Post Natal Depression

Dr 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 & 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 & 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 & 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.

Sepia 

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 

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.

Ignatia 

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.

Pulsatilla 

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.

Recurrence 

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 GP with a private homeopathic  practice.