5 Must-do’s When Treating Postnatal Depression

There are various risk factors and predictors that must be considered in each case of postnatal depression

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“There was never a night or a problem that could defeat sunrise or hope.”

– Bernard Williams

After the baby came the world became torturous; a grinding blend of greys and blacks.

For Joanne, hauling herself through each day and night felt like a constant battle against the staggering weight of her own choked feelings.

On our first meeting Joanne told me that while she had long since ceased carrying her daughter, she was still carrying a much heavier burden. A secret leaden burden “like a sob stuck in my heart.”

Joanne was a single mother. Her daughter’s father had done a runner during the early stages of Joanne’s pregnancy. After the birth, it wasn’t long before Joanne’s mother had to move in, because it was evident that Joanne had ‘failed to connect’ with her newly arrived daughter.

“Nights are endless. I just can’t look after the baby”, she mournfully told me.

It wasn’t just the baby’s cries that kept Joanne awake at night. It was the screaming wails of guilt, loneliness and fear. Life, love, humour, and hope had abandoned her, leaving her with a life that was no more than an endless, meaningless list of chores. And sometimes she couldn’t even manage to tick off the first one – getting out of bed.

Each of her infant’s cries seemed to bellow:

“You are no good! You are a failure!“

Joanne had postnatal depression. Her daughter was now nine months old, and she still felt desperately unhappy. Was there any hope for her?

When we help lift postnatal depression we help not only the person suffering with it but also their child and those close to them. Depression has ripple effects, and so does its cure.

Lifting postnatal depression helps not only the person suffering with it but also their child and those close to them Click to Tweet

First, what do we know about it?

Postnatal depression is not the same as ‘baby blues’

Postnatal depression is often viewed as a special subcategory of depression, though it’s hard to see how it differs significantly from the usual clinical depression. But it’s often incorrectly confused with the more common ‘baby blues’.

Many women experience mild mood shifts after giving birth. In fact, according to some sources ⁽¹⁾ over 50% of new mums experience baby blues, typically starting three or four days after birth and lasting about a week. Symptoms include weepiness, irritability, emotional overreactivity and anxiety.

Baby blues is not an illness, but the result of extreme hormonal readjustment after pregnancy. As unpleasant as baby blues can be, at least they are fleeting. Once the chemical readjustment has occurred, the baby blues are gone.

So postnatal depression is distinct from baby blues, and has much more in common with general clinical depression – it just happens to occur during new parenthood. It affects 10 to 15 percent of new mothers.

The symptoms are indistinguishable from any other clinical diagnosis for depression and seem to have much more to do with life context and circumstances and the emotional style of the woman suffering it than any chemical changes.

In fact, the common predictors for postnatal depression are the very same risk factors as those for developing depression at any other stage of life.

Common risk factors and predictors for onset of postnatal depression

Back in 2001 a large meta-analysis of 84 other studies was conducted to ascertain the magnitude and significance of the relationship between postnatal depression and different risk factors ⁽²⁾.

The study determined the following predictors of postnatal depression:

Low self-esteem
Childcare stress (if the mother already has children)
Prenatal general anxiety
Life stress
Inadequate social support
Difficult marital relationship
History of previous depression
Infant temperament (some babies are simply more demanding than others)
Baby blues, which can rock some mothers’ self-confidence to the point where it triggers longer-term depression
Low socioeconomic status
Unwanted and unplanned pregnancy.

As with clinical depression, some clinicians still insist on incorrectly reducing postnatal depression to a chemical aberration. But it’s clear that circumstantial factors and personal psychology are the biggest predictors.

“I feel like such a failure as a mum. And as a partner. That’s why my boyfriend left me when he found out I was pregnant!”

It was as if Joanne was speaking not to me but to herself, and I was sure they were words she’d recited to herself many times before. She also said she had always been “a worrier” and “down on” herself.

It was obvious that Joanne had demonstrated many of the predictors for postnatal depression before she’d even become pregnant. She already had low self-esteem, an unstable relationship, past bouts of depression, low income, and a weak social network.

She also had a big dose of guilt.

Postnatal depression can impact the mother-child relationship, which in turn can affect the child’s emotional and cognitive development and put them at risk of developing emotional and behavioural problems ⁽³⁾. Joanne instinctively knew this – she just didn’t know what she could do about it.

But there was one other thing that wasn’t included in the meta-analysis I mentioned, and looking back, for Joanne it was a significant contributor to her postnatal depression.

Depression and trauma

“I felt like I was going to die!”

Joanne looked terrified when I asked her how the birth was. Even 36 weeks later, describing the birth took her right back.

The birth had been complicated and protracted, though in the end thankfully both she and her new daughter Sophia were physically okay, but Joanne still couldn’t let go of the trauma.

“I get flashbacks to when my waters broke. I was all alone, and I couldn’t even get to a phone. And I have nightmares about the panicked look on the midwife’s face when she frantically called the doctor for help.”

Research has found a clear link between post-traumatic stress disorder and depression. One study found that 44.4% of traumatized patients suffered from comorbid depression one month after the trauma, and 97.3% of those continued to experience symptoms another three months later ⁽⁴⁾.

We can also see that many factors are interrelated. For example, a pre-existing predisposition to stress may in turn produce more unsettled infant behaviour, leading to more stress for the mother.

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Low self-esteem may prevent the mother seeking social support, leading to isolation and more negative rumination. Over time this can easily slide into depression. It’s easy to see how a vicious cycle can result.

Worries about how to cope, rumination, damaged sleep, strains on relationships, guilt about not being a good parent, fear for the welfare of the baby, and even issues with one’s own parents or childhood can all contribute to depression during new parenthood.

With all this in mind, here’s my list of three of the most important aspects of treating postnatal depression.

One: Deal with any trauma

Depression is essentially a stress-driven condition ⁽⁵⁾. Post-traumatic stress disorder generates, of course, a great deal of stress and makes it hard to move on from trauma. This leads to a kind of continual spontaneous regression to traumatic past events.

I helped lift Joanne’s PTSD in our first session using the Rewind method. Afterwards, she could calmly recall the birth with no anxiety. And she was sleeping better too, because she was no longer plagued with nightmares or flashbacks.

Lifting trauma will significantly help lift general stress, but we can help our clients feel better by relaxing more in general ways too.

Two: Lower stress generally

Stress is the fuel that keeps depression going ⁽⁶⁾. So teaching our clients to relax and manage stress can go a long way towards reducing their symptoms.

The stress of depression inhibits the left prefrontal lobe of the brain, which is responsible for feelings of happiness and hope; clear, strategic thinking; and perspective ⁽⁷⁾. So lowering stress can help our clients literally reclaim parts of their mind again. The parts they’ll need to overcome the depression.

We can lower stress partly by helping our clients meet their emotional needs (see Five below) but also directly by teaching them how to relax deeply at least once a day.

Lifting trauma and lowering stress directly can also help provide perhaps the most important ingredient of any effective depression treatment: hope.

Three: Provide hope

Making such a dramatic difference in the first session gave Joanne that most precious of human fuels: hope.

Things could get better and be different – maybe even quite quickly.

My next point is vital.

It’s been found that over-rumination causes and maintains depression, especially when there is no hope. But in people who ruminate a lot but do have hope, the depressive effects of rumination are mitigated ⁽⁸⁾.

Ironically, hoping that an antidepressant drug will work may be the most important factor in whether it helps lift the symptoms of depression or not ⁽⁹⁾.

I would go as far as to say you can’t treat depression effectively without understanding the central role of hope. As practitioners, we can help provide that hope, that most powerful of natural antidepressants. And we can do it in many different ways.

We can use hypnosis to help our clients to not only relax deeply but also sleep better and envisage feeling closer to their child, managing difficult times, and raising their self-esteem.

Depressed mothers often just don’t cut themselves any slack, so we can also help them do that while they learn to hope again.

Four: Remind them they are human!

So many depressed mothers I’ve treated talk through the mouthpiece of their depression. They may have gotten into the habit of ‘all or nothing thinking‘. If they’re not a ‘good’ mother, they must be ‘bad’, or ‘useless’, or ‘a failure’.

We can gently remind them that depressive thinking, is, by definition, biased, and therefore incomplete or inaccurate. It’s only human to feel tired, irritable, and unable to constantly maintain a feeling of emotional connection to others during the stresses of parenthood. At least to some degree.

Once emotional arousal and stress decreases, we can help our clients inhabit their observing self and see the depressive thinking for what it is.

They are only human, and as humans, they need to meet as many of their emotional needs as possible. We can help them do that.

Five: Help them feel complete (or at least a little more so)

When Joanne first came to see me, she was traumatized. She felt alienated from her own daughter. Like the rest of us, she had needs, and many of them weren’t being met. If I could just help her meet some of those needs better, then we could beat that depression faster.

It is vital that we understand human needs, and make a point of looking to see which needs are not being met for our clients and why.

To recap, we all have needs to:

Feel safe and secure day to day
Give and receive attention
Have a sense of control and influence over events in our lives
Feel stretched and stimulated by life to avoid boredom
Have fun and find enjoyment in life
Feel intimate with at least one other human being
Feel connected to and part of a wider community
Have privacy and time to privately reflect
Have a sense of status, a recognizable and appreciated role in life
Have a sense of competence, achievement, and self-esteem
Have a sense of meaning about life and what we do.

Lifting Joanne’s PTSD helped meet her need for feeling more safe and secure and also for a sense of control. Reminding her of her strengths and personal resources helped lift her self-esteem.

Helping her relax gave her the capacity to start feeling love for her daughter and improve her relationship with her mother, which helped re-establish her need for a sense of intimacy. This was helped along by rehearsing her feeling love for her daughter during hypnosis.

I even helped her gain the confidence to start going to the mother and toddler group she had previously abandoned so she could start to fulfil her need for feeling connected to the community and make new friends.

Many factors come into play when considering postnatal depression. Some women have unrealistic expectations of motherhood, and when the ragged rocks of reality shatter the silky utopian dreams of life being ‘perfect’ with a child, living can start to seem more bleak than it really is.

Perfectionists can struggle badly with the chaos of parenting. For others it may be the isolation, sleep deprivation, financial worries, pre-existing low self-esteem or PTSD from actually giving birth that triggers depression.

But whatever the cause, we can help clients help themselves to cope with stresses and make changes to how they live their life both as a new mother and as a rounded human being with varied needs.

Life was still tough for Joanne in some ways, but as her sense of hope strengthened, she began to feel real purpose again. She found she could enjoy, and concentrate on, watching movies and reading once more.

Bit by bit, Joanne was meeting more of her needs when and where she could. And also, by extension, the needs of her daughter Sophia. Life started to feel manageable again.

Towards the end of our work together, she said the words I’d always wanted to hear from her: “I’m a good mum.” And if that wasn’t enough…

“I never knew it was possible to feel so much love for my daughter.”

(Members of Uncommon Practitioners TV can watch me treating a woman who’d previously had severe postnatal depression here)

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About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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