Mental health issues - OCD, Anorexia and Post-natal Depression.

by laurennn333 (student)

Unit 14 Mental Health IssuesA01 Lauren Cryer

OCD

Definition: Obsessive-compulsive disorder: A psychiatric disorder characterized by obsessive thoughts and compulsive actions, such as cleaning, checking, counting, or hoarding. Obsessive-compulsive disorder (OCD), one of the anxiety disorders, is a potentially disabling condition that can persist throughout a person's life. The individual who suffers from OCD becomes trapped in a pattern of repetitive thoughts and behaviours that are senseless and distressing but extremely difficult to overcome. OCD occurs in a spectrum from mild to severe, but if severe and left untreated, can destroy a person's capacity to function at work, at school, or even in the home.

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OCD is one of the most common mental health conditions. It is estimated that up to 3 in 100 adults and up to 5 in 100 children and teenagers have OCD.

OCD usually starts in early adult life, with men tending to report earlier symptoms than women. However, OCD symptoms can begin at any time, including childhood.

The symptoms of OCD can range from mild to severe. For example, some people with OCD will spend about an hour a day engaged in obsessive compulsive thinking and behaviour. For others, the condition can completely take over their life.

Symptoms of obsessive compulsive disorder

While obsessive compulsive disorder (OCD) is a condition that can affect people differently, it usually causes a particular pattern of thought and behaviour.

Patterns of thought and behaviour

Most people with OCD generally fall into a set pattern or cycle of thought and behaviour. This pattern has four main steps:

Obsession – your mind is overwhelmed by a constant obsessive fear or concern, such as the fear that your house will be burgled.

Anxiety – this obsession provokes a feeling of intense anxiety and distress.

Compulsion – you then adopt a pattern of compulsive behaviour to reduce your anxiety and distress, such as checking that all your windows and doors are locked at least three times before leaving your house.

Temporary relief – the compulsive behaviour brings temporary relief from anxiety, but the obsession and anxiety soon return, causing the pattern or cycle to begin again.

Obsessive thoughts

Almost everyone has unwanted and unpleasant thoughts, such as a nagging worry that their job may not be secure, or a brief suspicion that a partner has been unfaithful. Most people can put these types of thoughts and concerns into context and are able to carry on with their day-to-day lives; they do not repeatedly think about worries that they realise have little substance.

Some common obsessions that affect people with OCD include:

fear of causing harm to yourself or to others through a deliberate action – for example, fear that you may attack someone else even though this type of behaviour disgusts you

fear of causing harm to yourself or to others through a mistake or accident – for example, fear that you may set the house on fire by accidently leaving the cooker on, which leads you to repeatedly check the kitchen appliances

fear of contamination by disease, infection or other unpleasant substance

a need for symmetry or orderliness – e.g. you may feel the need to ensure that all the labels on the tins in your cupboard face the same way

fearof committing an act that would seriously offend your religious beliefs

The majority of these obsessive thoughts have one thing in common they begin from fear.

Compulsive behaviour

Compulsions arise as a way of trying to reduce or prevent the harm of the obsessive thought. However, this behaviour is either excessive or not realistically connected at all. For example, a person with a fear of contamination by dirt and germs may wash their hands 50 times a day, or someone with a fear of causing harm to their family by thinking of disasters may have the urge to repeat an action multiple times to try and ‘neutralise’ the thought of harm. This latter type of ‘magical’, compulsive behaviour is particularly common in children with OCD.

Most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, but they cannot stop acting on their compulsion.

Some common types of compulsive behaviour that affect people with OCD include:

Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.

Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.

Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen or they will be punished.

Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.

Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use.

Causes

The exact cause of obsessive compulsive disorder (OCD) is unknown, but a number of theories have been suggested. These are explained below.

Genetic factors

There is evidence to suggest that OCD may be the result of certain inherited genes (units of genetic material) that affect the development of the brain.

No specific genes have been linked to OCD, but there is some evidence that the condition runs in families. For example, a person with OCD is four times more likely to have another family member with the condition compared with someone who does not have OCD.

An example of this is “I am 12 years old and OCD runs in my family. I have never been to a doctor but my mum is certain I have it. When I am on my computer everything I write must be corrected such as capital letters, spellings. Everything on my side of the room has to be symmetrical and free of dust. i must carry anti-bacterial gel everywhere i go and if I don’t have it I will go home or buy new ones. I have to brush my teeth for a certain amount of time. I count my steps and have to stop on an even number. My writing has to be perfect and straight. This does not particulary affect my life but I can’t not do these things and they may take up lots of my time” 2. ()

Brain abnormalities

Brain imaging studies have shown that people with OCD have abnormalities in some parts of their brain, such as increased blood flow and activity.

The affected areas of the brain deal with strong emotions and the response to those emotions. In the studies, after successful treatment with cognitive behavioural therapy or selective serotonin reuptake inhibitors (SSRIs), the activity in the brain returned to normal.

Infection

There have been reports of some children and young people developing OCD after an infection caused by streptococcal bacteria. It is possible that the antibodies (infection-fighting proteins) produced by the body react with part of the brain and cause OCD.

An example of this is “My daughter was exhibited signs of OCD when he was 15 years old. She had a history of chronic sinus infections and ear infections. She was tested for the strep by the psychiatrist but nothing showed. I find it very interesting that other infectious organisms beside the strep cause the OCD. She is very allergic and I definitely believe that the OCD may very well be an autoimmune response to the many allergens she confronts and the many sinus/ear infections she endured which were treated with 500-775 mg of Augmentin. She has been taking 80 mg of Prozac daily for the past seven years. Her OCD is under control however she does have some anxiety issues. She is a college graduate and has a masters degree. She is employed at a reputable financial firm.” 4. ()

Life events

An adverse life event, such as a bereavement or family break-up, may trigger OCD in people who already have a tendency to the condition – for example, due to genetic factors.

This life event could also affect the course of your condition. For example, the death of a loved one may trigger a fear that someone in your family will be harmed. Stress, which can also be caused by life events, seems to make OCD symptoms worse. However, stress on its own is not a cause of the condition.

This is a preview of the whole essay

An example of this is “I have been a sufferer of OCD since the loss of my Dad when i was in my teenage years, which affected me really badly i have had two nervous breakdowns and since then have had OCD all my life i am now 34yrs of age. I have a lovely and very supportive family but its a continuous struggle. I am on anti- depesenants and will probably never come off them. Most of the time i can control it but if I am anxious it can trigger i know my thoughts will stop and are not really me as its everything i am against. I was relieved that it is a recognised illness and i am not going mad. I don’t like my close family seeing me like this but it’s so hard to deal with it on your own. Reading other people who are also feeling the same is help towards myself feeling better and hopefully others.” 5.()

Family involvement

Your upbringing is not thought to cause OCD. However, some factors could make OCD more likely to develop. For example, having parents who are very overprotective.

It is unhelpful if the family of someone with OCD becomes involved. For example, someone with OCD may ask a family member for constant reassurance about one of their fears, such as whether they have locked the door. If the family member continually reassures them that they did, in order to make them feel better, it may prevent them seeking necessary treatment.

Effects of OCD

Obsessive-compulsive disorder (OCD) can quickly become all-consuming, and even physically disabling. A person may be able to do little else but spend time on the obsessions and compulsions. OCD sufferers often have a very poor quality of life because the condition rules most of their day, and the signs and symptoms are so troubling to friends and family.

With obsessive-compulsive disorder, the person may realize that the obsessions aren't reasonable, and may try to ignore them or stop them. Unfortunately this effort tends to only increase the person's distress and anxiety. Ultimately, the person feels driven to perform compulsive acts in an effort to ease her distress. Despite her efforts, the distressing symptoms of obsessive-compulsive disorder keep coming back. This leads to a vicious cycle of ritualistic behaviour that is characteristic of obsessive-compulsive disorder. It also shows similarities to the cycles seen in persons with bulimia nervosa, who respond to body image distortion with bulimic behaviours of binging and purging.

OCD compulsions can begin in one area of a person's life and spread to others, with the same behaviour patterns:

Treatment of OCD

The usual treatment for OCD is:

Cognitive behaviour therapy (CBT), or
Medication, usually with an SSRI antidepressant medicine, or
A combination of CBT plus an SSRI antidepressant medicine

Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act.

CBT encourages you to talk about:

how you think about yourself, the world and other people
how what you do affects your thoughts and feelings

Cognitive therapy is based on the idea that certain ways of thinking can trigger, or 'fuel', certain mental health problems such as OCD. The therapist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful, and 'false' ideas or thoughts which you have. Also to help your thought patterns to be more realistic and helpful. For example, if you have OCD it may be helpful to understand that thoughts or obsessions in themselves do no harm, and

you do not have to counter them with compulsive acts. The therapist suggests ways in which you can achieve these changes in thinking.

Behaviour therapy aims to change behaviours which are harmful or not helpful. For example, Compulsions. The therapist also teaches you how to control anxiety when you face up to any feared situations. For example, by using breathing techniques.

Cognitive behaviour therapy (CBT) is a mixture of the two where you may benefit from changing both thoughts and behaviours. This is the most common treatment for OCD. A particular variation of CBT called 'exposure and response prevention' is often used for OCD. For example, say you have a compulsion to keep washing your hands in response to an obsessional fear about 'contamination' with germs. In this situation the therapist may gradually 'expose' you to 'contaminated' objects. But, the therapist prevents you from doing your usual compulsion (repeated hand washing) to ease your anxiety about contamination. Instead, the therapist teaches you how to control any anxiety in other ways. For example, by using deep breathing techniques. In time, you should become less anxious about 'contamination' and feel less need to wash your hands so much.

CBTis a mixture of the two where you may benefit from changing both thoughts and behaviours. This is the most common treatment for OCD. A particular variation of CBT called 'exposure and response prevention' is often used for OCD. For example, say you have a compulsion to keep washing your hands in response to an obsessional fear about 'contamination' with germs. In this situation the therapist may gradually 'expose' you to 'contaminated' objects. But, the therapist prevents you from doing your usual compulsion (repeated hand washing) to ease your anxiety about contamination. Instead, the therapist teaches you how to control any anxiety in other ways. For example, by using deep breathing techniques. In time, you should become less anxious about 'contamination' and feel less need to wash your hands so much.

The other treatment in medication, the medication used to treat OCD is SSRI antidepressants Although they are often used to treat depression, SSRI antidepressant medicines can also reduce the symptoms of OCD, even if you are not depressed. They work by interfering with brain chemicals (neurotransmitters) such as serotonin, which may be involved in causing symptoms of OCD.

Anorexia nervosa

Definition: Anorexia nervosa is a psychiatric disorder characterized by an unrealistic fear of weight gain, self-starvation, and conspicuous distortion of body image. The individual is obsessed with becoming increasingly thinner and limits food intake to the point where health is compromised. The disorder may be fatal. ()

Anorexia comes from the Greek word ‘Loss of appetite’ Anorexia Nervosa – loss of appetite due to anxiety. one in two-hundred women are anorexic and 1 in every two- thousand men have anorexia, It most commonly develops from fifteen years onwards BUT it may develop at any age. Despite being an uncommon condition, anorexia is the leading cause of mental health-related deaths.

People with anorexia have problems with eating. They are very anxious about their weight and keep it as low as possible by strictly controlling and limiting what they eat. Many people with anorexia will also exercise excessively to lose weight.

It is thought that people with anorexia are so concerned about their weight because they:

think they are fat or overweight
have a strong fear of being fat
want to be thin

Even when a person with anorexia becomes extremely underweight, they still feel compelled to lose more weight.

Though people with anorexia avoid eating food whenever they can, they also develop an obsession with eating and diet. For example, they may obsessively count the calories in different types of foods even though they have no intention of eating it.

Some people with anorexia will also binge eat, i.e. they eat a lot of food in a short space of time. They then try to get rid of the food from their body by vomiting or using laxatives (medication that causes the bowels to empty; normally used for the treatment of constipation.)

The symptoms of anorexia usually begin gradually, such as adopting a restrictive diet. They then often spiral out of control quickly.

The cause of anorexia is unknown, but most experts believe the condition results from a combination of biological, psychological and environmental factors

The long-term malnutrition associated with anorexia can cause a range of serious complications, such as:

osteoporosis (weakening of the bones)
kidney disease
heart failure

The main symptom of anorexia is losing a lot of weight deliberately. For example, by:

eating as little as possible
making yourself vomit
doing too much exercise

A person with anorexia will want their weight to be as low as possible – much less than the average for their age and height. They are so afraid of gaining weight that they cannot eat normally.

After they have eaten, they may try to get rid of food from their body by making themselves sick regularly. Signs of regular vomiting could include:

leaving the table immediately after meals
dental problems such as tooth decay or bad breath, caused by the acid in vomit damaging their teeth and mouth
hard skin on their knuckles, caused by putting their fingers down their throat

The need to obsessively burn calories usually draws people with anorexia to ‘high-impact’ activities, such as running, dancing or aerobics. Some people will use any available opportunity to burn calories, such as preferring to stand rather than sit.

They may try to make food pass through their body as quickly as possible. For example, by taking:

laxatives (medication that helps to empty the bowel) or
diuretics (medication that helps remove fluid from the body)

Although anorexia means ‘loss of appetite’, people with anorexia nervosa do not usually lose their appetite; they like food and feel hungry.

However, they do not think about food in the same way as other people. This can show itself in various ways. For example, they may:

tell lies about eating or what they have eaten
give excuses about why they are not eating
pretend they have eaten earlier
tell lies about how much weight they have lost
find it difficult to think about anything other than food
spend lots of time reading cookery books and recipes

Someone with anorexia nervosa strictly controls what they eat. For example, by:

strict dieting
counting the calories in food excessively
avoiding food they think is fattening

eating only low-calorie food
missing meals (fasting)
avoiding eating with other people
hiding food
cutting food into tiny pieces – to make it less obvious that they have eaten very little, and to make the food easier to swallow
taking appetite suppressants, such as slimming pills or diet pills

They may also drink lots of fluids that contain caffeine, such as coffee, tea and low-calorie fizzy drinks, as these can provide a low-calorie, short-term burst of energy.

Some people with anorexia also begin to use illegal stimulant drugs known to cause weight loss, such as cocaine or amphetamines.

People with anorexia often believe that their value as a person is related to their weight and how they look. They think other people will like them more if they are thinner, seeing their weight loss in a positive way.

They often have a distorted view of what they look like (their body image). For example, they think they look fat when they are not. They may try to hide how thin they are by wearing loose or baggy clothes.

Many people will also practise a type of behaviour known as ‘body-checking’, which involves persistently and repeatedly:

weighing themselves
measuring themselves, such as their waist size
checking their body in the mirror

Anorexic people usually have low self-esteem or self-confidence. They may withdraw from relationships and become distant from members of their family and friends.

Anorexia can also affect the person’s school work or how well they perform their job.

They may find it difficult to concentrate, and they might lose interest in their usual activities. They may have few interests, even though they seem busier than usual.

Eating too little for a long time can result in physical symptoms, such as:

fine downy hair growing on their body
more hair on their face
their pubic hair becoming sparse and thin

Their heartbeat may be slow or irregular, which can lead to poor circulation. They may also:

have pain in their abdomen (tummy)

feel bloated or constipated
have swelling in their feet, hands or face (known as oedema)
feel very tired (fatigue), as their sleep patterns may have changed
have low blood pressure (hypotension)
feel cold or have a low body temperature (hypothermia)
feel light-headed or dizzy

In children with anorexia, puberty and the associated growth spurt may be delayed. They may gain less weight than expected (if any) and may be smaller than other people of the same age.

Women and older girls with anorexia may stop having their periods (known as amenorrhoea or absent periods). Anorexia can also lead to infertility.

There is no single cause for anorexia. Most experts have argued that the condition is caused by a combination of psychological, environmental and biological factors, which lead to a destructive cycle of behaviour.

A widely accepted model based on these factors is that some people have distinct personality traits that make them more vulnerable to anorexia.

Environmental factors, such as going through puberty or living in a culture where thinness is an ideal, then causes the person to begin a pattern of long-term dieting and weight loss.

The lack of a normal diet has a biological effect on the brain, which helps reinforce the obsessive thinking and behaviour associated with anorexia.

A cycle then begins. The more the person diets, the greater its effect on the brain and the greater the desire to lose weight. This means that symptoms gradually, and then rapidly, get worse.

Each of these factors is explained in more detail below.

Psychological factors

Research has found that most people who develop anorexia share certain psychological factors that help to define their personality and, to some extent, their behaviour. These include:

a tendency towards depression and anxiety
poor reaction to stress
excessive worrying and feeling scared or doubtful about the future
perfectionism – setting strict, demanding goals or standards
inhibition – where a person restrains or controls their behaviour and expression

Feelings of obsession and compulsion (though not necessary ‘full-blown’ obsessive compulsive disorder) – an obsession is an unwanted thought, image or urge that repeatedly enters a person’s mind. A compulsion is a repetitive behaviour or mental act that a person feels compelled to perform.

Environmental factors

The fact that most cases of anorexia develop during puberty suggests that puberty itself is an important environmental factor contributing to anorexia.

It may be that the combination of the hormonal changes during puberty and feelings of stress, anxiety and low self-esteem that many teenagers have during puberty could trigger anorexia.

Another important environmental factor is Western culture and society. Girls (and, to a lesser extent, boys) are exposed to a wide range of different media which constantly reinforce the message that being thin is the only way to be beautiful, and that thinness should be pursued at all costs.

At the same time, magazines and newspapers focus on celebrities' minor physical imperfections, such as gaining a few pounds or having cellulite.

Other environmental factors that may contribute towards anorexia include:

a stressful life event, such as losing a job or a relationship
bereavement
pressures and stress at school, such as exams or bullying
difficult family relationships
physical or sexual abuse

Biological factors

Your brain requires a healthy, nutritious diet to function normally. It uses a fifth of all the calories you eat. So the extreme dieting associated with anorexia can disrupt the normal functions of the brain, possibly making anorexia symptoms worse.

Malnutrition can also change the balance of hormones in the body, which can disrupt the normal functioning of the brain.

There are a number of theories on how the brain may be affected by anorexia. One theory is that the changes mentioned above cause the brain to become very sensitive to the effects of an amino acid called tryptophan, found in almost all types of food.

This sensitivity may then cause feelings of anxiety in people with anorexia when they eat. At the same time, starving themselves and excessive exercise is known to lower levels of tryptophan, which may make the person feel calmer and more relaxed.

Another theory is that the system controlling a person’s sense of appetite becomes disrupted.

Appetite is controlled by a part of the brain called the hypothalamus. When your body needs more food, your hypothalamus releases chemicals, known as neurotransmitters and neuropeptides, which stimulate your appetite.

Once you have eaten enough food, your body will release a hormone called leptin, which signals to your hypothalamus that you have eaten enough food. Your hypothalamus will release a different set of chemicals that essentially reward you for eating, and make you feel satisfied.

It is thought that due to changes in the brain, the ‘appetite-reward pathway’ becomes scrambled in people with anorexia. The feeling of fullness after a meal does not produce a sense of reward, but a sense of anxiety, guilt or self-loathing. In turn, feeling hungry may help to reduce these negative feelings.

Effects of Anorexia

One thing is certain about anorexia. Severe calorie restriction has dire physical effects. When your body doesn’t get the fuel it needs to function normally, it goes into starvation mode and slows down to conserve energy. Essentially, your body begins to consume itself. If self-starvation continues and more body fat is lost, medical complications pile up and your body and mind pay the price.

Some effects of anorexia

Since anorexia involves both mind and body, a team approach to treatment is often best. Those who may be involved in anorexia treatment include medical doctors, psychologists, counselors, and dieticians. The participation and support of family members also makes a big difference in treatment success. Having a team around you that you can trust and rely on will make recovery easier.

Treating anorexia involves three steps:

Getting back to a healthy weight
Starting to eat more food
Changing how you think about yourself and food

Medical treatment for anorexia

The first priority in anorexia treatment is addressing and stabilizing any serious health issues. Hospitalization may be necessary if you are dangerously malnourished or so distressed that you no longer want to live. You may also need to be hospitalized until you reach a less critical weight. Outpatient treatment is an option when you’re not in immediate medical danger.

Nutritional treatment for anorexia

A second component of anorexia treatment is nutritional counseling. A nutritionist or dietician will teach you about healthy eating and proper nutrition. The nutritionist will also help you develop and follow meal plans that include enough calories to reach or maintain a normal, healthy weight.

Counsiling and therapy

Counseling is crucial to anorexia treatment. Its goal is to identify the negative thoughts and feelings that fuel your eating disorder and replace them with healthier, less distorted beliefs. Another important goal of counseling is to teach you how to deal with difficult emotions, relationship problems, and stress in a productive, rather than a self-destructive, way.

Postnatal depression

Definition: Postpartum depression is A form of severe depression after delivery that interferes with daily functioning and requires treatment. It can occur a few days, weeks, or even months after childbirth. A woman with postpartum depression may have feelings of sadness, despair, anxiety, and irritability to a severe degree. Treatment involves counseling and/or medications.

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Postnatal depression is more common than many people realise and often cases may go undiagnosed.

It is estimated around 1 in 7 women experience some level of depression in the first three months after giving birth.

Rates of postnatal depression are highest in teenage mothers and is thought to affect all ethnic groups equally.

Postnatal depression usually develops in the first four to six weeks after childbirth, although in some cases it may not develop for several months.

There are many symptoms of postnatal depression, such as low mood, feeling unable to cope and difficulty sleeping, but many women are not aware they have the condition.

It's common to experience mood changes, irritability and episodes of tearfulness after birth – the so-called baby blues. These normally clear up within a few weeks. But if a woman experiences persistent symptoms, it could well be the result of postnatal depression.

It is important for partners, family and friends to recognise signs of postnatal depression as early as possible and seek professional advice.

Key symptoms are:

a persistent feeling of sadness and low mood
loss of interest in the world around you and no longer enjoying things that used to give pleasure
lack of energy and feeling tired all the time ()

Other symptoms can include:

disturbed sleep – such as not being able to fall asleep during the night () and then being sleepy during the day
difficulties with concentration and making decisions
low self-confidence
poor appetite or an increase in appetite (‘comfort eating’)
you become very agitated or alternatively you become very apathetic (can’t be bothered)
feelings of guilt and self-blame
thinking about and

Postnatal depression can interfere with your day-to-day life. Some women feel unable to look after their baby, or feel too anxious to leave the house or keep in touch with friends.

Frightening thoughts

Some women who have postnatal depression get thoughts about harming their baby. This is quite common, affecting around half of all women with the condition. You may also have thoughts about harming or killing yourself. These thoughts do not mean you are a bad mother, and it is very rare for either mother or baby to be harmed.

However, it is vital you see your GP if you have these or other symptoms of postnatal depression. Treatment will benefit both your health and the healthy development of your baby, as well as your relationship with your partner, family and friends.

Seeking help for postnatal depression does not mean you are a bad mother or unable to cope.

Spotting the signs in others

Many mothers do not recognise they have postnatal depression, and do not talk to family and friends about their true feelings.

It's therefore important for partners, family members and friends to recognise signs of postnatal depression at an early stage. Warning signs include:

they frequently cry for no obvious reason
they have difficulties bonding with their baby
they seem to be neglecting themselves – for example, not washing or changing clothes
they seem to have lost all sense of time – often unaware if ten minutes or two hours have past
they lose all sense of humour and cannot see the funny side of anything
they worry something is wrong with their baby, regardless of reassurance

If you think someone you know has postnatal depression, encourage them to open up and talk about their feelings to you, a friend, GP, or health visitor.

Postnatal depression needs to be properly treated and isn't something you can just snap out of.

Postnatal psychosis

A rarer and more serious mental health condition that can develop after birth is known as postnatal psychosis, thought to affect around 1 in a 1,000 women after giving birth.

Symptoms of postnatal psychosis include:

– feeling depressed one moment and very happy the next

believing things that are obviously untrue and illogical (delusions) – often relating to the baby, such as thinking the baby is dying or that either you or the baby has magical powers
seeing and hearing things that are not really there () – this is often hearing voices telling them to harm the baby

The cause of postnatal depression is not completely clear. Most experts think postnatal depression is the result of a combination of things.

These may include:

depression during pregnancy
a difficult delivery
lack of support at home
relationship worries
money problems
having no close family or friends around you
physical health problems following the birth, such as (loss of bladder control), or persistent pain from an or a forceps delivery

Even if your life is free of these types of problems and you had a straightforward pregnancy or labour, simply having a baby can be an extremely stressful and life-changing event that can trigger depression.

People often assume they will naturally adapt to parenthood overnight. But it can take months before people begin to cope with the pressures of being a new parent. This is true even for those who already have children..

In addition some babies are more difficult and demanding than others, and do not settle so easily. This can lead to exhaustion and stress.

Who's at risk

Factors which can increase your risk of postnatal depression include:

a family history of or postnatal depression (genetics appears to play a role in both of these conditions; but exactly what type of role is still unclear)
you experienced depression or postnatal depression previously, or other mood disorders such as

The role of hormones

Huge changes in hormone levels during and after pregnancy were once thought to be the sole cause of postnatal depression. This is no longer thought to be the case, although hormonal changes may still play a part.

One theory is some women are more sensitive to the effects of falling hormone levels after the birth. All mothers will experience hormonal changes but only some mothers will be affected emotionally.

The most important first step in managing postnatal depression is recognising the problem and then taking action to deal with it. The support and understanding of your partner, family and friends can play a big part in your recovery.

However, to benefit from this, it is important for you to talk to those close to you and explain how you feel. Bottling everything up can cause tension, particularly with your partner, who may feel shut out.

Support and advice from social workers or counsellors can be helpful. Self-help groups can also provide good advice about how to cope with the effects of postnatal depression, and you may find it reassuring to meet other women who feel the same as you.

Ask your health visitor about the services in your area.

Exercise

Exercise has been proven to help depression, and is one of the main treatments if you have mild depression.

Your GP may refer you to a qualified fitness trainer for an exercise scheme or you can find out more about .

Psychological treatments

Psychological therapies are usually recommended as the first line treatment for mild to moderate postnatal depression for women with no previous history of mental health conditions.

Some widely used psychological treatments are discussed below.

Guided self-help

Guided self-help is based on the principle that your GP can ‘help you to help yourself’.

For example your GP can provide self-help manuals detailing types of issues you might be facing and practical advice on how to deal with them. They also contain information on using cognitive behavioural techniques to help combat feelings of helplessness (see below for more information).

Your GP may also give details about an interactive computer programme, available via the internet, called ‘Beating the Blues’. This again takes a cognitive behavioral approach to battling depression.

Talking therapies

Talking therapies are where you are encouraged to talk through problems either one-to-one with a counsellor or with a group.

You can then discuss ways to approach problems in a more positive manner.

Two widely used talking therapies used in the treatment of postnatal depression are:

cognitive behavioural therapy
interpersonal therapy

Cognitive behavioural therapy

(CBT) is a type of therapy based on the idea that unhelpful and unrealistic thinking leads to negative behaviour.

CBT aims to break this cycle and find new ways of thinking that can help you behave in a more positive way.

For example, thinking there is a perfect ideal of ‘motherly behaviour’ is both unrealistic and unhelpful. All mothers are human and humans make mistakes. It is neither necessary nor helpful to try and be “Super Mum”.

CBT is usually provided in 4-6 weekly sessions.

Interpersonal therapy

Interpersonal therapy (IPT) aims to identify whether your relationships with others may be contributing toward feelings of depression.

Again, IPT is usually provided in 4-6 weekly sessions.

Antidepressants

The use of antidepressants may be recommended if:

you have moderate postnatal depression and a previous history of depression
you have severe postnatal depression
you have not responded to counselling or CBT, or would prefer to try tablets first

A combination of talking therapies and an antidepressant may be recommended.

work by balancing mood-altering chemicals in your brain. They can help ease symptoms such as low mood, irritability, lack of concentration and sleeplessness, allowing you to function normally and helping you cope better with your new baby.

Contrary to popular myth, antidepressants are not addictive. A course usually lasts six to nine months.

Antidepressants take two to four weeks to start working, so it is important to keep taking them even if you do not notice an improvement straight away. It is also important to continue taking your medicine for the full length of time recommended by your doctor. If you stop too early, depression may return.

Between 50 and 70% of women who have moderate to severe postnatal depression improve within a few weeks of starting antidepressants. However, antidepressants are not effective for everyone.

Antidepressants and breastfeeding

The (SSRI) types of antidepressants are usually recommended for women who are breastfeeding.

Tests have shown the amount of these types of antidepressants found in breast milk is so small it is unlikely to be harmful.

Side effects of SSRIs include:

feeling sick
blurred vision
or constipation
feeling agitated or shaky,
(not sleeping well) or feeling very sleep

These side effects should pass once your body gets used to the medication.

Discuss feeding options with your GP when you're making decisions about taking antidepressants.

Many mothers are keen to continue breastfeeding because they feel it helps them to bond with their child and boosts their self-esteem and confidence in maternal abilities. These are important factors in combating symptoms of postnatal depression.