Postnatal Depression: Problems in Diagnosis

In reply to my own last post, in which I quoted a mother saying that postnatal depression was a label slapped onto her natural reaction to the sudden change in her situation, I would like to clarify that I did not mean to dismiss any woman’s experience of postnatal depression. Although it presents a diagnostic challenge to psychiatrists, there is nonetheless an identifiable set of symptoms, which can be experienced as an illness which simply lands on you, however much support you have and however psychologically healthy you have previously been, and which can often be effectively cleared up by anti-depressant medication, along with or even independently from therapy.

While support is definitely a factor — both lack of it, particularly the lack of a supportive partner, but also in some studies the presence of ‘too supportive’ grandmothers — hormones also play a part. They have been particularly associated with the much rarer condition of puerperal psychosis, and the most common condition, the ‘baby blues’, a weepy, low period which often sets in on the third or fourth day after childbirth, but quickly clears. Previous experiences with depression, having a premature or ill baby, having lost your own mother as a child and recent life stresses are also elements which can play a part, according to the Royal College of Psychiatrists. They can create feelings of lowness, irritability, tiredness, guilt, anxiety, panic, inadequacy and being overwhelmed, along with the sleeplessness, lack of appetite and lack of interest in sex, which significantly impair day to day functioning and can be identified as PND when they occur in relation to a new baby.

I myself roughly divide the kinds of PND in my mind between depression due to lack of support and isolation, depression due to infantilisation of the mother by too much ’support’ which undermines the parents’ roles, depression due to an identity crisis, with a sense of the mothers’ self being removed from centre stage and replaced by the baby, strong expectations held by the mother or others around her about her new identity as mother, or body changes, and last but not least depression due to other factors, added to which the stressful situation created by a new baby is the last straw. I also think that PND can be a useful term for explaining a syndrome which can be suffered by new fathers.

I would also add a note of caution about diagnosis — I think due to this overlap between ‘normal’, inevitable feelings and ones which can be significantly changed with help, it is possible that mothers who are tested for PND by the health visitor, as is routine in the UK, may be less likely to be diagnosed if they are very emotionally articulate. If they describe their depressed feelings as present, but explain them and how they consider them to be normal under the circumstances, the health visitor may well concur, and the mothers concerned may not receive the help they are entitled to.