Postnatal depression: causes, symptoms, and treatment

Postnatal Depression

Kathy is a 27-year-old gravita 2 para 1 mother who came to the clinic with her baby, Molly, for the baby's six-week check up. Kathy's husband Bob told me that Kathy has not been sleeping much. He mentioned that Molly is colic prone and he thought that for this reason Kathy would sleep whenever given the chance, but this is not the case. Kathy is also currently breast-feeding, which should also be making her tired. Bob reported that Kathy cries a lot lately and he has found her numerous times standing over Molly's crib crying. After hearing these initial things from Bob, I think that it sounds like Kathy is suffering from postnatal depression as the signs such as crying and fatigue but being unable to sleep are common signs of postnatal depression.

In talking to Kathy, I wanted to find out if there were other things that could be the cause of her sluggish mood. During our conversation in which I asked questions about her marriage, finances and family and friend support groups, I discovered that her marriage to Bob is stable and that they do not presently worry about finances. Kathy reports that she has an extended family who support her and that she also has friends. Kathy was accompanied as well by her mother Sally who is currently living with the family to help out with the new baby. Sally has stated that she will help out as much as she can and will stay as long as the family needs her to stay.

When I talked to Kathy I noticed that she was quite tearful most of the time. She stated that she was not sad, but rather feeling blue and sometimes ambivalent about the fact that she was a mother. It appeared that her tears are related to a high level of emotion as opposed to feelings of sadness. Kathy also claimed that she worried quite a bit. While this is a common symptom of postnatal depression, Kathy's worries seem to go far beyond worrying about how to do certain things (like bathing, feeding, etc.) as a first time mother. I told Kathy that it was very common for mothers to be quite critical of themselves as first-time mothers in an attempt to normalize her feelings (Williams & Cantwell 2009, p. 20). Many first-time mothers believe that they are not good mothers because they are unsure how to do certain things correctly. I told her that Sally, her own mother, could be of great help in this department as she had obviously raised children successfully. Kathy thus stated that she felt that her mother was better at meeting the needs of Molly. I told Molly that I would like her to keep a notebook of her thoughts and feelings. When she is feeling sad or not good enough, I wanted her to write down what had happened before the incident and what she thought was the basis for her feelings. She said that she would be able and interested in doing that because she wanted to feel better. She stated that she did not like feeling this way. Writing down our feelings, I explained, is often very helpful (Aiken 2000, p. 17) in getting it out of our systems and being able to look at it objectively on the page.

I explained to Sally how important her helping the family was at this time as I sensed that Sally was feeling that her help wasn't appreciated because Kathy so frequently said thank you or took interest in what Sally was doing with the baby. I suggested to Kathy that she should consider seeing a therapist to talk about some of her feelings and I said that I could recommend some good ones if she was ready and willing. She seemed interested at the thought of talking to someone about what she was feeling. I said that I also thought that the doctor may want to do some blood tests just to make sure that everything was running smoothly in her body.

Kathy seemed to be restless as she was moving her hands and feet quite a bit -- another sign that is quite common in postnatal depressive patients. I also noted that there seemed to be some kind of anxiety in Kathy and the anxiety seemed to really be present when we talked specifically about the baby. She seemed hopeless as well in that she repeatedly stated that she feels that she can't do anything right. Anxiety over not knowing exactly how to do things as a first time mother are quite common (Dalton & Holton 2001, p. 45), however, Kathy's anxiety seems to be much more than just that. She reported that her focus had been quite scattered (not being able to focus for more than a minute) and that she is constantly worrying about Molly and her health and safety because of her own lack of concentration. She was worried that she would get distracted and something would happen to Molly. Again, I reiterated that those feelings and being so tired after pregnancy were very common (Kleiman 1994, p. 3).

I inquired about Kathy's family history of mental illness and she stated that there was no history of mental illness in her family. She admitted to seeing a counselor when she was in high school because she worried all the time, but other than that she never sought help from a counselor. I asked Kathy if the way she was worrying now about the baby was along the same lines of how she worried when she was back in high school. Kathy said that she was worrying a bit more now than she did back then and, of course, about different things, but she recalls being overly concerned about everything in high school and the feelings are similar. Kathy states that she even worries about worrying.