"It is believed that at the baby's birth a 'guilt chip' is inserted into every mother." This is a quote from a new book about dealing with the depression that can affect one in 10 women either during pregnancy or after the birth of their child. It's a line that's funny enough to raise a smile - unless you're a woman with postnatal depression (PND) who's afraid her depressive symptoms have harmed her baby.
Mothers can feel guilt for lots of reasons, but for a woman with PND it often comes from a fear that her depression will break the mother-baby bond, causing psychological damage to her child as a result, says psychiatrist Gordon Parker, Scientia Professor of Psychiatry at the University of NSW. He is one of the authors of Overcoming the Baby Blues, a new book about coping with depression in pregnancy or after giving birth.
This guilt, along with the stigma that still clings to mental illness, can discourage many women from getting the help they need to get well, he says.
"But even if a mother has depression for the first few weeks or months after the birth, once she's recovered the bond can be restored," he says. "What stops some women from getting treatment is the fear of having the baby taken away if there are doubts about her ability to cope. Yet it's only in extreme cases of mental illness that government services are likely to be called in and while this intervention is rare, it's generally supportive."
PND often comes as a complete surprise, often affecting women who've had no problems with depression before.
"It seems to come out of nowhere but when you take a history you often find that someone in the family had a problem with depression, so there's often a genetic predisposition that loads the gun while hormonal changes in pregnancy fire the bullet," Parker says.
Along with genes, other risk factors include hormonal influences including a thyroid imbalance or being prone to PMS, having a traumatic delivery, and extreme fatigue or insomnia after the birth.
Women who tend to be perfectionist or anxious can also become depressed if life with a new baby feels out of control, he says.
As for women who have experienced depressive episodes before they become pregnant, in Parker's experience they often manage to get through pregnancy without medication - although they're still at risk of developing PND.
"Women often say, 'I'm thinking of getting pregnant - should I stop taking medication?' If they have serious and difficult to treat depressive episodes I'd advise them to stay on it. But with milder depression, my approach is to taper off their medication and only reintroduce an anti-depressant if depression re-emerges," he says.
That's not to say that pregnancy guarantees a good mood that lasts for nine months. Many normal aspects of pregnancy can make women feel down such as lack of sleep, feeling fatigued and trying to adjust to a changing body.
"Women often sleep poorly during pregnancy not because they're depressed but because they're pregnant and poor sleep can lead to depression-like symptoms or increased levels of body chemicals that can cause these symptoms," he says. "So when symptoms of low mood appear in pregnancy it's important to talk to your doctor to find out what's going on. Is it depression, the pregnancy itself or just disturbed sleep?"
Overcoming Baby Blues by Professor Gordon Parker, Kerrie Eyers and Professor Philip Boyce, Allen & Unwin, $27.99
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