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.
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).