, or be experiencing a sense of failure that they can’t “do it all.” It takes strength and courage for some women to talk honestly about their struggles in the postpartum period.

Why Do Some Women Experience Postpartum Depression and Anxiety?
There is no easy answer as to why some women have PPD/A while others do not. New mothers’ changing hormones, lack of sleep, stresses (present and past), and loneliness can lead to PPD/A. A woman may also feel pressure to be the “perfect mother” as seen on TV or in magazines. Losses in life such as the death of a loved one or a difficult transition into motherhood may also contribute to PPD/A.

There is no single cause of PPD/A. While some women may know what is making them feel depressed, others may not. They may feel as though the illness has come out of nowhere. The experience of PPD/A is very real and difficult for everyone affected. Be aware that a woman does not bring PPD/A upon herself; it is not her fault. PPD/A shouldn’t be ignored or brushed aside. Women should ask for support and treatment as soon as they feel unwell.

How is Postpartum Depression and Anxiety Treated?
First, PPD/A needs to be identified. The Edinburgh Postnatal Depression Scale (EPDS) is a set of 10 questions that can help identify women who may be depressed. The EPDS does not diagnose PPD/A, but it does help identify women so they can get treatment and begin to talk about how they are feeling.

All mothers of two- and six-month-old babies are offered the EPDS by Public Health Nurses at health unit immunization clinics in Greater Victoria. If a woman does not come to the health unit for immunizations, her district public health nurse can arrange for her to receive the EPDS at another time. Family doctors and midwives also offer the EPDS during pregnancy and after the baby is born.

Help for PPD/A comes in many forms. Public health nurses, family doctors or midwives can refer women for counseling. PPD/A support groups can give women a safe place to discuss their feelings. Eating well, exercising and taking some time for themselves are other things women can do to feel better. Some women find that medications are helpful and many of these medications are safe to take while breastfeeding. If a woman is breastfeeding, it is important that she remind her doctor of this before starting any medication. Support from trusted friends and family also helps women to move through PPD/A.

There are numerous good books to read about PPD/A, many of which can be borrowed from the library. The Pacific Post Partum Support Society has a good website at www.postpartum.org. It is important that a woman finds support that feels right for her and fits with her beliefs and values.

PPD/A doesn’t last forever. Women get through it with treatment and help. If you or a woman you know is experiencing PPD/A, or if you want more information, please speak with a public health nurse, doctor, midwife or other health care professional. Help is available—you are not alone.

Amanda Attfield is a Public Health Nurse in the Victoria Health Unit.