WHY ME, WHY NOW?

There are a number of factors that cause and maintain depression. Each of the factors listed below plays a part in causing depression, and depression also then has an impact on these factors. A vicious cycle of inactivity, low mood, isolation, fatigue and negative thinking can feel like it is spiralling beyond your control. The longer it goes on the more you feel like you cannot get out of the trap. Start somewhere to do something differently and it can help to make you feel a bit more in control and slow down the depressive vicious cycle.

Situation

We know that there are certain factors that make it more likely for a woman to become depressed around the time of childbirth. We know that there is often, but not always, a difficult life situation that triggers depression. We also know that particular situations can make depression worse. Some situations that have been associated with depression include:

• Major life events – particularly around loss, for example, the death of a loved one, job losses and/or relationship breakdowns.

• Limited social contact – being socially isolated is a significant risk factor in depression and being more confined to the home because of a baby’s normal routine can also make you feel isolated.

• Relationship difficulties – unhappiness in our relationships can contribute to the onset and continuation of depression. After having a baby, women may feel their partner is unsupportive or too demanding.

• Job stress – risk factors include friction with colleagues, overwork or job insecurity

• Stress related to physical health – this is particularly associated with chronic conditions and those where the person is in substantial pain. This can also be a problem following a traumatic birth. Some conditions can directly trigger depression and fatigue, e.g., hypothyroidism (where the thyroid gland secretes too little thyroid hormone) and anaemia (where there is a low level of iron in the blood).

Thoughts

Clinical and research evidence has shown that depressed individuals have very particular ways of thinking about themselves, others and the world. These ways of thinking can trigger, and worsen, the experience of depression. Each of us is affected differently by situations, depending on how we think about them.

For example, imagine a phone call that a woman is expecting from a close friend that does not happen. The woman may regard this as evidence that the friend does not want to talk to her and is bored of her talking about her baby and thinks her friend is avoiding her. This person’s mood would then become further depressed and she would not call the friend. She feels hurt, upset and fearful of reaching out to anyone else in case they are also bored of her. She stops going to her mother and baby group. Her thinking is negative and unrealistic and makes her feel more depressed and behave in an avoidant way which does not give her an opportunity to disprove her thoughts. Another woman may be curious about the missed call but think that the friend is busy or has forgotten. They would call the friend themselves to have the conversation that was planned and their mood would be unaffected. This changed thinking has been described as the Negative Triangle. When you are depressed, you can often think negatively about yourself, about life and other people, and about your future.

Emotion

When depressed we can feel not just sad but overwhelmed by feelings of despair. A profound feeling of anxiety and often a sense of impending doom can accompany these depressed feelings. Others feel numb and detached. Some writers talk about this ability to switch off as a way of protecting ourselves against intense psychological pain. In the same way as your thoughts can become unrealistic and negative, your emotions can become extreme and unrealistic too. Sometimes women have emotions about being a ‘bad’ mother and that motherhood does not meet their expectations. There may be feelings of resentment because of the impact of a new baby.

Physiology

Depression can lead to very significant changes in your physical functioning. One of the most important changes is in sleep behaviour. You may be sleeping too much, be waking early, be unable to sleep when the baby is asleep, having broken nights or struggling to get to sleep. If sleep does not restore you, the next day is even harder to face. A vicious cycle of exhaustion, low energy and worry about not sleeping can cause further depression. It is normal to have a disrupted sleep pattern when you have a baby simply because of the baby’s sleep pattern and night feeds. The key is being able to get back to sleep when the baby sleeps between feeds. If you can do this you will feel better. For more information about sleep, please see the section on ‘sleeping better’. The physiological changes of depression make it harder to cope with the demands of life with a baby – and maybe a toddler too! Some people find that antidepressant medication is helpful to lift mood and can help in regaining a better sleep pattern and appetite. The changes in brain chemistry associated with depression have been demonstrated in research. However, we are still not entirely sure what comes first, for example, does depression produce the changes or vice versa. All that we know is that medication can be very helpful. We also know it is even more helpful if you learn cognitive and behavioural techniques. Research tells us that the recovery is more likely to last if you have learnt more coping skills.

Behaviour

Depression can have a big impact on how you behave. It can make you withdraw from your family and friends, stop you taking care of yourself, stop you doing things you used to enjoy and stop you getting on with your daily duties. It can even affect the way you feel about, and your ability to, care for your baby.

Having time to do things you used to enjoy and finding time to do everyday things can be difficult with the demands of a new baby. However, when you have more of a routine in place and have a little more time, not doing things and not having time for yourself can make you feel worse. It can add to your sense of inadequacy and add to the feeling that your life is out of your control.