Advice for partners and friends of those with PND

I know that my other half felt so bad that he hadn't realised that I had Postnatal Depression, as did several of my best friends. But I don't blame them for not noticing, I did a great job of hiding my feelings. I feared people thinking I was "not coping" with motherhood and I didn't want people to see me as the failure that I felt. So 'How are you?' questions were always responded to with 'I'm fine thanks'. Personally I had days when I wanted to just cry in response to that question, but I didn't want to show "weakness", plus no one wants to deal with that, no one expects a negative response to that question.
So my first bit of advice is really be observant, ask a couple more questions, show that you really do care about how they are feeling and they might be more open about it.

What you need to know

• PND is a form of depression, it is not a "lesser form"of depression, it can be as severe as any other form of depression.
• Postnatal Depression is not uncommon,  roughly 1 in 10 woman have PND.
• It can occur at any point within 1 year of the birth
• Men can get PND too, 1 in 25 of fathers in fact, so you also need to look after yourselves and speak to someone if you feel you need to.
• The hardest step is recognising it and acknowledging the thoughts and feelings and asking for help.
• You may be the one to recognise that low mood/tearfulness, although common in the first few weeks due to hormone changes and exhaustion, should not continue. Speak to her and find out how she is feeling, encourage her to speak to a professional, such as her health visitor or GP if it is not improving.
• Remember that with the right help, this can be resolved.

Factors that can predispose PND

• A previous history of depression or anxiety or bipolar disorder.
• A family history of depression 
• A traumatic birth
• Chronic sleep deprivation 
• Illness/health issues in the baby
• Breastfeeding difficulties
• Relationship difficulties
• Lack of support
• A dramatic drop in hormone levels post birth
• A particularly emotional pregnancy related experience- miscarriage, unexpected pregnancy,  IVF, multiples...
• Personality- low self esteem, perfectionist, OCD...
• 
  

Symptoms to look out for (not all these symptoms will be present, it differs from person to person which will be experienced)

• The "baby blues" lasting longer than 2 weeks
• A persistent feeling of sadness or tearfulness 
• Lack of energy, exhaustion
• Reduced enjoyment of things you enjoyed before
• Slow, hesitant speech.
• Trouble getting to sleep, or staying asleep but being tired.
• Withdrawing, isolating themselves from social situations
• Difficulties concentrating
• Trouble bonding with the baby
• Thoughts about harming themselves or their baby
• Nightmares 
• Panic attacks
• Feelings of failure, guilt, self blame, 
• Feeling unable to look after the baby or voicing concerns to that affect.
• Irritability
• Lethargy/ lack of motivation
• Changes in appetite  (reduced or increased)
• Frequently crying for no reason 
• Speaking negatively
• Self neglect
• Excessive worry
• Lack of their usual humour.
• Obsessing over their health or their babies
• Avoiding seeing friends and family
• Physical symptoms such as rapid heartbeat, sweating, sickness or fainting, headaches, blurred vision
• Low sex drive

How you can help

• Have a responsive conversation about how you are both feeling. Listen
• Encourage her to get professional help
• Remind her that she is a brilliant mum and doing a fab job.
• Tell them you love them
• Bring positivity into the house
• Be aware that she may take small comments or jokes to heart,be aware that venting may be taken personally too.
• Try to let any irritable comments she makes, pass without affecting your mood.
• Give your other half a lie in and take the baby for a walk so she cannot hear them and is able to rest.
• Tidy up after yourself and do some household chores without having to be asked.
• Comfort when she needs a good cry. 
• Keep her company, so she doesn't feel alone but also allow her, her own space at times.
• Take over to allow her time to have a bath/shower and give her that break, don't interrupt that time with non urgent questions.
• If possible then help with the evening/ night feeds to allow her to gave a chunk of unbroken sleep.
• If that's not an option, be the one to put the baby down to bed as you're likely to have much more success than mum who smells of yummy milk.
• Discuss with her the best practical ways in which you can help
• Appreciate that there will be good and bad days
• Don't laugh at the little things that you don't realise will upset her. My other half laughed when I accidentally touched a hot pan in a moment of exhausted stupidness and it led to a melt down on my part. 
• Take her out, if she is ready, don't force her out of her comfort zone.
• But also look after yourself, allow yourself some time too. Living with someone with PND is emotionally exhausting. Ask family members to help out.

A surprising amount of normality

6 weeks into my Sertraline prescription and after my first talking therapy session, I could feel that I was starting to return to my old self.

Lets start with some background to my personality.
Since a nipper I have been non-stop active, fun loving, consciencous,  caring and happy, but I have had some dips in my mood in the past, none of which required any kind of intervention though.
I've always been shy, when I was a youngster I was ridiculously timid. I recall a parents evening at the start of secondary school when my history teacher begged me, in front of my parents, to speak more in class.  I am fairly certain that is an unusual request for a teacher to make.
I have never had much self confidence and I have always set my standards too high, never been satisfied with my own personal achievements. An example being my GCSE results day. I got 6 A's, 5 B's and a C. I was absolutely mortified by my C. Rather than being proud of my A's and B's, I was heartbroken by my C in Spanish. There is nothing bad about getting a C I'd like to add but I had worked so hard and to me I had failed myself. My Spanish ended up getting re-marked and was upped to a B but by then I had experienced total disappointment.

I know I should be proud of my achievements, I worked so very hard to get to where I am. I think the school systems are partly to blame  (I "failed" my 11+ when it was expected I would pass, and then passed my 12+, I went off a grammar school where I was made to feel anything lower than a B wasn't good enough only to get a C in Spanish when I had been predicted an A, then at A level I got BBCD and was the only person out of all my friends not to get into university that year. I spent a year at home, whilst everyone else enjoyed uni life, and resat my exams) but my opinions on school assessment is another topic entirely. The point is, I set my standards high even at a young age and achieving didn't come easily to me. It wasnt until I was a sucessfully qualified 22 year old Physiotherapist, working with so many different people, patients and colleagues, from so many different backgrounds, and I was able to see that I was making a positive difference in their lives, that my self esteem began to improve. And over the 7 years since qualifying, I gradually became a much stronger person.

So back to the main point of this post. I didn't have a masses of confidence before I had post natal depression but the confidence I did have, had been built up over years of work , and so this monster had taken what confidence I had. I have had 11 months of feeling almost reclusive, with most conversation being no more complex than 'I think it's snack time' or 'have you done a poo? ' So I pleasantly surprised myself on a work course in London last week.

I have never been fazed when it comes to travelling so the trip alone to London did not daunt me one bit,  but once in London my apprehensive, polite, introvert self took over again. It was rush hour and I missed the first 2 tubes for the sole reason that, unlike everyone else in Baker Street station, I didn't confidently and forcefully push my way onto a train that had not a single inch of space left on it, and I was left behind each time.

Eventually making it to London Bridge and into my course room, something unusual yet distantly familiar happened, I found myself chatting to the other strangers in the room, mostly health professionals, all with a neurological interest. I immediately saw some of that bygone confidence and my true identity making a reappearance. It wasn't until that point that I realised how long it's been since I saw this person and quite how much I've missed them!
The day continued in this way. We had to do a role play type task, my idea of a nightmare, but at the end of the task, the course leader asked for some feedback and to my astonishment I was the first person in the group to volunteer my opinion and to top it off, I got a laugh from the group! My history teacher would have been so proud.
Don't get me wrong, it wasn't a total transformation from the PND me to the old me, I had my moments, like when I couldn't figure out how the hot water jug worked and eventually, timidly and in embarrassment asked someone to help me. But the old me was definitely reminding me every so often that they are still there and to me this brought hope and a monumental, positive step in my recovery.

I got home from London and received big cuddles from my son, it had been a long day away from him, the longest so far, and I had really missed him but I had also enjoyed my day. I had used my grey matter, been involved in intellectual conversation with actual adults and it had allowed me to rediscover my own identity. Today I was me and not just E's mummy.

As I write this I'm watching my little boy, who is 3 weeks from his first birthday, pulling himself up to stand and waving at me and I finally feel proud of myself. It's been a tough journey these last 11 months, with big highs and lows but my son is a handsome, well behaved, albeit cheeky,  intelligent little man and I played a massive role in that, I am truly seeing that now. Returning to work in 3 weeks time will be tough but stricking the right balance between being me and being E's mummy, I feel, will bring me back to that cheerful, confident person I was a year ago. Normality.

Starting on antidepressants

When my GP diagnosed me with Postnatal Depression her first recommendation was that I start on an antidepressant, Sertraline was her antidepressant of choice. At the time she did not give me any other treatment options. In her words, she felt I needed to be 'more stable' before I would respond well to any other input.

I was very reluctant to start on antidepressants, in fact I went against her professional recommendation initially and didn't take them. This was not just my own selfish reluctance, I was also aware that it can pass into the breastmilk. It was my GPs opinion that the risks outweighed the benefits to my bubba  (minimal risk of side effects to my baby verses a mum who was coping better). But she did also encourage me to cease breastfeeding. I went home and read some online research and still wasn't reassured.

4 weeks later when I met with my new health visitor I explained why I hadn't started on the Sertraline and how I wanted some other treatment options. She listened. It was explained to me that I was starting on a very low dose (50mg) and that the risks to my little man really were small especially as he only has two feeds a day from me now. She also disagreed that I should cease breastfeeding, and cited some research that concluded mood is lowered further in mothers who stop breastfeeding but are not ready to, but she wanted further treatment alongside the medication if I agreed to take it. She suggested Talking Therapy and input from their team to improve my son's sleep.

So I started taking 50mg of Sertraline (that was 5 weeks ago). I read all the possible side effects and I expected the first couple of weeks to be unpleasant but I barely noticed a difference. I felt slightly foggy and a marginally more sleepy for the first week and my appetite reduced a little but otherwise I was well. These minimal effect cleared after a week.

After 3 or so weeks I noticed that I was nowhere near as tearful as I had been and I was not taking absolutely everything to heart anymore. The medication was having a positive effect and, more importantly to me, didn't seem to be having any negative effects on my son. I was, however, also getting more sleep as the nursery nurses input had resulted in my son sleeping through the night. So my mood improvements were likely due to both these factors.

4 weeks into antidepressant treatment I had a review with my GP. She was pleased with my improvements and felt I was more positive. She still felt my confidence was down and that I would benefit from upping my Sertraline dose to 100mg. Again, she was unable to guarantee no side effects to my son. Again I have declined to follow her advice. I explained my trepidation and I compromised. My son is almost 11 months and I've always said that I want to breastfeed for 1 year. Over the next month I will begin to wean my bubba into cows milk and once he is fully weaned, if I still need to, I will up my dose.

I have some big changes happening over the coming month including returning to work, and I feel this may be a helpful step with regards to my well being. So we agreed to review how I was managing in 6 weeks time. So I will blog again in a few weeks to update.