'I didn't want to admit I wasn't coping.' The silent struggle of postpartum depression.

Content warning: This post contains mentions of postnatal depression and mental health some readers may find triggering.

Depression: the black cloud, the black dog, the fog, clinical depression, major depressive disorder… 

Whatever you know it by, you likely will either have experienced it yourself, or known someone who has. Depression is one of the least talked about, but frequently experienced illnesses worldwide.

The perinatal period is when a woman is most likely to develop a mental health condition. Despite all that, there is still such a stigma attached to being diagnosed with depression. As a clinical psychologist, I am passionate about reducing this stigma and encouraging people to talk about and seek help for depression.

It is a devastating but treatable disorder.

For years, Melissa Hopkins suffered in silence from depression. Then she decided to speak up. She tells Mia Freedman about that moment. Post continues after audio.

People tend to think they can ‘tough it out’ or ‘suck it up’ through an episode of depression, but why should we when there is help available? Would we ‘suck it up’ through a chest infection, or would we get to a doctor on the double? We are not embarrassed about having a chest infection. We don’t see it as ‘our fault’. We don’t see it as a sign of weakness, or an inability to cope. Nor should we when it comes to depression.

Depression is something that affects approximately one in six women in Australia at some point in their lives. It’s also the leading cause of disability worldwide. It can be caused by several things – none of which are our fault. Some people have a genetic vulnerability or predisposition to becoming depressed. Depression can also come on as a reaction to a stressful life event or period, known as a stressor. Often it’s caused by a combination of these two factors.

Like any other illness, depression affects us physically as well as mentally. Our sleep, our appetites, our energy levels, and our concentration all suffer. Why, then, are we so hesitant to seek the help we need, or to admit we are depressed? Why don’t we see it as a real illness?

If we broke our arm after having a baby, we would be rushing to gather all the help and support we needed. Likewise, people would be flocking to help us. But with mental health . . . not so much.

Why the stigma? Especially for new mums? A recent study found that 74 per cent of mums did not want to admit that they aren’t coping.

Having a baby is a huge life stressor and can be confusing. What is normal? Where is the line between hormonal/tired/stressed and depressed? We don’t know what we don’t know, and lots of people don’t know the signs and symptoms of depression.

Or they do, but being a new mum is so different from life before baby that feeling different often goes unnoticed.

In the blur that is the first weeks and months of parenting, it can be hard to identify what is wrong, beyond ‘something doesn’t feel right’. Mums might attribute that to sleep deprivation, being busy, or a normal adjustment to parenting. If we don’t know what’s wrong, we can’t seek help.

But it’s not that simple, of course.

There are other reasons we don’t seek help, like unrealistic expectations - both of ourselves, and from the society we live in. Societal expectations on modern new mums are brutal. I love this quote by Bunmi Laditan, blogger and author of The Honest Toddler. I think it sums up modern parenting life brilliantly.

"How to be a mum in 2017: Make sure your children’s academic, emotional, psychological, mental, spiritual, physical, nutritional, and social needs are met while being careful not to overstimulate, understimulate, improperly medicate, helicopter or neglect them in a screen-free, processed-foods-free, GMO-free, negative-energy-free, plastic-free, body-positive, socially conscious egalitarian but also authoritative, nurturing but fostering of independence, gentle but not overly permissive, pesticide-free, two story, multilingual home preferably in a cul-de-sac with a backyard and 2.5 siblings spaced at least two years apart for proper development, also don’t forget the coconut oil."

How to be a mum in literally every generation before ours: feed them sometimes. (This is why we’re crazy.)

Not only do we live under this vox populi, we are also expected to love every minute of it.

Society perpetuates the idea that motherhood should come naturally, that we will be in a state of constant bliss. During my first few weeks as a mum, people would constantly ask, ‘Are you just loving it?’ I’m sure I looked at them like they were crazy. I never replied with what was really in my mind: ‘Nope, not really’ or, on my more sleep-deprived days, ‘Please shut up!’ (Hey, at least I said please.)

Everywhere we go, from social media to random encounters in the supermarket queue, we are bombarded with the message to ‘enjoy every minute, because time goes so fast and they’re only young once’. (I still haven’t worked out if that is a threat or a promise.)

Society forgets that some days, from the new-mum trenches, life doesn’t always feel so wonderful.

It’s okay not to enjoy every minute of parenting. There are a lot of expectations around early motherhood and it can be scary for mums to reach out for the support they need when they feel bad about how they are feeling.

Our fears range from being judged by our peers to, at the far end of the spectrum, having our baby taken away from us because we are ‘not coping’. So, when we do develop a depressive disorder during pregnancy or after having a baby - known as postpartum depression - we often tend to hide it, either because we don’t understand what is happening to us, or because we are ashamed to admit it.

The problem is, when we hide it we get our wish. No one knows we are struggling, including those who need to know about it to help us.

There is another reason people don’t seek support for depression when they need it: a depressed person often puts herself last on her list of priorities. She doesn’t feel worthy of help. This is a lie her mind tells her, a side effect of depression. If this is you, know that you are worthy of care - from others, and also self-care.

Postpartum depression or PPD affects between 10 and 20 per cent of new mothers - no small number. It’s a significant public health problem, particularly apparent in developed countries like Australia. This figure is just those who have come forward and sought help. The number of people suffering is likely much larger.

PPD is like any other clinical depression. The difference is in its onset, not in its symptoms or the way it is experienced, except for the added layer of pressure that is present because the new mum has a new baby in her care.

The onset of PPD is triggered by pregnancy or having a baby. PPD is usually diagnosed within the first few months postpartum - officially, only during pregnancy and the first four weeks postpartum, but many specialist practitioners will extend the diagnosis up to a year postpartum, and sometimes longer. 

PPD is different to the baby blues, which is not an illness but a normal hormonal response, and usually it goes away on its own, not requiring treatment or medication. It usually disappears in the first week or two postpartum. PPD is different: it's a disorder, and it is important to seek help for it.

At its worst, PPD claims lives.

It’s important to note that everyone’s experience of PPD is different, and the symptoms you experience may not look like someone else’s experience of PPD. You may have just a few of the symptoms and not have the others at all. Symptoms of PPD may include the following:

• not behaving ‘like yourself’ 
• a low, very sad mood, perhaps you are crying a lot more than usual 
• feeling overwhelmed, like you can’t or don’t want to be a mum anymore 
• not bonding with your baby 
• feeling guilty 
• feeling angry and irritable a lot, you may even describe it as rage
• feeling disconnected from the people around you
• feeling empty or numb, like you are running on autopilot
• finding it hard to concentrate, make decisions, or function cognitively in general
• increase or decrease in appetite, or significant weight gain or loss (could be either)
• loss of interest in things you used to enjoy
• trouble getting to sleep or staying asleep, or trouble staying awake (could be either)
• loss of energy and feeling fatigued
• loss of motivation to do things
• feeling as if your body is moving too slowly
• thoughts of escape or even of death or dying
• harming yourself on purpose

To meet the criteria for a depressive disorder, some of these symptoms will have been present for you for longer than a couple of weeks. We all have bad days and will have experienced some of these symptoms from time to time, but a diagnosis is only made if it is a persistent problem, not a bad day here and there.

It may be a good idea to chat to a doctor or therapist about PPD. They will assess you and provide you with the help you need.

I wanted to add a point about the first symptom listed - not behaving ‘like yourself’. This will obviously vary person to person. This may mean, for example, if you are someone who has always been very social and extroverted, and suddenly you don’t want to leave the house, that may be a symptom of PPD.

Or, if you were always quite happy in your own company, and an introverted type of person, but suddenly you can’t stand being alone and can’t wait to get out of the house every day then that may be a symptom. Two completely different experiences, but with one thing in common: the person is acting in a way that is not usual for her. 

If you do find yourself feeling ‘not yourself’ or notice any of the other symptoms I've listed, the best thing you can do is to let someone know.

This is an edited extract from Beyond the Bump by Sally Shepherd ($29.99, Allen & Unwin). It has been republished here with full permission. 

Sally is an experienced clinical psychologist with a passion for and expertise in helping new mums adjust to parenthood and cope with the common challenges associated with the first year postpartum.

If you think you or someone you know may be suffering from depression, contact PANDA – Post and Antenatal Depression Association. You can find their website here or call their helpline – 1300 726 306.