From: MHM Journal - Volume 6, Issue1

Many people know about Post-Natal Depression, but how many know it can occur even before the baby is born? In these cases, knowledge is the power to save patients

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I could feel the judgement burning into my forehead like a scarlet letter D as I lapped the hospital corridors... I had no cast, no crutches, no IV stand trundling alongside me. And yet I was ill. It was a daily fight against the disease.I was 18 weeks pregnant and hospitalised for Peri-Natal Distress. This is my story.

HOW DID THIS HAPPEN?

When I fell pregnant with our third (planned) baby, my husband and I were over the moon. I had adored my two previous pregnancies because, after the morning sickness subsided at around 12 weeks, I felt beautiful, blissful, and radiant.

So this time around, when I found myself sinking into a state of increased darkness and fear, I was confused and distressed. At first I was ashamed and tried to hide what I was going through, afraid of the judgment of others. I told myself it would pass, but instead of improving, I got worse. I realised something was very wrong, but I couldn’t put my finger on what it was. This was more than the usual fatigue and moodiness that comes with many pregnancies (including my previous two).It got so bad that I was having major panic attacks and days when I was too terrified to get out of bed, even to take the kids to school. I had horrifying visions and thought I was going insane. That’s when we sought help through SADAG, and I was diagnosed and hospitalised with PND.

SILENT KILLER?

PND is not a terminal illness, but it can be a fatal one. PND can destroy marriages, break up families, wreck careers and, in the most extreme cases, result in suicide and/or infanticide. The challenge with diagnosing PND is that many of its symptoms – such as changes in appetite or sleep patterns – are natural results of pregnancy and early motherhood.

Similarly, many tired expectant or new mums don’t have the time that they used to for personal grooming or hobbies. However, when these symptoms interfere with a woman’s ability to cope with daily life and connect with her child, or include other more ominous indicators (such as those listed in the sidebar), action should be taken to help her immediately.

Neither my OBGYN nor my psychologist (whom I was seeing for work-related issues but with whom I’d also discussed my current state of mind) picked up on my PND. Both are caring, competent professionals, but lacked the information and resources to help me at the time. Under the subsequent care of an informed psychologist-psychiatrist team, I eventually achieved a full recovery. This highlights the importance of making information readily accessible to medical and mental healthcare professionals. If you don’t know what it’s like, how can you help?

Talk to your colleagues, talk to your friends, but most importantly talk to your patients. The more people know about PND, the quicker it can be treated, and the healthier and happier our society will become.

WHAT IS PND?

• What used to be called Post-Natal Depression is now increasingly being re-termed Peri-Natal Distress as the medical fraternity recognises it can occur both during and after pregnancy as both typical depression and/or heightened anxiety.
• Approximately 1 in 3 families is affected by PND in South Africa, according to SADAG. That translates to around 50 000 women per year.
• Although PND is highly treatable and curable, it’s generally under-diagnosed in our society. This means many women struggle unnecessarily, with repercussions that can negatively affect marriages, families, careers and communities.

SYMPTOMS OF PND

Some signs to watch out for in your patients:

• Loss of joy and humour
• Disinterest in things that previously brought them pleasure
• Increased self-criticism
• Anxiety and/or panic
• Not bothering to wash/dress
• Changes in sleep patterns
• Changes in appetite
• Concentration problems or confusion
• Sadness/misery
• Constant exhaustion/lethargy
• Reduced ability to cope with daily life
• Excessive crying
• Feelings of worthlessness
• Thoughts of harming herself and/or her children

A typical diagnostic tool is the Edinburgh PND Scale, available at www.psychology-tools.com/epds Additionally, a full medical evaluation should be conducted to rule out other conditions which can produce similar symptoms (such as infections, tumours, thyroid problems or nutritional defi ciencies).

Lauren Shapiro is a writer who has written a book about her experience in the hope that spreading the word will destigmatise this awful disease so that more women can and will get help.Through the Window: How I Beat PND is available in hardcopy and e-book through www.laurenshapiro.co.za/books It is essential reading for any professionals who care for expectant and new mother