Living with postnatal depression

Living through postnatal depression is usually one of the most overwhelming, frightening, isolating and debilitating experiences a woman can have. She may feel her world has fallen apart, that everything is black or nothing makes sense.

Worse still, people experiencing depression often lose hope or the belief they can recover and lead a worthwhile life. But people who have come through episodes of depression are able to look back and see how fallible their loss of hope was.

Discrimination and stigma

Many people feel ashamed of having postnatal depression and can sense other people's fear, prejudice and low expectations for them. Media coverage can give the wrong impression that people with mental illness are likely to be violent. Employers and landlords don't really want to know people who have a mental health problem.

Workmates and friends may turn their backs on a person they know who has mental illness. Even families and whanau and mental health workers can be over-anxious, controlling and pessimistic about lives of people with a depression. None of this helps. Sometimes the discrimination feels worse than the illness itself.

Support and information

Women with postnatal depression often do better if they seek support people who are caring, non-judgemental and who see their potential. Some get their best support from others who have been through the same kind of experience. Other people find a counsellor or another type of mental health worker who is supportive. Friends, family or whanau may offer good support.

Women with postnatal depression can make more informed choices if they educate themselves about their condition and the types of treatment and support available. It is also useful to know about your rights.

Using services

Many people with severe postnatal depression, sooner or later, go to see their GP or a counsellor or are referred to mental health services.

If you fear you might harm or kill yourself or your baby it is vital you seek help immediately.

Sometimes it is hard for women to seek help because they feel ashamed and want to hide their distress. Acknowledging they have a mental health problem and need help can be very scary. People often say the best services are ones where they are listened to, treated as equals and are given support or treatment that works for them. Otherwise, the service is unlikely to meet their needs.

Recovery

Once an episode is resolved, woman with milder forms of depression can expect to return to everyday activities, without much impact on their life. It is important they have enough support to cope and to ensure the bond with the baby is given every opportunity to develop.

Much of this support will need to be practical - help with household tasks, care of the baby and any other children, and opportunities for the woman to have unbroken sleep and periods of time out.

Sometimes people are given quite pessimistic predictions about their lives by mental health professionals. But even if you continue to have episodes of depression at other times, you can still experience recovery and live a happy and worthwhile life.

Important strategies for recovery

• Learn about postnatal depression and psychosis, and the treatment options. Get information to help make sense of what has happened, and learn what to expect, so you can make informed choices about what is best for you.
• Participate in decisions about your treatment.
• Become familiar with any early warning signs of relapse, and be part of developing a plan for maintaining wellness. Health professionals involved in your care will help with this.
• Receive treatment and support from people you trust, who expect the best for you and are able to accept how you are at any time.
• Have the continuing support of family or whanau and friends, who know about the condition and understand what they can do to support your recovery. Practical support with running the house, child and baby care, and opportunities for time out are important.
• Take the opportunity to recuperate - to sleep more if you need to, relax, after an acute episode be encouraged to become active as you are able.
• Take steps to improve your general health. If at all possible exercise each day, eat a healthy diet, and have plenty of fluids - these will help you to recover and keep well.
• Be realistic in what you expect of yourself, especially during the episode. When things seem too hard, take them on one step at a time.
• Do something enjoyable each day, and try to focus on positive thoughts and memories.
• Find the ways of coping that work best for you. These are different for each person, but are a critical first step on the path to recovery.
• Avoid or really cut down the use of alcohol and illegal drugs, as these may worsen your condition and increase the chances of relapse.
• Talk to your health professionals if you are considering stopping treatment and work together with them to find some compromise that will ensure continuing wellness but address your concerns about the treatment. If you are on medication, it is very important that the decision to stop taking it is made with the input of your doctor and anyone else involved in your treatment.

Family/whanau views

Families and whanau often experience real grief, isolation, powerlessness and fear as they witness their loved one struggling with postnatal depression. During a crisis they may find they cannot understand the person's behaviour or communicate with her any more. Even after a crisis they may find their relative withdrawn or hard to be around.

Their feelings for their relative can swing from compassion for her pain, to grief at the loss of the person they once knew, to hostility towards their relative for disrupting their lives. Families and whanau often worry that their relative will never get better and may have to revise their expectations for that person.

Discrimination and stigma

Families and whanau may feel shame or embarrassment if their relative behaves in an unusual way when they are very unwell. They may shut themselves off from their friends and neighbours or feel these people are avoiding them.

Support and information - family and whanau

Families and whanau often feel drained and stressed and need support to look after themselves as well as their relative with postnatal depression. Their other family or whanau relationships can get neglected when the needs of the person with postnatal depression have to take priority.

There are several ways families and whanau can get support. They can get in touch with other families and whanau who have had similar experiences. Some mental health services provide good support options for families and whanau. Families and whanau need information on the person's condition, their options for treatment and their rights.

Experience with services

Families and whanau frequently find that services do not listen to their views about their relative. Ideally, families and whanau who are involved in caring for someone with mental illness need to be able to communicate freely with professionals about their relative.

Recovery

Most, if not all families and whanau want to help their relative recover. Unfortunately, sometimes the person with postnatal depression blames their family or whanau and does not want them to be involved in their care. Research shows that if families and whanau can share information, skills and support with their relative and the professionals who look after them, the likelihood of recovery is much greater.

Important strategies to support recovery

Family, whanau and close friends of women who have had postnatal depression or psychosis have found the following strategies important and useful.

• Learn about postnatal depression, its treatment, and what you can do to assist recovery.
• See yourself as part of the treatment team and, in particular, learn about the signs of relapse and with the help of health professionals agree with the woman how you can help her to stay well.
• Understand her symptoms for what they are. Try not to take them personally or see them as being difficult.
• Help the woman to recognise stress and find ways of coping. This includes helping her solve problems that worry her.
• Encourage her to be more active, but without pushing or criticising, as this may make things worse. Accepting how she is now and having realistic expectations for her is very important.
• Help and encourage her to exercise, try to do enjoyable things and see the positive side of life, but without ever pushing.
• Encourage her to continue treatment, and, if applicable, to avoid alcohol and drug abuse.
• Encourage or help her to contact a culturally appropriate support group or organisation. They exist in many regions.
• Find ways of getting time out and feeling okay about this. Caring for a family or whanau member with postnatal depression can be stressful. It is critical to do what is needed to maintain your own wellbeing.

See also: Postnatal depression; postnatal depression - treatment; postnatal psychosis

Support groups

See the support organisations (which include helplines) under Further information and support below.

Original material provided by the Mental Health Foundation of New Zealand, 2002. Edited by everybody, June 2005.