Motherhood, mental illness and beyond

Posts tagged ‘post-natal depression’

Musings on depression and pregnancy

I read about a study this week that claims women who suffer from depression in pregnancy may pass the illness on to their children. The article in question on the mental health website Black Dog Tribe explains:

Researchers at the National University of Singapore asked 157 pregnant women to answer a questionnaire to ascertain their mental health during the 26th week of pregnancy. Within two weeks of birth their babies were given MRI scans to look at the structure of their brains – in particular the amygdala.
 
It was found that the mother’s level of depression had no effect on its volume. However, researchers found reduced ‘structural connectivity’, or abnormal wiring, in the right amygdala of infants of more depressed mothers. The finding suggests that abnormal amygdala function can be transmitted from mothers to babies before birth.
 
Researchers believe that a history of maternal depression might contribute to a tendency to the life-long increase in the vulnerability to mental illness in children.

Great. Wonderful. Women are already expected to exist in some weird sort of protective bubble while pregnant, constantly threatened with potentially disastrous outcomes for the unborn child if we even think about breaking the rules on eating, drinking, smoking, taking medication, exercising – the list seems endless. But now women must also worry that the state of their mental health may affect that of their child for life.

Don’t get me wrong, the research is interesting (although I would like to see a much larger and more thorough study examine the same question). If these conclusions are upheld then it becomes all the more important that mental health during pregnancy is monitored and the woman supported. But I worry about the impact that the publicity surrounding this study may have on women who are already struggling.

Post-natal depression (PND) is becoming much more prominent in the awareness of both the public and healthcare professionals. Although the media tend to sensationalise any news story where a mother is believed to have PND, it is becoming less stigmatised and pregnant women are usually given literature or at least a chat explaining the warning signs. Far less publicised though is its counterpart, ante-natal depression (AND).

I have suffered from both – PND twice and AND once. They were equally awful and traumatic but at least when I had PND I sort of knew what was going on. It was a “thing”, something I’d been warned about and that my husband had been on the lookout for given my history of depression. But I’d never heard of AND. When I plucked up the courage to tell my midwife how I was feeling it was dismissed as being down to my circumstances (an unexpected and difficult pregnancy, having a toddler, having to move twice in 4 months then claim benefits etc etc). A few weeks later a remarkably unsympathetic GP told me the same.

But I know now that it was AND. The sinking feeling every morning when I woke up still pregnant; the dread that I might miscarry warring with the dread that I might not; the certainty that I was ruining my daughter’s life. Instead of joy I felt disgust whenever the baby moved inside my expanding belly. I felt as though I was infested, occupied by an alien being, but I was rational enough to feel searing guilt as well. What kind of mother was I, to loathe my unborn child? True, the pregnancy was unexpected but we’d always planned to have another child at some point. I couldn’t understand why I felt the way I did but I knew it was wrong. At times I even felt suicidal but I didn’t act on those feelings because, ironically, I didn’t want harm to come to the baby.

Had I been told, back then, that I might be condemning my child to an increased risk of mental illness – well, it may well have tipped me over the edge. Studies like the one described above are necessary but when there is little or no support available for women who may have AND then they could be dangerous. I was so utterly ashamed of how I felt during that pregnancy that I barely spoke of it to anyone, especially after having my concerns summarily dismissed.

Why is PND becoming such a well-known illness but not AND? They’re two sides of the same coin, in my experience. The feelings of worthlessness, despair, shame, guilt and unrelenting misery are the same whichever side of the birth you are. Women and healthcare professionals need to be educated; they need to be taught that like PND, AND is a treatable illness and not a character flaw.

To any woman who’s reading this and is concerned that she may be suffering from ante-natal depression I say: you are not alone. You are not a bad person, nor are you or will you be a bad mother. Talk to someone about how you feel. Don’t be ashamed and certainly don’t worry about what one small study suggests. Far more research needs to be done in this area before the suggestion of a causal link even becomes a real possibility.

As for me, my son is now nearly 2 and is a happy, sunny little fellow. I try not to worry about what the future holds, mental health wise, for either him or his elder sister.

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I am searching

DH starts his new job in 10 days time, leaving me solely responsible for the children for the first time in a year and a half. This is a massive change in our lives and while it’s a positive change it’s also a terrifying one. I am scared, I am nervous and I am cowering. But I am also searching.

I am searching for the woman I used to be.

I am searching for the woman who spent her nights moshing in underground metal clubs.

I am searching for the woman who survived the death of her fiancé at just 19 years old.

I am searching for the woman who worked for the government for 6 years, often working 10 hour days with a 75 minute commute each way.

I am searching for the woman who had the confidence to travel abroad to lecture at an international conference.

I am searching for the woman who survived the loss of her most trusted friend while suicidal with post-natal depression.

I am searching for the woman who managed to take care of her 2 year old daughter while heavily pregnant and suffering from ante-natal depression, with her husband working nights and studying at university during the day.

I am searching for the woman I used to be, the woman who has somehow become lost in a fog of depression, cyclothymia and anxiety. I used to be capable of so much; now even the thought of going out to see friends sends me into a panic.

Somehow I need to remember who I used to be. I need to find my strength, my confidence, my resolve and most of all, my self.

Depression, SSRIs and pregnancy

Today the BBC has reported that according to an adviser for NICE (the National Institute for Health and Care Excellence) women who are fertile should be discouraged from taking SSRIs, a class of anti-depressant. The rather aptly named Professor Stephen Pilling was quoted as saying:

“The available evidence suggests that there is a risk associated with the SSRIs. We make a quite a lot of effort really to discourage women from smoking or drinking even small amounts of alcohol in pregnancy, and yet we’re perhaps not yet saying the same about antidepressant medication, which is going to be carrying similar – if not greater – risks”.

Professor Pilling claims that there is evidence that taking SSRIs in early pregnancy increases the risk of a baby being born with a heart defect from 2 in 100 to 4 in 100. If this is true then of course new guidelines need to be considered. (Having said that, in my experience doctors are already extremely cautious when prescribing any kind of medication to a woman who is pregnant or breastfeeding.) However it is other quotes attributed to him that have infuriated me. According to the BBC article :

He says that women not suffering from the most severe depression who become pregnant whilst taking the drug are taking an unnecessary risk.

“You’ve got double the risk. And for women who are mild to moderately depressed, I don’t think that those risks, in most cases, are really worth taking” he said.

“It’s not just when a woman who’s pregnant is sitting in front of you. I think it needs to be thought about with a woman who could get pregnant. And, that’s the large majority of women aged between 15 and 45.”

First of all the diagnosis of depression is extremely subjective, often relying on the individual answering a multiple choice questionnaire that has points assigned to each answer. If you score above a certain number then bingo! You’re depressed. But what one person interprets as mild depression may be what another person feels is moderate depression. Someone who is severely depressed may not believe they are because they’re not considering suicide.

I’ve had episodes of depression since my early teens, including 2 bouts of post-natal depression (PND) and 1 bout of ante-natal depression (AND). The first time I had PND I refused to take any medication because DD was breastfed and I was scared that the anti-depressants would affect her through my milk. As a result I was severely depressed for a very long time despite various other therapies and I planned my suicide on multiple occasions. I am concerned that if Professor Pilling’s reported opinions become guidelines the same may happen to women who are pregnant.

If, through the media sensationalising this or through poorly worded new guidelines, a pregnant woman is made to feel the way I did it’s entirely possible that she may consider taking her own life (and therefore that of her unborn child). If a woman suffers from depression that requires a particular treatment then she should be given that treatment. At the end of the day, uncomfortable though it is for me to say, the life and wellbeing of the woman is more important than that of her foetus.

Any suggestion otherwise removes a woman’s bodily autonomy, her right to decide what happens to her body. This is dangerously close to a number of anti-abortion laws that have been proposed in the United States, where the supposed rights of the foetus (usually a non-viable foetus) would outweigh the rights of the mother, who is reduced to the status of a mere incubator.

As for Professor Pilling’s apparent suggestion that “pre-pregnant” women (so any woman who is capable of conceiving, and therefore presumably including pubescent girls) might be refused access to SSRIs, it’s ludicrous. Would a doctor refuse a diabetic woman her medication? Or an epileptic woman? Both of these conditions often require medications that can be risky for a foetus yet I doubt that many doctors would recommend their patients stop taking them merely because they might conceive a child.

What are your thoughts?

My inferiority is complex

I always got high grades at school. I played several musical instruments. I went to university and obtained 2 degrees. I had good jobs, first as a forensic scientist and then as an analyst for part of the Foreign Office.

And now here I sit. I am unemployed, unfit to work and living on benefits. My husband is also unemployed at the moment and has been for some time. We have 2 small children whom we manage to feed and clothe adequately (partly thanks to my mother, who pays for their coats and shoes). My husband and I aren’t fed or clothed as adequately – we mainly eat pasta, I’m down to my last pair of jeans and the only shoes I have are an old pair of hiking boots. (At least they’re practical for this never-ending winter! :-)).

So what happened? After the birth of my daughter I was unable to return to work due to a combination of PND and what I now know to be generalised anxiety disorder (GAD). I was eventually dismissed from the job I loved on the grounds of ill health. My husband had lost his job some months earlier, when DD was only a few months old, and so we had no income and no way to pay the mortgage. Eventually the inevitable happened – we were declared bankrupt and our home was repossessed, forcing us to move in with my parents 200 miles away.

After a couple of months we discovered that I was unexpectedly pregnant with DS. We had to move out and start claiming benefits. Fortunately by this time DH was working again but he was made redundant when DS was 6 months old.

My mental health still isn’t good enough for me to work (I have recently been diagnosed with cyclothymia as well as GAD). Degenerative disc disorder means that even if I was mentally fit to work I would be unable to do any job more physical than sitting in front of a computer.

And I am ashamed. Although this situation isn’t my fault, isn’t our fault, I am deeply ashamed of what my life has become. I hate not being able to work, being reliant on the state and my mother’s charity. Every time someone asks me what I do I say brightly “Oh, I’m at home with the children at the moment” as though it was a choice we had made (and of course if money was no object I’d be happy to be a SAHM while the children are young).

Most of my friends are university friends and have good jobs. Many of them are starting to have children of their own and returning to work, something I was unable to do. I hate my weakness in not being able to go back to the job I loved. I feel inferior to those who choose to return to work and inferior to those who have to. I feel inferior to those who are wealthy enough to have one parent at home through choice. In short I feel inferior to just about everyone.

I used to be so confident, so good at what I did and I had a bright future ahead of me. These days I do almost anything I can to stop acquaintances realising the truth of what I am – the double stigma of being mentally ill and living on benefits is too much. I can’t remember the last time we had friends over, or the children had someone round to play – we always go to other people’s houses instead.

Rationally I know that I have little to be ashamed of. This situation isn’t our fault, we do all we can and things will improve one day. But I feel the shame nonetheless, and inferiority has become a part of my identity now. It’ll take a lot to shake it loose.

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