Postnatal Depression

“I just felt that it wasn’t worth living anymore. In fact I even considered committing suicide, only I didn’t have the guts to do it. I just can’t seem to enjoy or get into the things which I used to like doing. My husband doesn’t understand. He says that I should just pull myself together and get on with my life. I can’t sleep properly, eat properly. I can’t even stand my husband touching me. We haven’t had sex in over two months since I began to feel this way. I used to enjoy going to church but I couldn’t be bothered anymore. Besides, I just feel so tired every day; I can’t lift myself enough to go.”

Jane is in her mid-30′s and has become depressed following the birth of her second child. She is suffering from a depressive illness. It is estimated that 10 – 25% of women and 5 – 12% of men will do so at some point in their lifetime. As a rough estimate, some 1 in 10 people will suffer from a depressive illness in their lifetime. Suicidal thoughts are often dominant and most people who commit suicide do so because of a depressive illness. The good news is that depressive illness is very treatable (as in Jane’s case, who responded very well to antidepressant drugs and counselling). The bad news is that as much as half of those with serious depressive illness do not seek medical help or fail to have it diagnosed.

Depression during pregnancy is common, though fortunately most cases are mild and pass with time. Pregnancy is a time of many changes: changes in looks, changes in one’s body, changes expected in life circumstances with the new addition to the family, etc. Pregnancy is also a significant life event for husbands. The description of major depression after childbirth also applies to that during pregnancy.

Childbirth is often associated with mood changes and “depression after childbirth” refers loosely to the three forms of depression that may result: the “baby blues”, major depression (also called postnatal depression) and puerperal psychosis.

  1. The “Baby Blues”
    This is the most common form of depression after childbirth, affecting 2/3 to 3/4 of mothers. It usually begins in the days after delivery and mums are troubled by mood swings – they may be cheerful and exceedingly happy for a period, only to become tearful, distressed and irritable the next. It usually lasts only a few days and requires no physical treatment as it clears up by itself. It is thought to be linked to the marked physical (hormonal) and psychological adjustments the body makes after childbirth.
  2. Major Depression (Postnatal Depression)
    Major depression is thought to affect about 10% of mothers. It usually appears within six weeks of delivery but sometimes later, and is recognised by the collection of symptoms and signs which persist for longer than two weeks. American psychiatrists call such an illness a “major depressive episode” or “major depression” to differentiate it from the more “minor depressions” of everyday life. It is also called postnatal depression by others. As mentioned above, these conditions respond well to antidepressant medication and/or counselling.
  3. Puerperal Psychosis
    The third and most severe condition is sometimes called puerperal psychosis. A “psychosis” is the term used to indicate a person who is out of touch with reality. This out-of-touch with reality may be manifested by hearing voices (hallucinations), having strange and unusual ideas and odd behaviour. Relatives usually remark that “the person is a very different person and behaves oddly”. About 0.1% of mothers are affected and the majority of these psychoses are manic-depressive ones (hallucinations, unusual ideas and behaviour occurring either with very low mood – depressive psychosis – or very high mood – manic psychosis). More rarely, schizophrenic psychosis, where signs of psychosis are not accompanied by a marked change in mood, may occur. Although comparatively rare, the period after childbirth represents the period of maximum risk of a woman having such a psychotic episode.

This is a higher risk in mothers who have previously had similar episodes after deliveries. Because of the risk to both mother and child (the intensely negative thoughts about self, the baby, the present and the future in depressive psychosis may lead to the mother committing suicide and/or killing the child to “spare the child from misery”), treatment is very important. The great majority of these cases respond very well to physical treatments such as medication and electro-convulsive therapy (ECT).

As mentioned above, the baby blues will pass on their own but the two more severe forms of postnatal depression – major depression and puerperal psychosis – require medical attention. If you have any concerns, there are a number of sources to turn to for help and advice.

  1. Firstly, if you have any concerns, bring them up to your nurse or doctor when you attend the antenatal or postnatal clinic. Your nurse or doctor will be able to advise you further.
  2. Secondly, your family doctor will also be a good source of help and advice.
  3. Lastly, you may wish to consult a psychiatrist (though the majority of cases can be quite adequately handled by the first two sources of help). The Institute of Mental Health/Woodbridge Hospital (IMH) runs a number of clinics in the community. Both the National University Hospital (NUH) and Tan Tock Seng Hospital (TTSH) have psychiatric outpatient facilities too.

  • Postnatal depression is common.
  • The majority of cases will clear up on their own.
  • The more severe cases require professional help and respond very well to treatment.
  • If in doubt, do not delay seeking help or advice from a professional.