Post-natal depression

Jenifer Worden discusses how homeopathy can help women suffering from this distressing condition

The first thing that can be said about post-natal depression (PND) is that to the women who have suffered it and those women reading this article, who may be suffering from it, the effects of PND are distressing, debilitating and are very real.

PND is not uncommon, with up to ten per cent of all mothers affected to a greater or lesser degree. The incidence of PND is higher in the months imme­diately following childbirth but it is not unknown for a small number of women still to be suffering the effects a year after the birth of their child.

PND and its symptoms
PND may be defined as a non-psychotic depression occurring during the first six months after the birth of a child. The term “non-psychotic depression” for the lay person means that the mother does not suffer from hallucinations or delusions. These are the symptoms of a severe mental illness and require urgent specialist medical attention from a con­sultant psychiatrist.

PND, on the other hand, can affect all women after childbirth but more often women who have a history of life events such as bereavements or a poor marital relationship which includes lack of support, feelings of “having to manage on one’s own”, coupled with a general perception of being isolated.

Another factor that adds to the pres­sure of some women who suffer from PND is that the family do not know how to react to the mother who is suffering, so through lack of knowledge and, in some cases, understanding, are dismis­sive of the problems faced by a woman after childbirth. This then creates a fur­ther spiralling of the helplessness some women undoubtedly feel, leading to a sense of inadequacy and not being able to cope, which inevitably leads to in­somnia, anxiety and debility.

Additionally, other symptoms may be present including a difficulty in con­centrating, a loss of confidence and self-esteem, not eating properly due to a lack of interest in food and, in extreme cases, recurring thoughts of death, or even suicide itself. With regards to the latter, it must be stressed that this is a very rare event and it may be that there are other underlying causes for such thoughts.

While the mother is the direct suff­erer of PND, it must not be forgotten that the behaviour of the patient can impact on the family or close loved ones, leading to tensions and stresses within the family group, which in turn re-impacts on the mother. This then becomes a self-perpetuating downward spiral of tension, misunderstanding and depres­sion. Because of the potential devastat­ing effects on the family life overall, it is important that the mother seeks help as soon as possible. It is also not uncommon for a new mother to be in self-denial about her problems but realistically the feelings of inadequacy normally will tell her that all is not well and therefore she should seek professional help.

PND and the working woman
Whilst PND has been recognised for some time as a clinical condition, the effects on the family and society in gen­eral were not so pronounced in the years leading up to the war. However, dur­ing that period, between1940 and 1945, women were conscripted in large num­bers to work in factories, munitions and to serve in the Armed Forces. This new role for women and the changes to society immediately following the war meant that women went to work as mat­ter of course and became de facto a joint, or second bread winner.

It is in this expanded role for women, in a working environment, that she may fear having a baby will in some way compromise her ability to fulfil this role. As a consequence, this can produce seri­ous problems with depression immedi­ately following the birth of the child.

In this context, therefore, the under­lying problems which cause PND are accentuated by economic concerns or the loss of position in a company or a job, should the mother have to take time away from her employment to attend ante­natal classes, hospital appointments and so on. These pressures inevitably bring about a guilt complex whereby the mother is torn between the love and desire for her baby and fulfilling her role as a part­ner in a marriage or relationship.

It must not be assumed that the depression suffered by non-working mothers is any less severe or debilitat­ing than that for women who work. It is only that in the latter case, where sec­ondary considerations may be involved, the depression may be accentuated or intensified.

Seeking help
It is very important for women suffer­ing from PND to understand that they are not alone and help is available in many ways: from counselling, medica­tion and complementary therapies. Firstly with respect to counselling, this can be done informally by the health visitor who can carry out a brief ques­tionnaire to assess a woman’s mental state and then offer appropriate support or non-directive counselling as “active listening visits”. For many women, this will be sufficient to allow a full recov­ery in a matter of weeks.

Secondly, if the symptoms do not subside, medication prescribed by the GP can help but, for those women who are worried about the side-effects of any drug prescribed for depression, there are homeopathic remedies which can be used.

This is very important because, to a large number of people, there is unfor­tunately a stigma about being diagnosed with depression and seeking possible help. It is because of this and of the reported problems associated, rightly or wrongly, with the drugs prescribed to combat depression, that homeopathy can be of such benefit.

Homeopathy and PND
I think it is important to state that when considering a homeopathic approach to the problems of PND, it should always be remembered that homeopathy can do the patient no harm. Indeed, there is a large body of evidence to support the premise that it can make a substantial difference to the sufferer. As a practis­ing NHS GP and with over ten years experience in homeopathy, I am able to look at the problem from both perspect­ives. Therefore, when I have a patient who is unwilling, unhappy or unable to tolerate conventional medication, I then recommend the homeopathic approach. However, before recommending any complementary medicine, I try to deter­mine if there are any underlying social factors which will lead me to advise one treatment rather than another. Generally, I have a choice of four or five homeo­pathic remedies which have helped to bring about a marked improvement in the well-being of the patient.

This is my foremost remedy for PND. It is used essentially for the woman who comes to see me in floods of tears, com­pletely resigned to the fact that she is unable to care for or hold her baby. She thinks she hates the baby and her part­ner, can see no way out of her problems and despairs of recovery. Sleeplessness is a major problem, which leads to fatigue and the vicious circle of sleep deprivation and feelings of inadequacy.

We all know how much worse things seem when we are tired. Even though these women do not want to be with their families, they cannot bear to be alone. They feel cast off from the world around them, a symptom which we refer to homeopathically as being “forsaken”; a word which I feel describes succinctly the way a woman with PND feels about herself. In the midst of this depression, no matter how bad the woman feels, if she can be encouraged to take some exercise or, even better, to go dancing, she is very likely to make a substantial and noticeable improvement with Sepia.

Lycopodium is not always the first rem­edy that I, as a homeopath, think of when considering post-natal depression but patients who exhibit the symptoms of low self-esteem, weeping when sym­pathy is shown and feelings of hope­lessness and despair are those who may benefit from this remedy.

These women may also have a fear of failure, particularly in relation to the stress of their new role as a mother and the change in their responsibilities. Like Sepia, patients who will recover with Lycopodium often feel better in the evening but they do not experience the improvement which exercise and love of dancing usually bring. Women who are helped by this remedy may also have had a history of irritable bowel type symptoms sometime in the past.

Like Lycopodium, Ignatia is a plant-based remedy and is recommended when the mother has a variety of emotional problems. Symptoms can vary widely and may also be contrasting, with the woman sometimes feeling as if she is on an emotional roller-coaster. This can manifest itself with mood swings and impulsiveness.

The woman may also have had unrealistic or romanticised ideas about childbirth and what caring for a small baby would entail. She then finds her­self falling below the high standards that she has set herself and then feelings of guilt arise, leading to depression.

Patients will often try to hide their symptoms, fearing that their child may be taken from them, should they show that they are not coping as well as they think they should. They then endeavour to present a façade that all is well and usually only those who are very close to the mother will be aware of the emotional turmoil she is experiencing.

However, sympathy and a recog­nition of the desperation felt in these circumstances and a recommendation that the mother seeks help can, in itself, be a great therapy.

Widely used by homeopaths for a vari­ety of female hormonal problems, Pulsatilla is sometimes overlooked when it comes to treating the symptoms of PND. Like Sepia, patients who may be helped by taking Pulsatilla will be tear­ful and cry when relating how they feel. However, sympathy makes them feel bet­ter and they often say how crying helps, whereas Sepia patients usually weep without the feeling of any relief from their symptoms. Women who may bene­fit from Pulsatilla tend to be of a softer personality than those being helped by Sepia, and often will seem to be of a more maternal inclination, which is why their feelings of depression are more dif­ficult for them to understand after hav­ing the baby they wanted so badly. Patients who respond to Pulsatilla may also have changeable moods but the swings tend to be less pronounced in those women for whom I would re­commend Ignatia. Overall, Pulsatilla is a remedy for a more gentle type of the patient than the other remedies previ­ously mentioned.

One question I frequently get asked by women who have suffered after the birth of their first child is can it happen again if they have further children?

The short answer is yes; it can, but is far less likely, although the circum­stances under which the second child is conceived will have a large bearing on the mental health of the mother after birth. Factors such as home environ­ment, relationships and lack of support will all have a consequence on whether a woman will face the same, or similar, problems but mothers usually cope much better because they are aware of the problems having faced them once already. However, they should not be frightened to seek help on the basis of “you were like this last time so you must know what it is”.

Finally, what is vital for women suffering from post-natal depression to remember is that you are not alone. As a mother myself, I know how easy it is to feel that somehow you are not wor­thy or adequate. Do not worry, help is available to you from many different sources including counselling, conven­tional medicines and homeopathic reme­dies, so don’t despair and don’t be frightened to ask for help. It is there and available for you.

Jenifer Worden MBChB MRCGP MFHom is a part-time NHS GP in Ringwood, Hampshire and has a private homeopathic practice in Highcliffe, Dorset. She treats patients with a wide range of conditions and across the complete age range.