Dr. Stuart joined Doug on Mornings to discuss perinatal depression, and hope for those who are currently struggling with it.
Dr. Stuart began with the statistics: around 1 in 7 mothers experience it.
“It affects about 10% of mums in high-income countries, and anxiety disorders are actually even higher in that kind of period.”
Depression-Like Symptoms
He said it is essentially a syndrome, that includes symptoms of depression, but becomes quite widespread in the way it impacts mothers.
“For example, they feel worthless, they get upset and tearful at things that shouldn’t normally upset and make them tearful. They can often withdraw from either their family or even from the baby and feel a disconnection, rather than the close connection that you would normally expect.”
It can affect mothers differently, but overall be very challenging.
“For a lot of women, they never actually disclose the symptoms because they feel shame or they’re worried about stigma. They have this underlying belief that they should be coping.”
Dr. Stuart said they have narratives that compare themselves to other mothers.
“I should be able to… I’ve seen my friends do this,” he listed as examples.
Baby Blues vs Perinatal Depression
Dr. Stuart said that the baby blues are fairly common. Around 80% of mothers experience baby blues in the first couple of weeks where they get tearful, mood swings and overwhelm.
“That resolves on its own generally, whereas postnatal depression often comes in a little bit later. It’s more persistent, it’s more severe, and it doesn’t just go away with a good night’s sleep,” said Dr. Stuart.
“Research certainly shows that maternal depression can actually increase over time. And in one Australian cohort, nearly 15% of mums of four years were still suffering from some symptoms of depression.”
Present During Pregnancy
Dr. Stuart explained that we now commonly refer to this syndrome as perinatal depression, rather than post-natal, as it can start in the later stages of pregnancy.
“It’s important that we that we refer to it that way and that we consider it before mums deliver because it can definitely be present,” he said.
Long-Term Effects
Left untreated, perinatal depression can affect both parents long-term. Dr. Stuart implored parents to look for signs early on.
“As doctors, we’re trained to look for these things, but sometimes, all can seem well on the surface, unless you ask the right questions.”
He recalled a patient of his a few years ago – a professional mother and her husband who were extremely pleasant to talk to.
“Something just didn’t feel right with mum. Dad was holding bub, they were sitting just opposite me and they were actually just in for bub to get their vaccinations.”
Dr. Stuart said he looked at the mother and asked, “Are you okay?” She replied, “Yeah,” in a very unconvincing way. When he asked again, she broke down and the father grabbed the baby and waited outside.
“I sat with her for maybe, half an hour, 40 minutes. And she was just in pieces. She just was not coping at all.”
He was able to get her the right treatment and support so that she could do incredibly well.
“Sometimes it’s just about being that human in the room and just saying, “Is everything okay?” Because it doesn’t seem like it is. I’ve definitely picked that up on a few occasions and it sticks with you. I know that’s made a difference to that family.”
What to Look For
He said that sometimes it is intangible, or an “X-factor,” where someone can sense something isn’t quite right.
Asking questions like, “Are you coping okay?” with persistence in that question actually shows that a person cares, according to Dr. Stuart
“If you know somebody well and you think that mum’s not coping well or that dad’s not coping well, ask them and, you know, point them in the right direction,” he said.
How Sleep Contributes
Sleep is a massive and underappreciated driver that can be both a symptom and a cause that becomes a vicious cycle. Dr. Stuart said this is due to sleep quality than sleep quantity.
“Anybody who’s had a kid knows sleep is shot to pieces for the first few months and it can be even longer. That lack of quality sleep is absolutely devastating. It’s legitimately used around the world as a form of torture.”
He encouraged parents not to underestimate the impact poor quality sleep can have on a person’s mental health.
The Depression Scale
The Edinburgh Postnatal or Perinatal Depression Scale is the gold standard measurement around the world that doctors use to assess their patients.
“It’s these 10 questions that essentially cover subjects such as guilt, sleep disturbance, slow energy, loss of pleasure, suicidal thoughts, which are the things that we’re looking at in terms of postnatal depression. So it’s actually quite a sensitive tool.”
Doctors use this scale to track a patient’s wellbeing using a numbered system.
“If it tells me that your postnatal depression is 8 today, and then we come back in a couple of weeks’ time and it’s 14, well things are moving in the wrong direction. Whereas if you start at 23 and it’s down to 16, well we’re moving in the right direction. So really it’s a point in time indicator as to where roughly we’re at, and then when we revisit that in future, we can see whether we’re making progress or not.”
Masking
Due to the guilt that a lot of women feel around perinatal depression, they have an ability to mask it, so that they appear to cope. Doctors understand this is part of the process, and therefore ask the questions that get to the crux of the issue.
“We start probing that quite early on. I generally prepare for it when mum comes in and we have the news that she’s pregnant and we start to build that relationship. And then we send them off, usually around 20 weeks, they’ll go off to the midwives or to an obstetrician in order to finally have the baby.”
He explained that when they return during the early weeks of their baby’s life, doctors use this opportunity to bust myths and break down masks that they can often wear.
Perinatal Depression in Fathers
Dr. Stuart explained that, though controversial, there is evidence that 8-10% of new fathers form depressive episodes around 3-6 months after their baby is born.
“To me, it makes sense that in mums there’s lots of hormones and other things which are having to try and settle down after you’ve delivered a baby. Not to mention the fact that, hey, by the way, here’s a baby, go look after it.”
He emphasised that it is a massive challenge to not only recover from all those wounds and injuries but be thrown into the responsibility of motherhood. He also said there is no comparison between parents, but the statistics show that dads are still affected.
“It is under-recognised that dads in the postnatal space suffer. It is worse for dad and the first child because there is a massive life adjustment where there is suddenly an extra person in the house and a sense of significant additional responsibility.”
Some of the estimates suggest up to 25% of new dads are really struggling with fatherhood and a new lifestyle adjustment.
“Men are more likely to present with anger or irritability, maybe risk-taking behaviour or substance use rather than with the sadness or crying that we can often see with mums.”
He continued, “Lots of dads, and certainly lots of mums don’t even know that it’s a thing. But one of the biggest risk factors for dads, and one of the things that makes me pay attention to dad is actually if mum’s depressed. Because if mum has postnatal depression, that definitely has a negative impact on dad as well.”
Comparison can set an expectation for many parents, but acknowledging the times when they aren’t coping can get them closer to finding the right solutions.
Next Steps
1. It’s Not Baby Blues
Dr. Stuart said the first steps is recognising that you are not dealing with the baby blues.
“It’s much more severe, and there’s a lot of risk factors, but previous mental health problems, a lack of support, relationship difficulties and social isolation, these are all higher risk items.”
2. Don’t Forget About Dad
He implored couples to not forget about the dads in this process.
3. The Solutions
The solutions include a myriad of different treatments such as, psychology, medication, peer support, practical help.
4. The Organisations
He listed a few organisations which are critical in assisting these cases.
The Panda National Helpline
Open Monday to Saturday.
Lifeline on 13 11 14
Open 24-7.
Local GP
He said it is always a good idea to visit your local GP. Ensure they validate your feelings.
“If your GP tells you just to snap out of it, you’re sitting in the wrong office. Go find a better GP.”
Check out the full conversation with Dr. Stuart below.