Postnatal Depression

Unlike many psychological and psychiatric diagnoses, Postnatal Depression actually defines itself quite. Postnatal literally describes the time after giving birth, and depression is a symptom where a person feels down, sad, numb, incapable, questions the self, has little to no energy, and may feel suicidal and or contemplate self harm. This term is reserved for the one who gave birth to the child.

This temporary condition can start to show signs in the third trimester and can continue up to the child’s second birthday.

Painting of a tired mother and two children

In the absence of a history of any significant depression (including a teen goth or emo phase), then this is most commonly caused by hormone disruption. While the level of oestrogen in people experiencing postnatal depression is around the same as those who are not, it was found that oestrogen supplementation improved depression symptoms in many of the people experiencing this symptom with little relapse over an extended period of time. While oestrogen supplementation is generally an effective first strategy, individuals should work closely with their treating professional as not all bodies are the same, for example thyroid hormones can also be disrupted and can sometimes be a secondary cause and so on.

If there is a history of mental health and or thyroid problems, then often the cause for postnatal depression is that the person has ceased their medication while pregnant and breastfeeding. Frequently this is not a wise or necessary decision. Few mental health and thyroid medications have been shown to actually cause foetal or newborn problems (breast feeding). While there have been some correlation with “later mental health problems” for the newborn, this has been mostly falsely attributing the pathology of mental health issues with the medication to treat an underlying long term hereditary condition. Correlation does not mean causation.

While most mental health medications are safe, many health professionals are unwilling to guarantee that there is no risk. It is important to do a risk analysis – the additional risk of the pregnant or breastfeeding person becoming distressed and potentially other symptoms will likely have a much worse consequence for the foetus and newborn than the medication that mitigates this. The medications that we know are not safe to take are clearly labelled as such, while the other medications are generally listed as “may be a risk” because no one wants to promise it is safe and be proven wrong. The reason I suggest 10+ year old medications is that unsafe medications would be apparent by now and added to that “don’t take it if pregnant/breastfeeding” list.

Another major factor in postnatal depression is undiagnosed or barely managed mental health conditions. This can include ADHD, Autism, anxiety, depression and several others. You may have had this managed before pregnancy, but with the hormonal and routine change, that management strategy can no longer cope, and it is now time to consider diagnosis and medication. Your child is going to stick around for about 2 decades and the first 8 years are going to be very disrupted – this is the new normal. Oestrogen hormone supplementation can help a few anxiety, depression, ADHD people, so is a good first step and indicator that you should be looking more seriously at these conditions, or SSRI medication may be more appropriate.

The last two factors to consider are around lifestyle. These can co-occur with the above causes, and should not be ignored.

The more mundane factor is that you have just had your entire life turned upside down, especially if this is your first child. Adjusting to being on call 24/7 is hard. The Geneva Convention for War explicitly states that Sleep Deprivation is a no no, and yet our new born babies require us to be sleep deprived for months, sometimes years. Tasks that used to take 1 day to complete will now take 8 days to complete and we can feel like we are failing on every front. We often fall for the Naturalistic Fallacy, that only the old ways are best which denies us modern solutions; or the Natural Mother Fallacy, that we will somehow just instinctively know how to parent our kid without lessons or help; or the Uber Parent Fallacy, that we can somehow maintain a job, a child, our house chores and social life.

Everything takes longer, everything requires more preparation, and everything takes extra supplies. The change in your appearance and status can be quite a blow to your self esteem. People can be more interested in seeing your child than you, and you can begin to feel like a slave to the kid. This is not uncommon and can be an indicator of some of the above biological causes. Medication and therapy can help re-adjust this.

The more concerning factor is that your partner may not be a good person. A common tactic of certain controlling and abusive types is to tie their victim down with a dependency to enhance the belief that they can’t leave. A child is a perfect mechanism for this kind of lie. When clients come to see me with postnatal depression and they’ve known the father for less than 2 years, I check for red flag signs of abuse. This can be complicated by the perceptions of the person with postnatal depression being skewed by the above discussed biological causes, so the therapist needs to be mindful of that and look at methods to test and detect potential domestic violence that are independent of the clients reports. It is a delicate thing to check as we do not want to have vulnerable parents disbelieved and leave them at risk, nor do we want to give too much credence to potentially distorted perceptions and malign the good character of the father.

To learn more about abusive relationships, take a look through this section [Link].

While these are the top 5 causes of postnatal depression, this is not a complete list. If you are struggling with your mood, energy, confidence, or have odd ideas such as hurting yourself or giving up, – alk to your partner (if safe to do so), doctor, obstetrician and child nurse. If any of these people ignore your concerns, move on to a new specialist until they hear you out and do some actual checks.

Ask your GP to see a therapist (while Hospital Therapists are okay for a quick chat, they aren’t generally good for ongoing care, so generally see an external consistent therapist).

Spoon Theory and Resource Management

Maintaining Mental Health if frequently about resource management. Do I have enough neurotransmitter to do this task? Do I have enough bravery to overcome my anxiety to do that? Do I have enough attention to focus on this? Can I put enough towards remembering the details of this course, without having to pull the necessary ability away from relationships?

Spoon theory is a good way to look at this. The cost of tasks is simplified to spoons. We get a certain amount each day, depending on how well we slept, whether we took our medication and have we eaten enough suitable food.

We spend spoons to do tasks, both starting them and completing them. Not all tasks are created equal. Getting out of bed is quite cheap for most people, but it is darn expensive if you are depressed and or have back pain. Some tasks replenish your spoons back, such as eating, but you needed enough to make the food in the first place. How often have you stood at the fridge door looking for something to eat, but you only see ingredients?

Some spoons are specialised. When you run out of social spoons, you may be able to use other spoons at a ruinous rate, with the result that you get very tired very quickly. Sometimes it is worth the cost, but sometimes you really should just leave. You may have the spoons to be Arts and Crafty, but have run out of social spoons, so can’t People or make decisions right now.

We can look at tasks that are commonly expensive and work out ways to make them cheaper.
– If a problem with social is that auditory processing differences means lots of energy is used to compensate for noisy environments, ask for the gathering to be held in a quieter place, or bring noise cancelling headphones to help filter out some noise
– We can gang a few similar tasks together so that the startup cost only needs to be paid once and only the doing task cost is needed
– We can pre-choose some things, so that the default option is both simple and cheap, and only chose differently if you have spare energy and desire to do so

Often ADHDers release spoons in block amounts. If a task isn’t complex enough, or important enough, no spoons are released for that. A solution for ADHDers can be to add complexity to some tasks (multi-tasking, music/tv in the background, adding a personal challenge) so that the big block of spoons you release all get used up, instead of wasted. Urgency can trick your brain into releasing a block of spoons, but over use of this can leave you exhausted without much being done. There are many more ADHD hacks than this.

It can seem frustrating to put effort into streamlining some processes as you don’t see the benefits of that streamlining immediately. When you next do that task, you’ll find that it’s easier and you have extra spoons for other things. This can require financial set up, or logistical set up, or sorting and categorising. Maintenance of this efficiency can be hard when we are exhausted, because we ran out of spoons.

Learning to keep an eye on your spoon level and start to shut the task down before you get that empty. This is a form of enteroception that many people with mental health struggles also struggle with.

We can over streamline and fall into perfectionism. This can lead to endlessly trying to ease our anxiety by doing some kind of improvement that never pays off, because you are fixing the wrong thing.

It can take time for spoons to regenerate. We need to eat regularly, sleep and give ourselves some down time. Down time can look like switching off or doing a fun and different activity. You’ll know it is regenerative as when you finish that bit, you feel more able to do other things.

This is just a quick snapshot. If you want some help beyond this, perhaps contact us for an appointment.

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