For many women, becoming a new mother is synonymous with joy and fulfilment, and despite the anticipated sleep deprivation and meltdowns, mothers are excited to bond with their new little one. But this bond may not happen to all mothers, and some can have difficulty in forming an emotional connection, even going as far as to feel that their new child is a stranger1.
Most of these intense emotions can be attributed to the hormonal changes that happen during birth, but it also means that mothers are at higher risk from suffering extreme mood disorders, and even developing postnatal depression. Many mothers may not know to seek help or understand their newfound emotions, and so their symptoms can get progressively worse, eventually impacting their own mental health, their new baby and family around them. So seeking help as soon as possible is essential to fighting postnatal depression, and with the right support, most women make a full recovery2.
What is postnatal depression (PND)?
Postnatal depression (PND), also called postpartum depression (PPD), is a type of depression that can happen in women after giving birth. In Hong Kong, about one in every ten mothers3 suffer from PND after childbirth.
Those suffering may feel a complex mix of emotions and behavioural changes that at times can be debilitating, heighten anxieties and stress. While PND is most common in women, many men can also develop4 depression, as new responsibilities occur during the postpartum period.
Postnatal depression vs baby blues
PND is sometimes also confused with the ‘baby blues’ (or postpartum blues) — a more common experience felt by women post-birth. While both share similar symptoms, baby blues typically begin within the first two to three days after delivery.
The baby blues should last no more than a few days (even up to two weeks) before it subsides and hormones level out. On the other hand, postnatal depression is more intense, severe and longer-term5. It typically occurs around 2 to 8 weeks after delivery (or even in some cases after a year)6.
This affects 50% of women after delivery and usually occurs 3-5 days after delivery. With family support the symptoms will subside spontaneously in days.
tearfulness, sleeplessness, irritability, mood swings
This affects 10% of women after delivery, risk is increased in women who have had depression in the past or have recently had a stressful life event. It can occur within a year after delivery. Untreated depression can lead to childcare problems and endanger a mother and baby’s life.
persistent low mood, fatigue, irritability, early morning awakening and anxiety, feelings of inadequacy, hopelessness, wish to end her or the baby’s life, physical symptoms of persistent headache, backache, abdominal pain
This is rare and affects less than 1 in 1000 women after delivery. It occurs more frequently in first time mothers and usually occurs within 2 weeks after birth. However in some women the symptoms may become obvious only within a year after birth.
This is a psychiatric emergency and family members who suspect this should contact the accident and emergency department of a government hospital as soon as possible.
Range from depressive symptoms to extreme euphoria, disinhibition, and overactivity. Prominent features to look out for include hearing non-existent voices, bizarre thoughts of being harmed by others, ideas of self or infant harm. Symptoms may be transient and fluctuating, hence difficult for family members to notice.
Signs and symptoms of postnatal depression
Again, feeling the baby blues is normal when you’ve just had a baby. But longer issues can be signs of postnatal depression, which needs immediate treatment. The following is a list of common symptoms of PND:
- Sadness and hopelessness
- Excessive crying
- Withdrawal from friends & family
- Difficulty bonding with the baby
- Sleeping problems
- A loss/increase in appetite
- Feeling guilty and shameful (often alone)
- Desire to harm oneself/harm the baby
- Hard to concentrate and signs of memory loss
There's no single reason why some individuals develop postpartum depression. Many suggest that the leading causes of PND stem from emotional issues brought about through hormonal changes, physical changes and stress. Even though PND can manifest in parents with no history of depression, it’s more likely to develop in parents with a personal history of:
- Family depression
- Depression during pregnancy
- Having a complicated birth/delivery
- Little support from a partner
- Financial stresses
This list is not exhaustive, and not every woman will experience all of the above symptoms. If you’re experiencing symptoms, suspect postnatal depression or anxiety, please talk to a GP or midwife as soon as possible. If left untreated, PND can develop into postpartum psychosis, which is a more serious mental illness.
This list is not exhaustive, and not every woman will experience all of the above symptoms. The following online questionnaire has been shown to be an effective screening test for postnatal depression. If you’re experiencing symptoms, suspect postnatal depression or anxiety, please talk to a GP or midwife as soon as possible. If left untreated, PND can develop into postpartum psychosis, which is a more serious mental illness.
It's important to emphasise that many mother who suffer from postnatal anxiety often neglect to seek help as they don't feel like they have the symptoms of postnatal depression. But in fact, seeking advice and reaching for help is beneficial at all times. If you're unsure about any of your symptoms or emotions, please reach out to a medical professional for advice.
Treatments for postpartum depression
With professional help and support, most women make a full recovery. It’s best to visit a GP or midwife to know which treatment is best for you (as you need to be diagnosed and screened). However, here are some common types of treatments for PND you should be aware of:
Usually recommended as the first line of treatment, it involves the use of guided self-help materials to help identify issues you might be facing and offer practical advice on how to deal with them.
Antidepressants work by balancing mood-altering chemicals in your brain. They ease the symptoms of irritability, low mood, lack of concentration and sleeplessness. Your practitioner may recommend this line of treatment if psychological treatment does not help.
You’ve probably heard the phrase ‘sleep when the baby sleeps’. This advice is rooted in science. A study that looks specifically at the correlation between maternal sleep and depression has highlighted the importance of napping during the day as it lowers the risk for depression.
4. Support group
For some women, it can be extremely beneficial to join a support group. Talking openly and honestly to other mothers who've experienced similar emotions can be a source of comfort and finding a connection with others can help overcome struggles. At our OT&P Family Clinic, we host a postnatal depression support group every other Friday.
Often, a combination of medication and therapy is suggested for patients diagnosed with PND; but treatment will be tailored to an individual’s needs and emotions.
Where to get help in Hong Kong
Postnatal depression can be an uphill battle for overwhelmed new parents when a new baby arrives. Rest assured, however, that you’re not alone; PND can be more common than you think and fortunately, it’s treatable.
It’s essential to seek help as early as possible if you are feeling depressed. In Hong Kong, there are some resources you can reach out to on the phone:
- The Samaritan Befrienders Hong Kong: 2389 2222
- Suicide Prevention Services: 2382 0000
- Social Welfare Department 24-Hour Hotline: 2343 2255
- Hospital Authority Mental Health Direct (24 Hours): 2466 7350
- Family Health Service 24-Hour Information Hotline: 2112 9900
How OT&P Healthcare can help
MindWorX is our dedicated mental wellness clinic with experiences psychologists, psychiatrists and healthcare professionals who are equipped to help with postnatal depression. Our team has also been hosting a support group for PND since 2013. We offer a secure and confidential space for mothers to share their experiences with each other, and we provide practical tools to promote healing.
While postnatal depression is a condition no one wishes for themselves, help is available and never far away.
1. South China Morning Post. 2018. A Mother’S Battle With Postnatal Depression, And How She Overcame It. [online] Available at: <https://www.scmp.com/lifestyle/health-wellness/article/2144284/postnatal-depression-its-causes-symptoms-and-consequences> [Accessed 26 March 2020].
2. nhs.uk. 2018. Postnatal Depression. [online] Available at: <https://www.nhs.uk/conditions/post-natal-depression/> [Accessed 26 March 2020].
3. Centre for Health Protection, 2014. Postpartum Depression: A Public Health Problem. [online] Available at: <https://www.chp.gov.hk/files/pdf/ncd_watch_sep2014.pdf> [Accessed 26 March 2020].
4. University of Nevada, Las Vegas, 2019. Forgotten fathers: New dads also at risk for postpartum depression: Study provides an in-depth look at new fathers' experiences with PPD. [online] ScienceDaily. Available at: <www.sciencedaily.com/releases/2019/03/190307091448.htm>.
5. womenshealth.gov. 2019. Postpartum Depression. [online] Available at: <https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression> [Accessed 26 March 2020].
6. Alhusen, J.L., Alvarez, C. (2016). Perinatal depression. The Nurse Practitioner; 41(5): 50–55.