About Me

Kent, United Kingdom
I have the perfect family but still struggle to find the light in the darkness of post-natal depression.

Tuesday, 19 August 2008

Now I'm cross!

But fret not - you're not in for another whinge about people daring to get on with their lives!
I received today courtesy of my doctor sister an interesting review from the British Medical Journal about the treatment of PND.
And it was interesting - there was a bit about a study which stimulated the hormonal changes of pregnancy and birth in women with and without a history of depression and which resulted in depressive symptoms only in women with a history of PND, suggesting perhaps an abnormal sensitivity to "the normal physiological changes of childbirth".
It talked about ways to prevent it, particularly in future pregnancies, which was of course of great interest to me.
But when I got to guidance about how to treat PND I started to get cross.
Apparently, NICE guidelines recommend a stepped care approach, starting with self-help strategies and non-directive counselling. Which would be where the "listening visits" from the health visitor came in.
Then the next step is CBT - cognitive behavioural therapy. That comes BEFORE any form of medication.
Which was totally not my experience. After the listening visits and self-help strategies ("Why don't you meet up with a friend for coffee? Or have a nice bath?" - that sort of thing) didn't work I was immediately sent away with a prescription from my GP - on my first visit to him!
And when I returned to report I wasn't feeling better, still therapy wasn't mentioned and instead I was given a higher dose of happy pills.
It was only after returning again with no improvement despite the higher dose that I was referred to the mental health team and then finally things started moving.
The review could not be any clearer - it says: "Antidepressants are recommended only if the patient declines psychological therapy, if it does not work or if the woman has a history of severe depression." So why did it not happen in my case? Half my degree is in psychology, and I was totally aware that CBT or something similar was what I needed yet it was only months down the line that I was offered any kind of psychological treatment, and even further that I actually managed to access anything remotely helpful.
I know I sound cross, and that's because I am. Not just for me, because bizarrely the act of having to battle with the medical profession to access the help I needed - and deserved - actually helped me focus on getting through everything, but for the legions of women out there who may not have the strength to fight.
I've said it before, I'm sure, but pretty much everything I read about PND rammed home the message that it was treatable and all you had to do was to ask for help and you would get better.
Yet what happens when you ask and the help is not forthcoming? If you're me, you start fighting (this may sound familiar to some of my colleagues...), but if just the physical act of getting out of bed, getting dressed and making it down to the surgery is almost too much to bear then there may not be any energy left to fight.
And when it can take all the courage you have to make the appointment and confess to "failing" as a mother you may not be in a frame of mind to start arguing.
And then there is a very real risk of serious harm to either the mother or her child. The report itself says: "PND needs to be identified and treated promptly and adequately because it can result in a range of lasting adverse outcomes for mother and child."
Unfortunately that was not my experience. I now have to rely on my Wise Mind - identified from the therapy I PAID to access after almost a year of battling - to convince myself that Tasha is not at risk of "lasting adverse affects". But that's another post.
Rant over, btw...

1 comment:

The Muser (aka Beautiful Mama) said...

Hey! I just found your blog through facebook. I too struggled with depression after I had my baby (and during pregnancy) and was also shocked at how hard it was to get help--still! Even after years of publicity on this issue. I knew I was at risk and so had a therapist, but I moved 3 months after the birth and it took a long time to find a new counselor. I ended up on meds, but in conjunction with therapy really, really helped...Glad you found the help you needed too!