Many people wonder what increases the risk of developing perinatal depression/anxiety (PNDA)?
In addition to the obvious stressors of adapting to having a baby in your world, there are some biological, genetic, psychological and social factors (our upbringing, for example) that might make us more vulnerable to struggling emotionally and mentally after the birth of a baby.
Here are some of the risk factors that may contribute to developing PNDA:
- Existing or past mental health challenges
- A family history of mental illness
- A history of experiencing abuse (physical, sexual or emotional)
- A complicated/ stressful pregnancy
- A traumatic experience of birth (including feeling out of control or disempowered about the events leading up to or during the birth)
- The previous loss of a baby (miscarriage, stillbirth, termination)
- Previous reproductive stress/ losses (IVF)
- Health issues with your baby, including a premature birth
- Ongoing issues in settling or feeding your baby
- Not having a positive attachment with your own mother/ parent
- A lack of practical support
- Feeling isolated from emotional connection
- Drug and alcohol addiction
- Financial stress
- Relationship stress
- Sleep deprivation
If you are experiencing any of the above it does not mean you are destined to develop perinatal mental health issues. It is rarely one trigger but rather a cluster of factors that combine to put someone at risk. It’s helpful to have an understanding of your own history and sensitivities so you can get extra support should you need it to stay well. Getting help early can reduce the impact on yourself and your family.
What is the treatment for PNDA?
Because there are a variety of interacting factors that cause PNDA, recovery often involves more than one approach, dealing with both internal and external stressors to address emotional and psychological health as well as attending to practical issues.
Sometimes we need help untangling the various challenges that are contributing to us feeling unwell.
Asking for support is the first and most crucial step, and will often lead to a quicker recovery. A well-informed compassionate health professional can be one of your best allies for recovery. These might include:
- Your General Practitioner
- Obstetrician
- Midwife
- Child Health nurse
- Psychologist
- Psychiatrist
- Social worker
- Counsellor
Treatment approaches
Treatment approaches for perinatal mental health can often work well in combination. It’s important that you are involved in the discussion to decide the best treatment choices for you. Remember you can always seek other options and opinions.
Tips for talking to your doctor/ General Practitioner (GP)
If you’re pregnant or a new parent and concerned about how you’re coping, talking to your GP/ doctor is a good place to start.
Your doctor should be able to provide you with unbiased and up-to-date information and advice, supporting you to make the best decision for your circumstances. They can listen to your concerns, start to make an assessment and recommend a treatment plan, which may involve a referral to an appropriate specialist, such as a counsellor/ psychologist. They may also suggest medications.
It’s important that you feel comfortable sharing your specific issues with your doctor. If you don’t have a regular doctor or don’t feel confident with your existing one, it may be worth finding a doctor with a special interest in mental health.
The PANDA National Anxiety and Depression Helpline (1300 726 306) can help you to find a doctor in your area.
It’s normal to feel anxious about booking and turning up to your first appointment. Many parents feel nervous opening up about the real experiences of parenthood. Often the media reinforces imagery of parenting as a time of deep fulfilment and delight (remember those ‘Huggies’ commercials?), making parents feel even more alienated when those images don’t match up to the real experience of parenthood.
But bear in mind that GP’s are familiar with working with parents during the perinatal period and many new parents experience anxiety and depression during this time. Seeking help is a sign that you want what is best for you and your family. The earlier you get support the sooner you can begin to feel better.
For your first appointment, It may be worth requesting a longer consultation so you’re not rushed in explaining your symptoms.
If English is not your first language, you can ask for an interpreter. Most people find talking about personal issues easier in their first language.
You might want to take a friend or family member with you. When you are sleep deprived and anxious it’s common to have difficulties remembering information. A trusted person can help you articulate and share your concerns, ask questions and take notes.
You might find it helpful to write a list of your symptoms and questions before the appointment as a prompt.
It’s important for your doctor to know if you have been diagnosed with or experienced any mental health issues in the past, or if you have had any current or previous thoughts about suicide so they can give you the right kind of care.
You can expect your doctor to ask you questions about your symptoms, your physical health and environment (sleep, exercise, use of drugs or alcohol), your mental health history, the nature of any distressing thoughts, how your daily life is being affected, and whether you have any thoughts about harming yourself or your child. Health professionals are trained to assess for risk and their primary concern is keeping you and your family safe.
Mental health symptoms can change quickly during pregnancy and new parenthood so update your doctor on any changes.
You can expect your doctor to provide a potential diagnosis, order any necessary tests, and make a suggestion for a treatment plan,
Your experience with your doctor should feel respectful and not rushed, and you can expect them to patiently explain the treatment options or referrals and ask you about your preferences.
Remember, you have the right to understand your diagnosis and treatment options and to be able to ask questions about anything you don’t understand.
Questions you might have could include:
- What are the options and alternatives for treatment?
- What are the possible side effects of any medications?
- How soon should I expect to feel better?
- Who are you referring me to and what do they do?
- What are the expected waitlists for treatment?
- What are the costs of treatment, am I covered by Medicare?
- Is there anything I can do for myself to improve my symptoms?
If the first doctor you see doesn’t address your needs, please don’t give up. Not all doctors are equal in their qualifications or experience in supporting patients with perinatal mental health. Seek another opinion, until you get the help you need.
Getting a Mental Health Care/Treatment Plan (MHCP)
If your doctor refers you for counselling to a psychologist or another allied health professional, they will likely give you a mental health care/ treatment plan. This entitles you to receive Medicare rebates for up to 10 individual appointments per year. (Note: the government has extended this to 20 appointments per year due to the Covid pandemic up until 30 June 2022). The current rebate is $88.25 per session.
There is a review process after session 6 and session 10, where you’ll need to see your GP again to decide on whether the treatment is working well for you.
If you’re wanting to access these Medicare rebates for a particular service, let your GP know before booking an appointment as they may require a longer consult to complete the paperwork with you. This usually includes completing a questionnaire about your mental wellbeing.
Counselling
Counselling is an opportunity to talk about your thoughts and feelings with a trained professional to gain clarity about your situation and the next steps. Counselling can be provided by a counsellor, psychologist or social worker. You can discuss with your GP what Medicare rebates are available.
Many people find it useful to have a neutral person separate to family or friends to talk openly with about what’s really going on.
The right counsellor will help you feel understood and supported and work with you in deciding the best approach for your recovery. This might include discussing strategies to manage stress and anxiety, identifying unhelpful thoughts and beliefs, exploring self-care and other support systems in your life.
Your counsellor can adapt the conversation to your needs and find out what’s most important for you.
At WACPPS, our counsellors are experienced and qualified in supporting women in the perinatal period – during pregnancy and for the years after the birth of your child.
The first step in arranging counselling is to see your GP who can make a referral for you. They may organise a Mental Health Care/Treatment Plan (MHCP) which enables you to receive Medicare rebates to subsidise the cost of sessions.
Medication for PNDA
For some parents, medication can be a helpful part of their recovery. It is often more effective in combination with counselling.
Many parents have understandable concerns about the side effects of taking medications while pregnant or breastfeeding. There are several medications that are deemed low risk during the perinatal period and your doctor should be able to acknowledge your concerns and talk you through the various options.
For some parents there is a stigma about taking medication, such as fears about being viewed as less capable. This is often related to the stigma of mental health in general. Fortunately, our society is changing and it is now more widely understood that our physical and mental health are inextricably linked.
Traumatic experiences or sustained periods of emotional and physical stress can impact the chemistry of our brains, and medication can help rebalance and relieve severe symptoms.
Some parents report that medication assisted them to function from one day to the next, providing more clarity and stability to make future decisions about their wellbeing.
The decision to take medication doesn’t have to be permanent, it may offer a lifeline during a difficult patch in your life.
Antidepressants are the most common kind of medication prescribed during the perinatal period and can be used to treat anxiety as well as depression.
All medications can have side effects, some of which improve overtime, however if you don’t react well to a certain medication, your GP can help you modify the dose or change to another type. Remember to consult with your doctor before changing or stopping your medication abruptly as this can make you unwell.
If things get worse
Our mental health can be sensitive to change. If you find yourself feeling worse, or not coping. Please let your doctor or someone know as soon as possible.
If you are feeling unsafe, are thinking about hurting yourself or anxious about your ability to care for your baby, you may require a higher level of care until things improve. Your doctor may refer you to a Mother Baby Unit. This is a residential support service within a hospital where you can stay with your baby while having access to psychological and medical support.
Sometimes a crisis can happen before or between appointments. If you have ongoing thoughts about suicide, please ask someone to take you to the emergency department at a hospital or call triple zero (000).
To talk with someone you can call the Suicide Call Back Service on 1300 659 467, Suicide Line on 1300 651 251, or Lifeline on 131114.
