POST PARTUM DEPRESSION

Stephanie is a mother of three. All her pregnancies and deliveries were uneventful. She went through the post natal period of her first two children without any issues. However after the delivery of her third child, she started feeling very sad, she would cry for unknown reasons, she was constantly worrying about the baby. She thought about ending her life daily even though her life seemed "relatively perfect". In her words

My postnatal depression snuck up on me as a dark shadow, every morning waking up and noticing a heaviness and blackness to my mood. The only 'comforts' were private fantasies about ending it all, running away, escaping my responsibilities, tearing myself to shreds to try and grasp why I felt so bleak."

POST PARTUM DEPRESSION/ POST NATAL DEPRESSION

The birth of a baby can trigger a jumble of powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something you might not expect — depression. Unlike the baby blues (I discussed in my last write-up), postpartum depression is a more serious problem—one that shouldn't ignore. However, it’s not always easy to distinguish between the two.

HOW OFTEN DOES IT OCCUR

Postnatal depression occur in 10–15% of post-partum women usually within 3 months of childbirth.

 Those women who are emotionally unstable in the first week after childbirth are at an increased risk of developing postnatal depression.

Postnatal depression is not associated with social class nor number of children one has.

Common signs of depression

You may go through some of the following. You probably will not experience all of the symptoms

low and sadness

reduced self-esteem

tearfulness for no reason

anxiety particularly about the baby’s health and an inability to cope. 

Mothers may experience reduced affection for their baby which may be expressed as Lack of interest in your baby, Negative feelings towards your baby

Worrying about hurting your baby

Lack of concern for yourself

Loss of pleasure

Lack of energy and motivation

Feelings of worthlessness and guilt

Changes in appetite or weight

Sleeping more or less than usual

Recurrent thoughts of death or suicide

CAUSES

There's no single cause of postpartum depression. It may start for no reason. Physical, emotional and lifestyle factors may all play a role.

Physical changes. After childbirth, a dramatic drop in hormones (estrogen and progesterone) in your body may contribute to postpartum depression. Other hormones produced by your thyroid gland also may drop sharply — which can leave you feeling tired, sluggish and depressed. Changes in your blood volume, blood pressure, immune system and metabolism can contribute to fatigue and mood swings.

Emotional factors. When you're sleep deprived and overwhelmed, you may have trouble handling even minor problems. You may be anxious about your ability to care for a newborn. You may feel less attractive or struggle with your sense of identity. You may feel that you've lost control over your life. Any of these factors can contribute to postpartum depression.

Lifestyle influences. Many lifestyle factors can lead to postpartum depression, including a demanding baby or older siblings, difficulty breast-feeding, financial problems, and lack of support from your partner or other loved ones.

RISK FACTORS 

Postpartum depression can develop after the birth of any child, not just the first. The risk increases if:

You have a history of depression, either during pregnancy or at other times

You had postpartum depression after a previous pregnancy

You've experienced stressful events during the past year, such as pregnancy complications, illness or job loss

You're having problems in your relationship with your spouse or significant other

You have a weak support system

You have financial problems

The pregnancy was unplanned or unwanted

The Impact of Postpartum Depression on Children

Behavioral problems: Children of depressed mothers are more likely to develop behavioral problems down the line, including sleep problems, temper tantrums, aggression, and hyperactivity.

Delays in cognitive development: Development is often delayed in babies and children who have depressed mothers. They may learn to walk and talk later than other children. They may also have many other learning difficulties, including problems with school.

Social problems: Children of depressed mothers have difficulty establishing secure relationships. They may find it hard to make friends in school. They may be socially withdrawn, or they may act out in destructive ways.

Emotional problems: Studies have shown that children of depressed mothers have lower self-esteem, are more anxious and fearful, are more passive, and are less independent.

Depression: The risk of developing major depression early in life is particularly high for the children of mothers with postpartum depression.

TREATMENT 

Self-help for postpartum depression

The best thing you can do if you have postpartum depression is to take care of yourself. The more you care for your mental and physical well-being, the better you’ll feel.

Simple lifestyle changes can go a long way towards helping you feel like yourself again.

Don’t skimp on sleep. A full eight hours may seem like an unattainable luxury when you’re dealing with a newborn, but poor sleep makes depression worse. Do what you can to get plenty of rest—from enlisting the help of your husband or family members to catching naps when you can. 

Set aside quality time for yourself to relax and take a break from your mom duties. Find small ways to pamper yourself, like taking a bubble bath, savoring a hot cup of tea, or lighting scented candles.

Make meals a priority. When you’re depressed, nutrition often suffers. What you eat has an impact on mood, as well as the quality of your breast milk, so do your best to establish healthy eating habits.

Get out in the sunshine. Sunlight lifts your mood, so try to get at least 10 to 15 minutes of sun per day.

Ease back into exercise. Studies show that exercise may be just as effective as medication when it comes to treating depression, so the sooner you get back up and moving, the better. No need to overdo it: a 30-minute walk each day will work wonders.

Lean on others for help and support

Make your relationships a priority. When you’re feeling depressed and vulnerable, it’s more important than ever to stay connected to family and friends—even if you’d rather be alone. Isolating yourself will only make your situation feel even bleaker, so make your adult relationships a priority. Let your loved ones know what you need and how you’d like to be supported.

Don’t keep your feelings to yourself. In addition to the practical help your friends and family can provide, they can also serve as a much-needed emotional outlet. Share what you’re experiencing—the good, the bad, and the ugly—with at least one other person, preferably face to face. It doesn’t matter who you talk to, so long as that person is willing to listen without judgment and offer reassurance and support.

Join a group for new mothers. Even if you have supportive friends, you may want to consider seeking out other women who are dealing with the same transition into motherhood. It’s very reassuring to hear that other mothers share your worries, insecurities, and feelings.

COPING WITH POST-PARTUM DEPRESSION

Find people who can help you with child care, housework, and errands so you can get some much needed rest.

Make time for yourself every day, even if it’s only for 15 minutes. Do something relaxing or that makes you feel good about yourself.

Keep a daily diary of your emotions and thoughts. Let everything out and keep track of your progress as you begin to feel better.

Give yourself credit for the things you’re able to accomplish, even if you only get one thing done in a day. If you aren’t able to get anything done, don’t be hard on yourself.

Give yourself permission to feel overwhelmed.

Remember that no one expects you to be supermom.

Be honest about how much you can do and ask others for help.

PROFESSIONAL TREATMENT

Individual therapy or marriage counseling – A good therapist can help you successfully deal with the adjustments of motherhood. If you are experiencing martial difficulties or are feeling unsupported at home, marriage counseling can be very beneficial.

Hormone therapy – Estrogen replacement therapy sometimes helps with postpartum depression. Estrogen is often used in combination with an antidepressant. There are risks that go along with hormone therapy, so be sure to talk to your doctor about what is best—and safest—for you.

Antidepressants – For severe cases of postpartum depression where you’re unable to care for yourself or your baby, antidepressants may be an option. However, medication use should be accompanied by therapy, and closely monitored by a physician.

POST PARTUM BLUES

POST NATAL/POST PARTUM BLUES
Nike just had a baby after 8 years on waiting on the Lord.She was very happy her prayers had been answered. She bought all sort of baby things. As the first grandchild of both families there was so much fuss about the baby. Come delivery, everything went smoothly. Two days after the baby was born, Nike found herself irritated at the whole world, she sobbed for no reason. Got lost in thoughts. Nike was totally baffled as she was wondering why she wasn't overjoyed about the birth of her child. What Nike did not understand was she may have had post natal blues.

POST NATAL BLUES.
Postpartum simply means after delivery. Post partum blues is a very common thing. It occurs in almost 7 out of every 10 women who just put to bed. Its a bit distressing especially for new mothers who expect to be ecstatic and elated about the newly born. They find themselves tearful, cranky and a bit confused. For those who know, "its that what the heck is all this" you had after your baby. It is different from post partum depression in its intensity and duration. very simply put although not very correct, its a very mild form of depression after you put to bed.

To define it, Postpartum blues is a brief psychological disturbance, characterized by tearfulness, mood swings and confusion in mothers occurring in the first few days after childbirth lasting about 1-2 days. The new mother feels worried about her baby, anxious, unable to concentrate, tired and unable to sleep and tearful for no apparent reason.


HOW OFTEN DOES IT OCCUR?
It occurs in about 50%-75% of women commonest at the third to fifth day post delivery


CAUSES
There is no particular cause.

It is thought to be linked to hormonal changes that happen during the week giving birth. The body gradually returns to pre-pregnancy state.
Postnatal blues has been positively associated with:
1. Poor social adjustment: Having no friend or support system. No one to turn to in need of distress
2. poor marital relationship: difficulty with one's spouse
3. fear of labour
4. anxious and depressed mood during pregnancy.

There is no association between the development of postnatal blues and life events so its not a reaction to stressful things occurring around time of delivery, nor social class or obstetric factors.


HOW LONG DOES IT LAST FOR?
Post natal blues is not an illness. It resolves over a few days.


TREATMENT
There is no treatment per se as it's transient.
What can be done to help a new mother include
Reassuring the mother. Tell her she is a good mum.
Listening to her
Helping her out. In Nigeria, where the mother in law comes to stay as part of tradition, most might be an extra burden because you might have to cook and clean after them
Limit visitors. Its a joyous event but we know most babies are awake at night. A new mother sleeps when the baby is asleep and that is during the day. So visitors interrupt those precious few hours of sleep you get.


N.B
The summary of the medical jargons is post natal blues is very common. About half to two-thirds of all women experience it. So if you find yourself unduly teary, irritable after delivery it might be this.
But post natal blues is transient lasting 1-2days. It lasts less than a week. If you however find yourself feeling this way for a long period of time ( over 2 weeks, please see your doctor)

MYTHS ABOUT MENTAL ILLNESS

MYTHS ABOUT MENTAL ILLNESS

As Africans, we have heard all sorts of myths and folk-tale about almost every topic in life: from pregnancy, to food fads, to mental illness. Unfortunately, myths associated with mental illness is not limited only to Africa. It is widespread and contribute to an age-old stigma, leading many to withdraw into shame and avoid seeking the help they need. 

Today we talk about the common myths and dispel these myths.

Myth 1: “MENTAL illness is a white man’s thing: Africans don’t have it.”

A lot of people still believe this.

This particular myth has two schools of thought within it.

One school, when they say this, really mean that while they believe in the concept of “madness,” they disagree with the idea that this problem is a medical one. As far as they are concerned, psychiatry is white peoples’ attempt to ignore the reality of the spiritual and try to solve spiritual matters with their scientific ideas.

The other side of this myth is that illnesses like anxiety disorders and depression and schizophrenia are due to white’s people over development, and emotional weakness from too much food and good living. To them, strong people, who are dealing with real life issues don’t have time to get depressed or have panic attacks. They have saying like it’s when you have 3 squares meals, light and water that you can then have a mental illness

 Fact: One in every 4 or 5 people have one form or the other of mental disorder. Yes, even right here in Africa.

Myth 2. Mental illness is caused by demons or evil spirits, and the solution is deliverance/exorcism

As Africans, we have been taught to attribute everything to spiritual causes. Mental illnesses are attributed to spiritual attacks by the patient and the respond by fasting and praying. Family members respond by taking the person to (usually in this order: their local church, celestial or some strong Pentecostal church, alfa then some baba in some village then finally maybe a psychiatric hospital). Even when they come for treatment. They come to fulfil some form of righteousness. Let it not be that we didn’t try this one.

Fact: Mental illnesses are due to a combination of factors. There are demonstrable abnormalities in their brains 

Myth 3: People with mental health problems can snap out of it if they try hard enough.

You hear people go snap out of your depression. Read a book. Watch a movie. You will be fine.
Fact:

Mental illnesses are not like bad mood you can snap out of or can be talked out of. There isn’t an on/off switch which allows one turn off the symptoms associated with it. Some mental illnesses especially the mild episodes may have a duration span meaning without treatment, it will run its course and wane over time. So when some people go: I snapped out of mine. I didn’t have to go and see any doctor or take any medication. They might have had a mild episode which ran its course, bearing this in mind, no mental illness should be trivialized. Nothing cuts deeper to someone with depression than when his or her serious condition is trivialized by another who doesn’t understand it. Truth is, depression and other mental illnesses have the ability to kill, so why wouldn’t we take them seriously?

People with mental health can get better, and many recover completely, but most realize their need for intervention at some level.

Myth 4: People with mental illness are violent and unpredictable

Fact:

This is a negative stereotype associated with people with mental illness. THE FACT IS THEY ARE NO MORE VIOLENT THAT YOU AND I. The vast majority of people who are violent do not suffer from mental illness. In our bid to understand some despicable acts of violence, we labels such offenders as having a mental illness. In fact, most violence typically results not from any mental illness but from more commonly shared factors with the general public, such as feeling threatened or excessive use of alcohols or drugs.

Myth 5: Children and teens don’t experience mental health problems

Fact: There is an old belief that children and adolescents are too immature to have a mental illness. It has been found that not only is this false but one in five children and adolescents has a diagnosable mental illness; even very young children may show early warning signs of mental health issues. Children and teenagers however have different clinical presentations from those of adults.

Myth 6: Mental illnesses cannot affect me

Fact: Sorry, but no one is immune. No one is superman. In fact, mental health problems are very common. One in five adults experiences a mental health issue; One in 10 young people experiences a period of major depression, and One in 10 Nigerians will suffer from a serious mental illness, such as schizophrenia, bipolar disorder, or major depression. This means almost every family in Nigeria will have some family member (immediate or extended) with a mental illness (test this but thinking of that uncle or aunty or cousin that it’s been suggested has a mental illness). Mental illnesses do not discriminate; they can affect anyone.

Myth 7: Mental illnesses are brought on by a weakness of character

Fact: Mental illness can strike anyone, at any time, whether you’re “weak” or strong—it knows no bounds. And it has nothing to do with being weak. Some of the strongest people you’ll meet are those who’ve coped with depression or mental illness all their lives. While various factors like the death of a loved one or a job loss can contribute to onset of a mental illness; they are actually due to a combination of various forces: biological, psychological and social factors. Never is a diagnosis of mental illness an accusation of weakness.

Myth 8: People with mental illnesses cannot hold down a job

Fact:  A person with a mental illness can do the same jobs as his well-bodied counterparts. They are actually doing this. There are lots of people with mental illnesses who cope well with their jobs. Realistically, all jobs are stressful to some extent. However, studies show that people with mental illness who find competitive jobs enjoy a higher quality of life. Besides allowing people to support themselves, work is also a powerful form of therapy. This being said there are however a few with more severe illnesses who can’t cope with their jobs. Those ones tend not to cope even with basic activities, so don’t judge anyone. 

LET'S TALK ABOUT DEPRESSION

A depressive disorder is an illness that involves the body, mood, and thoughts. It interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her.

It is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Depression is a common but serious illness, and most people who experience it need treatment to get better. Appropriate treatment, however, can help most people who suffer from depression.

There are various types of depression. The most common types of depressive disorders are

Major depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

Dysthymic disorder, also called dysthymia, involves long-term (two years or longer) less severe symptoms that do not disable, but keep one from functioning normally or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations, and delusions.

Postpartum depression, which is diagnosed if a new mother develops a major depressive episode within one to six months after delivery.

Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer.

Bipolar disorder, also called manic-depressive illness which is not as common as the other depressive illnesses, and characterized by cycling mood changes: severe highs (mania) and lows (depression).

Symptoms

Not everyone who is depressed experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

The symptoms of depression include

·        Persistent sad, anxious, or empty mood

·        Feelings of hopelessness or pessimism

·        Feelings of guilt, worthlessness, or helplessness

·        Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex

·        Decreased energy, fatigue, being "slowed down"

·        Difficulty concentrating, remembering, or making decisions

·        Insomnia, early morning awakening or oversleeping

·        Appetite and/or weight loss, or overeating and weight gain

·        Thoughts of death or suicide, suicide attempts

·        Restlessness, irritability

·        Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain

CAUSES

There is no single known cause of depression. Rather, it likely results from a combination of genetic, biochemical, environmental, and psychological factors.

Research indicates that depressive illnesses are disorders of the brain. Brain-imaging techniques, like magnetic resonance imaging (MRI), show that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite, and behaviour appear to function abnormally. In addition—chemicals (neurotransmitters) that brain cells use to communicate—appear to be out of balance.

Some types of depression tend to run in families, suggesting a genetic link. However, depression can occur in people without family histories of it as well. Research shows that risk for depression results from the influence of multiple genes acting together with environmental or other factors.

In addition, trauma, loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Subsequent depressive episodes may occur with or without an obvious trigger.

Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented.

Once diagnosed, a person with depression can be treated with a number of methods. The most common treatments are medication and psychotherapy.

How to Help Yourself If You Are Depressed

Depressive disorders can make a person feel exhausted, worthless, helpless and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not reflect actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

·        Set realistic goals in light of the depression and assume a reasonable amount of responsibility.

·        Break large tasks into small ones, set some priorities and do what you can, as you can.

·        Try to be with other people and to confide in someone; it is usually better than being alone and secretive.

·        Participate in activities that may make you feel better.

·        Mild exercise, going to a movie or a ball game, or participating in religious, social or other activities may also help.

·        Expect your mood to improve gradually, not immediately; feeling better takes time.

·        It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition—change jobs, get married or divorce—discuss it with others who know you well and have a more objective view of your situation.

·        People rarely "snap out of" a depression. But they can feel a little better day by day.

·        Remember, positive thinking will replace the negative thinking that is part of the depression, and this negative thinking will disappear as your depression responds to treatment.

·        Let your family and friends help you.

How Family and Friends Can Help the Depressed Person

If you know someone who is depressed, it affects you too. The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment. You may need to make an appointment on behalf of your friend or relative and go with her to see the doctor. Encourage him to stay in treatment, or to seek different treatment if no improvement occurs after six to eight weeks.

The second most important thing is to offer emotional support. This involves understanding, patience, affection and encouragement. Engage the depressed person in conversation and listen carefully. Do not dispel feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Report them to the depressed person's therapist. Invite the depressed person for walks, outings, to the movies and other activities. Keep trying if he declines, but don't push her to take on too much too soon. Although diversions and company are needed, too many demands may increase feelings of failure. Remind your friend or relative that with time and treatment, the depression will lift.

FAQs. WHAT'S THE DIFFERENCE BETWEEN A PSYCHIATRIST AND PSYCHOLOGIST?

FAQs. 

ARE YOU A PSYCHIATRIST OR A PSYCHOLOGIST.

What's the difference? 

So in keeping with the series, I'll be answering the one of the most frequently asked questions.

Are you a psychiatrist or psychologist? And what is really the difference between the two. 

Both the psychiatrist and the psychologist have been professionally trained to deal with people with psychological distress or mental illness.

I am a psychiatrist. Who is a psychiatrist? 

A psychiatrist is a trained medical doctor who then goes into specialist training of psychiatry.

So in the Nigerian setting, that's 

6+x years of medical school.

1 year of internship/house job.

1 year of youth service.

Minimum 4 years of specialist training. 

A psychiatrist sees, diagnoses the client and can prescribe drugs for the client. 

Who is a psychologist?

A psychologist is someone who studied psychology in the university and then goes ahead to train as a clinical psychologist. 

4+x years in school.

1 year youth service.

2+x years as a clinical psychologist.

A psychologist is more of the talk therapy. They do not prescribe drugs. 

They both work hand in hand for the progress of the patient. 

2. Are there psychologist in Nigeria (usually after I have explained I'm a psychiatrist). 

The first time I got asked this question, I was about to pass out. Then I realised there is a lack of knowledge concerning mental health. 

There are psychologists available in Nigeria both in the mental health sector and general health sector. 

Ideally every unit in the hospital not just mental health units should have at least a psychologist to help deal with the various issues associated with ill health. A psychologist should be readily available when bad news is broken to a patient or his/her relatives. But I said ideally so that's not the case. 

Psychologists can be found in the centres I listed in the previous post. 

If you have any questions concerning Mental Health, please mail me at mentalhealthadvocacyng@gmail.com

FAQs - WHERE TO SEEK HELP

FAQs - WHERE TO SEEK HELP 

As a mental health practitioner, I get asked various questions about mental health in Nigeria. I'll be doing a series on these frequently asked questions.

1. Q: Where can I or my relative seek mental health care from?

A: There are various government and private centres for mental health care. 

There are mono centres which attend to just mental health. 

These are 

Federal Neuropsychiatric Hospital, Yaba, Lagos.

Federal Neuropsychiatric Hospital, Calabar.

Federal Neuropsychiatric Hospital, Uselu, Benin.

Federal Neuropsychiatric Hospital, Barnawa, Kaduna. 

Federal Neuropsychiatric Hospital, Enugu.

Neuropsychiatric Hospital, Aro, Abeokuta.

There are also psychiatric/ mental and behavioural disorder units in each teaching hospital.  Some federal medical and state/general hospitals have a psychiatrist. So you can also seek care from these places. 

There are various private mental health clinics scattered all over the various states with new ones coming up daily so  I might not be able to list all.

There is a program by the WHO called the MHgap- Mental Health gap which includes Mental Health care into the Primary Health Care system. A pilot has been done in Osun state with a good outcome. Hopefully this will be implemented soon. This will mean Mental Health will be more readily available. 

If you have any questions concerning Mental Health, please mail me at mentalhealthadvocacyng@gmail.com