Psychologist Nathalie Salaun on Postnatal Depression
Nathalie Salaun is a Chartered Counselling Psychologist (CPsychol), specialised in the cognitive and behavioural treatment of anxiety disorders, obsessional disorders, stress, relationship difficulties, self-esteem and depression. She is also a Mindfulness teacher. She has worked as a Chartered Counselling Psychologist since 2005, at first for The Priory Hospital, in their inpatient, day-care and outpatient services and then for the NHS, in secondary care, in North London. She now has a private practice in London and spends her time between London and Barcelona. She offers face to face appointments in London and and also appointments via Skype. She is currently developing a programme of Well Being workshops to take place in Barcelona in spring 2018.
What is post-natal depression (PND)? Are the symptoms, both physical and mental?
PND is a type of depression that a large number of women suffer from after having a baby. In the west, one in seven to ten women experience PND; it is a very common illness which requires treatment. The symptoms are similar to those of common depression. The most common symptoms are:
- Feelings of helplessness and hopelessness: negative automatic thoughts that nothing will ever get better and there’s nothing you can do to improve your situation. Crying or wanting to cry all the time.
- Feeling irritable and angry: negative automatic thoughts about your baby and loved ones.
- Loss of interest in daily activities: no interest in or ability to enjoy former hobbies, pastimes, social activities and loss of libido. You may feel indifferent towards your baby and loved ones.
- Appetite or weight changes: significant weight loss or weight gain, you may forget to eat or notice an increase in comfort eating.
- Sleep changes: either insomnia, especially waking in the early hours of the morning, and/or oversleeping and/or unable to stay awake.
- Psychomotor agitation or retardation: either feeling restless or sluggish and physically slowed down.
- Loss of energy and lethargy: feeling fatigued and physically drained. Even small tasks are exhausting or take longer.
- Self-loathing: strong feelings of worthlessness or guilt. Harsh criticism of perceived faults and mistakes. Negative automatic thoughts of being useless and a terrible mother.
- Concentration problems: trouble focusing, making decisions, or remembering things.
- Anxiety and/or Panic: obsessive worrying about your health or that of the baby, fear of harming the baby, afraid of being alone with the baby, unable to work out what your baby needs, seeking reassurance all the time.
- Suicidal thoughts: these thoughts are common with depression and should not be brushed off.
How can a woman distinguish between having PND and feeling low after having a baby?
It is natural for a women to experience low mood following child birth, half or two thirds of women report experiencing the symptoms described above for a short period of time ( 3 to 10 days). This is known as the “baby blues”. The symptoms tend to subside as the mother adjusts to her new role as well as adjusting to the rapid change in female hormone levels following child birth.
Adjusting to life as a mother can be difficult. Having a baby is probably the most significant life changing event that a women experiences. Coping with day to day stress of a new baby can be a trigger for depression. If the symptoms described above persists and/or increase in intensity, it may turn out to be post-natal depression. It is recommended to talk to your GP or Health Visitor if you have any doubts. The sooner you address the Depression the quicker you will recover.
Can anyone get PND? In what circumstances are mothers more likely to experience PND?
Given the right circumstances, any new mother can suffer from postnatal depression. Specific risk factors have been identified with a women’s likelihood of developing postnatal depression:
• Previous episode of depression: this is the most predictable factor. Once a person has experienced depression, there is a high risk of relapse, however, it can be minimized or prevented with treatment.
• History of depression in the family and/or depression during pregnancy
• Stressful pregnancy
• Prolonged labour and/or delivery complications
• Problems with the baby’s health
• Difficulties breast feeding
• Experiencing severe “baby blues”
Other social and psychological risk factors are:
• Lack of practical, financial, emotional support
• Difficulties in close relationships
• Difficulties in feeding/settling baby
• Unrealistic expectations about motherhood and babies fuelled by the media and society
• Moving house
• Making work adjustments
Is it true that mothers suffering from PND will not be able to breastfeed? Does having PND have an effect on the baby?
Women with PND can breastfeed, if they choose to. A large number of women treated with anti-depressants also breastfeed. It is likely that anti-depressants affect breast milk just as alcohol would, however, according to medical and pharmaceutical research, the affect of anti-depressants on baby’s health is of no significant threat. A mother who is depressed may withdraw and be unable to care for her baby and this is why it is important to acknowledge the depression, seek support and discuss the treatment options with her doctor.
Do you believe social factors (i.e. trying to be superwoman) can contribute to PND?
Often, the reality of motherhood does not match the mother’s expectation and this can create a conflict between what she imagined and what is. The birth of a baby brings permanent changes to a women’s life. She may experience a loss of status, having left work. She may feel a loss of independence since caring for a baby requires one’s full attention every moment of the day. She may feel isolated from her friends and work colleagues. Her relationship as she knew them have changed, her mother is a grand mother, her partner a parent and so on. She may feel a loss of control over her life and may overcompensate for these losses by trying to maintain a similar life style to the one she had before being a mother.
She may place unrealistic demands on herself and be reluctant to ask and/or accept help from others and so on. It takes time to adjust to being a mother and contrarily to popular beliefs, mother do not always bond with their babies straight away, they do not know instinctively what to do and motherhood is not just a time of joy. So unless, one has super power, it is best to give up unrealistic expectations, if not it can lead to burn out and depression.
How do you treat mothers with PND?
The first step I take when working with mothers suffering from PND is to assess their support network and help them deal with practicalities such as getting help with domestic tasks, babysitting, cooking and so on. Once practical and emotional support are in place we would then concentrate on relieving the symptoms of Depression.
My main therapeutic approach is Cognitive and Behavioural Therapy (CBT) which hypothesise that it is not the situation that makes us feel depressed but rather our interpretation of the situation. For example, we may all be at the same party, but our experience of the party will be unique based on our own individual perception. This in turn will depend on our past experiences, our beliefs, our behaviours and so on. CBT hypothesises that because our experience is subjective; we are often mislead by our perception of a situation. Our thoughts, feelings and behaviours reflect our state of mind and not necessarily what is actually happening.
Depression is like wearing dark tinted glasses, everything is negative. A woman with postnatal depression will have a lot of negative automatic thoughts about herself and her abilities as a mother, her particular situation and life itself since the baby. This perception will be based on her beliefs about what motherhood should or should not be; how she should or should not feel; what she should/should not do and so on. These expectations will dictate and reinforce her negative thoughts, feelings and behaviours, and she will feel trapped in a negative spiral.
The aim of CBT is to bring some objectivity into the situation: we cannot change the facts in life but we can look at them from numerous perspectives. Each perspective has a different outcome and some perspectives are healthier, more empowering and more positive than others, these result in positive outcomes.
Normally, how many sessions would a mother with PND need?
Each person is different, although we may experience similar thoughts, feelings and behave in similar ways we are unique. The length of the therapy will depend on many factors including: how severe the depression is, how well the person takes to the approach, how many of the risk factors described above she can relate to. Nonetheless, CBT is a goal oriented approach, short-term to medium-term therapy: a course of CBT typically lasts between 5 to 15 weekly sessions. Some chronic or life long problems may require longer term treatment.
How do you feel about anti-depressant drugs?
Anti-depressants can be very helpful and many studies have shown that the combination of anti-depressants and CBT is the most effective treatment for depression compared to anti-depressants alone and other forms of talking therapies. This does not mean that depression can only be treated with anti-depressants and CBT or that everyone who is depressed should take anti-depressants. We are all different and we have choices. What is important when feeling depressed, is to discuss the treatment options with your doctor and your loved ones and together make an informed decision on what is the best treatment for you and your baby.
How long can PND last?
PND can last a year or more depending on the severity and personal circumstances. The sooner a woman acknowledges her suffering and seek help, the sooner she will recover.
Can fathers suffer PND?
No one is immune to experiencing depression. Fatherhood is also a testing time for a man and it is not unusual that he too will need time to adapt. Depression can be triggered by difficult or stressful life events such as the arrival of a baby.
Can PND come and go?
Postnatal depression will not last forever; there is a natural end to a depressive episode whether it is PND or common depression. However, research shows that men and women, who have suffered from depression in the past, have a high risk of relapse. Relapse can be triggered by any stressful life events so it is important to be prepared and seek help to prevent and/or to minimize a relapse into depression
Is there a higher instance of Expat women suffering from PND considering they are normally away from family and friends?
Lack of support is one of the many risk factors in PND so it may be that expatriate women are more vulnerable in that way, however, it is unlikely that a single risk factor triggers PND. None the less, because they are away from home and their familiar sources of support, it is important that expatriate women make it a priority to create a supportive network around them.
How can family and friends help a mother suffering from PND?
A women suffering from PND needs whatever support friends and family can give her. She probably feels overwhelmed by the task of looking after the baby, let alone doing the cleaning, cooking, shopping and all the practicalities involved in day to day living, so she certainly needs help with these. If you know someone suffering from PND, encourage her to be active and to treat herself, to spend some time alone with her friends and with her partner; listen to her and reassure her that you love her and that she will get through this; do not tell her to “snap out of it”, if she could, she would have done so. Depression is not a choice: it is a common painful life experience that needs to be taken seriously. Find out information about PND and support networks and encourage her to seek help from her doctor, a counselor, a therapist or a psychologist so not to prolong her distress but instead to begin recovery and begin enjoying motherhood.