1. What is the difference between the baby blues, Post Natal Depression and Post Natal Psychosis?

Baby blues is the most common observed postpartum mood disturbance. Symptoms are mild and include mood lability, irritability, tearfulness, generalized anxiety, lack of energy, eating and/or sleeping little or too much. Onset is within a few days of childbirth and symptoms remit within days. Treatment is often not required.

Post Natal Depression can be understood as perhaps, a continuation of “baby blues” where symptoms become more severe and these often present in the first 6 weeks following delivery or onset is more gradual. Most cases require treatment from healthcare professionals..

Post Natal Psychosis is the most severe postnatal affective disorder -- the onset is often rapid, with symptoms presenting as early as the first 48-72 hours postpartum. Over and above the mentioned symptoms (see point 1), mothers may have a depressed or elated mood (which fluctuates rapidly) disorganized behaviour, delusions and hallucinations.

2. Why do mothers get the baby blues around day 3 post-birth – is it because of the massive change in hormones that is going on, possibly also linked to the breast milk that comes in around then too?

There may be several factors causing this, some of which include hormonal changes, sleep deprivation, the sudden increase in responsibility and the expectation from others and oneself to be “Superwoman” and be able to do everything. Since research indicates that the beneficial effect of breastfeeding is strongest at 8 weeks after birth, we may expect the intention to breastfeed to play a crucial role in mothers’ feelings of success or failure in relation to their original plans and aspirations about breastfeeding. For example, mothers who may have planned to breastfeed, but were unable to do so may struggle, likewise -- mothers who had not planned to breastfeed, but went on to breastfeed may equally struggle.

3. What are the symptoms of Post Natal Depression and also Postnatal Psychosis?

See point 1, and in addition, this type of depression differs from other types, in that women who struggle with it feel deep disappointment in themselves because of the societal belief that motherhood should be positive, natural, fulfilling, and wonderful. Social media has greatly contributed to this -- depicting children as perfect and that the mother has time to go to the gym, wear makeup, and succeed in her career. As a result, mothers often feel guilty, helpless and inadequate when faced with the day to day demands of their new baby. They, at times, lose interest in caring for their baby, express that “they do not want it” and may or may not experience guilty feelings.

It is always important to remember that PND varies amongst women, so presentation is not always the same!

Although research tells us that Post Natal Depression is the most common complication of childbirth, it is stigmatised and therefore -- some mothers find it difficult to come to terms with it.

4. How common is PND?

A recent study estimates that 34.5% of women in South Africa battle postnatal depression. I must emphasise that this a greatly under-researched area in our country so I imagine PND is often underdiagnosed or misdiagnosed because of a lack of awareness and stigma.

5. I’ve heard that a certain percentage of dads also suffer from PND – could you give me some statistics on this and possibly tell me why?

Very, very under researched in South Africa. An American 2010 study indicated that the prevalence of PND in men between the first trimester and 1 year post birth was 10.4% and that the highest levels of depression was during the first 3-6 months.

6. How is PND usually treated and where can parents suffering from PND get help?

Fortunately, treatments found to be effective for PND include:

  • Psychotherapy for the mother
  • Parent-Infant psychotherapy which is a specialised form of psychotherapy that focuses on working with the parent-infant relationship. Other primary caregivers of the baby can also be worked with in therapy.
  • Antidepressant drugs are also safe and efficacious in women suffering from PND, including those who are breastfeeding.
  • Mothers or family members can contact a Clinical Psychologist or Psychiatrist to seek help.

7. Are people who suffer from depressions, anxiety and/or other mental health issues more prone to developing PND? If so, is there anything they can do before the birth to try prevent this?

Strong predictors for PND include:

  • depression and/ or anxiety during pregnancy
  • Past history of psychiatric illnesses
  • Stressful Life events e.g. fertility complications
  • Lack of social support
  • Strained marital relationship
  • Socioeconomic status
  • Unresolved emotional issues from the past pertaining to the mothers’ own experience of being ‘mothered’ and prior sexual abuse

It is highly probable that many women may have experienced symptoms previously but never sought treatment. It is important that women open up to health professionals about their past psychiatric illnesses and/or increase awareness of mood during pregnancy, although this may difficult particularly if the woman may not view these feelings as being pathological, but rather a normal consequence of pregnancy.

8. Do you think I’ve missed something? Yes, and very importantly: the consequences of PND to child, mother and family.

  • Impaired mother-infant relationship
  • Neglect of the child
  • Family breakdown
  • Cognitive delays, emotional and behavioural problems in children of depressed mothers
  • Suicide and infanticide

I realise you are specifically writing about Post Natal Depression, but Antenatal Depression is also worth mentioning because there is a lack of awareness in this area. Therefore, symptoms of depression are no more common or severe after childbirth (Post Natal) than during pregnancy (Antenatal).

Depression during pregnancy can have a negative effect on the uterine environment and therefore having an impact on the unborn foetus. Rates of a South African study estimates that 39% of mothers suffer from Antenatal depression.