'I almost missed it'

"My job is diagnosing and treating mental illness, and yet I brushed aside some early warning signs" ... Dr Dawn Barker
"My job is diagnosing and treating mental illness, and yet I brushed aside some early warning signs" ... Dr Dawn Barker 

Her job is diagnosing and treating mental illness, but even Dawn Barker brushed aside warning signs of postnatal depression in a friend. She shares her story.

A few months ago, one of my best friends sent me a text message. This isn’t unusual in itself: we live at opposite ends of the country and our long, relaxed phone calls of old have been replaced by brief, typed sentences snatched from the time spent looking after our young children.

But the content of this message surprised me; she wanted to put her two-year-old into daycare. Her new baby was taking up all her time, she said, and she rarely sat down and played with her toddler any more. She worried that her daughter would lag behind the other children academically when she started school. “I feel like I’m failing her,” she said.

I paused when I read this. Like many other mothers, my friend is an intelligent, capable woman who put her career on hold to embrace motherhood. She and I would swap stories of our children, encouraging each other in our relaxed parenting styles: wearing our infants in slings all day, co-sleeping when we needed to, breastfeeding on demand. This message didn’t sound like that friend.

But I dismissed my niggling doubt. She was probably paying too much attention to the women in her mothers’ group, women who were inflating their own children’s abilities, as most of us do at times. She was probably just tired. I reassured her that her daughter was in the best place: at home with her mum.

I planned to call her that week to have a chat, but with three children of my own, including a baby, I just didn’t find – or make – the time. A couple of weeks later, I was crawling into bed after yet another hectic day, and realized I hadn’t seen my phone for hours. I found it buried in the nappy bag, out of batteries. I plugged it into the charger, then saw a text message that had been sent hours earlier, from the same friend. All it said was this: “I don’t know how you cope with three children. I feel like I’m barely coping with two.”

I closed my eyes briefly as I recalled her words from a few weeks earlier. This wasn’t my friend writing. This was something that I knew all too well from my work as a psychiatrist. This was postnatal depression.

The time around birth is one of high risk for mental health problems in women. It’s a time of massive physical, emotional, and social changes. Relapses of pre-existing mental illness (like anxiety, depression or psychosis) are common, particularly as some psychiatric medications are unsafe to take while pregnant or breastfeeding.

Some mental illnesses are specific to the weeks and months after pregnancy.

Post-natal depression is thought to affect almost 16 per cent of Australian women. It’s common and treatable, but still under-reported and under-diagnosed. When I ask the mothers of my paediatric patients if they suffered from postnatal depression, they often admit that they did – but were too ashamed to ask for help.

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A rare – but very serious – condition after pregnancy is that of postpartum psychosis. This occurs in only one or two cases per 1000 women, but it is sudden and considered a psychiatric emergency. These mothers are often confused, with hallucinations and delusions, and don’t appreciate how unwell they are. In the worst cases, they’re at significant risk of harming themselves or their babies.

Thankfully, these tragic outcomes are uncommon. Much more common is the effect on family relationships: disrupted attachment and bonding between mother and infant, and marital strain. Depressed mums are often unable to respond to a baby’s emotional demands, which then makes the child more vulnerable when it comes to their own future mental health.

As for me, it was the next day before I could talk to my friend. She sobbed as she rattled off the symptoms of depression: fatigue, insomnia, guilt, low mood, a sense of hopelessness. She tried to rationalise her symptoms and deny that she was unwell. She said it was probably normal; she was just tired; she didn’t want medication in case it harmed her breastfed baby. But still, she did the right thing by booking in to see her GP, talking to her husband, and organising some help at home. Her GP confirmed the diagnosis, referred her to a psychologist, and prescribed her an antidepressant.

I’m pleased to say that over the next few weeks, her mood lifted and she is now much better.

The whole episode shocked me and filled me with guilt. My job is diagnosing and treating mental illness, and yet I brushed aside some early warning signs that, in hindsight, were obvious. Her husband, living in the same house, also didn’t notice how unwell she was, or maybe he didn’t know what to do about it. The two people who should have noticed that something was wrong almost missed this.

The outcome here was good – but it’s not always the case.

If you are worried about mental health problems in yourself or a friend, talk to your GP or any other health professional. You can find out more at Beyond Blue (1300 224 636) and Post & Antenatal Depression Association, PANDA (1300 726 306). For immediate help, call Lifeline on 13 11 14.

Dawn Barker is the author of Fractured, a novel which looks at the issue of postnatal psychosis.