COPING WITH DEPRESSION
The following guidelines are designed to help you cope more effectively with the symptoms of depression.
Loss of interest, slowed activity, lack of energy
When you're depressed, it's often hard to get any enjoyment or pleasure out of things. This can include not getting enjoyment from your baby. As a result, you may have stopped doing things you used to enjoy. Having nothing enjoyable in your life then helps keep the depression going. It often helps to slowly get back into your routine and also to increase the number of things that you enjoy. Your doctor, counsellor or friend can help you.
1. Identify things you used to do regularly and things which you used to enjoy.
Write down the things you did every day (or every week) before you were depressed. Now think about the things you enjoyed doing and those that you wanted to do and write them down too. You might want to talk about these with someone else.
Before becoming depressed:
| My routine activities: | Pleasant acitivities: | Activities I want to do: |
|---|---|---|
| e.g. Grocery shopping | e.g. Going for a walk | e.g. Reading |
2. Plan to gradually increase the routine and pleasant activities.
Once you have identified your daily routine activities and pleasant activities, with the help of your doctor, counsellor or friend, you can slowly bring these into your new routine with your baby and also try to do some of the pleasant activities you enjoy. Choose something you can do with your baby or where there are crèche facilities. At the beginning of each week you can choose activities from your "daily routine" list and "pleasant activity" list and build them into your day.
3. If a task seems too difficult, try breaking it into a series of small steps
Set yourself the goal of completing one step at a time. For example, making a flower bed can be broken down into a number of smaller tasks:
Choose some new plants
Pull out the old plants (need gloves and spade)
Prepare the soil (need compost and fertiliser)
Put in the new plants.
4. Above all reward yourself for your efforts.
Ask others around you to encourage and praise you for each small step you take. Recovering from depression is a bit like learning to walk again after breaking your leg.
Remember, it is important to do these activities even when you do not feel like it.
Getting going again can help you feel better.
Loss of appetite
Eat small portions of food that you particularly like. Drink plenty of fluids, especially fruit juices and milkshakes. Remember that if you are breastfeeding you will need extra calories but make sure these calories are from the right food groups. If you need more information on diet, speak to your health visitor.
Sleeping better
Sleep problems are very common and are usually referred to as insomnia. People can become very distressed when they feel that they are not getting enough sleep and it can be one of the more troubling experiences for depressed and anxious people. It can be particularly distressing when you have had a baby and the thought of sleep seems like a distant luxury.
How much sleep do we need?
The need for sleep varies from person to person and depends also on our age and levels of activity. Studies show that people range between needing 4 hours a night up to 10 hours or more a night. As we get older, our sleep patterns change as babies we can sleep for 17 hours each day whereas in adult life most of us need between 7 and 8 hours a night. Sleep patterns change during pregnancy and after childbirth so that women are able to cope with waking for night feeds. We know that breast milk contains relaxation endorphins which help women to sleep more restfully after night feeds.
What if I dont sleep?
People can become very worried when they feel that they arent getting the amount of sleep that they need and this can make it even harder to fall asleep. The occasional sleepless night has little effect on our physical and mental health but if this becomes quite frequent you will start to feel tired, drowsy and may find yourself dropping off to sleep during the day. This can be very dangerous if you are driving. You will also find it difficult to concentrate and make decisions. It may feel harder trying to look after a baby and family and you may start to feel depressed.
Types of sleep problems
The following information applies if your baby sleeps through the night and you are still unable to sleep. If, however, your baby does not sleep well you should seek advice from your health visitor. Knowing what sort of sleep problem you have can help when it comes to trying to deal with it. (You can tick next to the ones that apply to you):
Getting to sleep (onset insomnia or anxiety) - difficulty with falling asleep is the most common problem that people experience, particularly those with anxiety. It can take several hours for some people to get to sleep but usually the quality of sleep is good when it happens.
Staying asleep - this includes a disturbed sleep pattern, with frequent waking in the middle of the night and difficulty getting back to sleep.
Early morning waking (early-morning insomnia or depression) - this includes waking earlier than desired, sometimes several times during the early morning hours and having difficulty getting back to sleep. This is common in depression.
Poor quality sleep
Not getting enough sleep, sleeping lightly, with restless, disturbed and inconsistent sleep and feeling un-refreshed upon wakening.
What are the causes of sleep problems?
There are a number of reasons why sleep problems can develop. These include:
The natural effects of ageing - as we age we sleep less often and less deeply.
Medical reasons the need to go to the toilet increases in with urine infections
Physiological reasons - pregnancy.
Pain and discomfort such as arthritis or an injury.
Emotional upset following bereavement or loss.
Medication can sometimes interfere with your sleeping patterns.
Depression and low mood - disturbed sleep is common when someone is depressed. It is common for a depressed person to have problems getting to sleep or to wake up early in the morning and then struggle getting back to sleep again.
Stress, anxiety and worry - your sleep can be affected by the way that you feel. If you are stressed or worried about something then you may have difficulty falling asleep because your mind is working overtime.
Surroundings - the environment around us can make a big difference to our sleep. For example, a bedroom that is too hot or too cold, too noisy (perhaps your baby is sharing your room and is a noisy sleeper) or too light and a mattress that is too hard or too soft can affect the quality of our sleep. Sleeping in an unfamiliar place can also affect our sleep.
Unusual or disrupted sleep routines - working shifts that frequently change can affect the pattern of a persons sleep.
Good sleep habits
If your baby sleeps through the night, develop regular sleep times:
Go to bed and get out of bed at about the same time, regardless of how tired you are.
Try not to take naps during the day because naps may make you less sleepy at night. (However, in the first few weeks after the baby arrives and if you are feeding frequently during the night it makes sense to nap during the day if you can. This is a temporary way of coping at this time).
Avoid caffeine, nicotine and alcohol. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can cause waking in the night and interferes with sleep quality. There are other health reasons for avoiding nicotine and alcohol during pregnancy and when young babies/children both for your own health and theirs.
Get regular exercise.
Avoid exercising close to bedtime because it may stimulate you and make it difficult to fall asleep.
Dont eat a heavy meal late in the day. However, a light snack may aid sleep.
Surroundings
Make your sleeping place comfortable by ensuring that it is dark, quiet and the right temperature. If there is too much light try using a sleeping mask. If noise is a problem, try earplugs, a fan or a white noise to cover up the sounds (but only do this if there is another adult around to listen out for the baby).
Pre-sleep routine
Follow a routine to help you relax and unwind before going to sleep, such as reading a book, listening to music or taking a bath.
Use your bed for sleep and sex: - try not to associate your bed with other activities that create arousal such as talking on the phone, reading and worrying. Avoid anxiety arousal just before bedtime (e.g. avoid arguments and challenging tasks).
Do not try to fall asleep - this will only increase your frustration and anxiety. Try saying to yourself I will only concentrate on the relaxing feelings in my body because this paradoxically is an effective way of increasing sleep by giving up trying to fall asleep!
Challenge your worrying thoughts - if you are lying awake for more than 15 minutes, get up and go into another room. Write down your negative automatic thoughts, such as I will never get to sleep, and Ill have an awful day tomorrow and challenge it. Be more realistic if I dont get enough sleep, at the worst, I will feel tired and irritable, but I will be able to cope.
Practise relaxation and breathing techniques. - visualise a relaxing scene or try to make your mind go blank to enhance restfulness.
Dont expect immediate results. Give yourself time to unlearn your disturbed sleeping patterns.
Loss of interest in sex
Seek non-sexual activities with your partner that you still enjoy. It is very common to lose interest in sex at this time. This is not surprising due to the emotional and physical adjustments and all the new demands of motherhood. You can explain to your partner that your loss of interest and affection is a symptom of your depression, not a rejection of him, and that these symptoms will be temporary.
Miserable feelings, unpleasant thoughts
These negative thoughts and feelings tend to focus your attention on things you do not like about yourself or your life. These thoughts also tend to make your problems seem worse than they really are. As well as concentrating on your negative features and experiences, when you are depressed you tend to underestimate your positive characteristics and your ability to solve problems. A number of strategies may help you achieve a more balanced view of things:
Make a list of your three best features - perhaps with the help of a friend or relative. Carry the list with you and read it to yourself whenever you find yourself focusing on negative thoughts.
Keep a daily record of all the small pleasant things that happen and discuss these events with your friends when you see them.
Recall pleasant occasions in the past and plan pleasant occasions for the future (this may best be done in conversation with a friend).
Identify those areas of your life that are positive. When you are depressed it is easy to lose sight of those things that you value in your life. Think about life before depression. What did you value and what was special? Make a list of them.
e.g. Family
Children
Work
Sport
Music
Having identified those areas of your life that are positive, discuss them with your doctor and/or counsellor.
Avoid discussions about your bad feelings. Expressing unreasonable thoughts about yourself is not helpful - solving realistic problems is helpful. Friends may politely interrupt such conversations and redirect the discussion to positive issues or useful problem solving.
Consider alternative explanations for unpleasant events or thoughts. Although your initial explanation may be that you are at fault, rethink these conclusions and write down all other possible explanations for these events or thoughts.
Your health visitor or GP can tell you about how to get information about balancing your thinking.
Dealing with worries and problems
If you find that you are worrying, endlessly turning over your different problems in your head, try putting your worry to a useful purpose. For example, my baby cries all the time, I cant settle him/her, so I must be a useless mother. Pick out one or two problems that seem really important and make a decision to resolve them. You may like to ask a friend to help you.
Sit down with a problem solving sheet (your health worker can provide you with one) and go through the following steps:
Say exactly what the problem (or goal) is.
List 5 or 6 possible solutions to the problem - write down any ideas that occur to you, not merely the 'good' ideas.
Evaluate the good and bad points of each idea in turn.
Choose the solution that best fits your needs.
Plan exactly the steps you will take to put the solution into action.
Review your efforts after attempting to carry out the plan. Praise all efforts. If unsuccessful, start again.
Your health visitor can tell you where to find more information about problem solving techniques.
Dealing with stresses
Depression is more common in people who have had to make major adjustments in their lives during the past year (e.g. death of a loved one, birth of a baby, loss of a job, or moving house). These adjustments may result in continued stress. Over time, this stress may make people vulnerable to depression. Thus, in order to fully resolve the depression and to prevent recurrence it is important to resolve the stress.
The same problem-solving approach described in `dealing with worries' can be used to help you deal with stress. With the help of a friend or your health worker, try to define exactly what aspects of the major change are causing the stress. For example, the birth of a baby is a major adjustment, and the aspects causing most stress for you might be difficulty getting time alone or dealing with disturbed sleep. Then go through the steps outlined above in order to devise a detailed plan to resolve the issue. There are agencies which provide specialist advice and support with particular types of problems - for example, debt or relationship problems. Your health worker may have information about these agencies or you could ask your local Citizens Advice Bureau for their addresses. The Citizens Advice Bureau is listed in the telephone directory.
Not all stresses can be fully resolved. However, there is usually some way of helping you cope better so that the impact of the stress can be reduced. For example, some chronic illnesses cannot be cured, but doing relaxation exercises may help someone to deal with the pain and support groups may be able to provide useful tips for how to live with the condition. Some communications skills, such as assertiveness training, can help people deal better with difficult relationships or situations at work or at home. Your health worker may be able to give you information about these. Many local Colleges of Further Education or Community Schools run day and evening classes in relaxation, yoga and assertiveness skills. Support from friends and family is also very important. Now is the time to ask for and accept support.
SUMMARY
Depression around the time of childbirth affects 10-15% of women
Depression has characteristic symptoms that affect a person's thoughts, feelings, and everyday functioning.
Postnatal depression resolves over time, but without any treatment it can persist past the babys first birthday
Antidepressant drugs help relieve some of the symptoms but take time to work.
Keeping a record of progress
Decide how much you experience each of the following problems. If you have other problems, write them down at the end of the list.
Not at all / Mild / Moderate / Severe
Problem
Feelings of sadness
Loss of interest or pleasure in things you used to enjoy
Lack of energy/tiredness (more than you would expect when looking after your baby)
Poor/disturbed sleep (and unable to sleep when your baby is asleep)
Poor concentration/ forgetfulness
Slowness
Restlessness
Reduced interest in sex
Physical aches/pains
Believing that you are no good
Feelings of hopelessness
Thoughts of harming yourself and/or your baby (death)
Feelings of guilt/self blame
Other problems
You can check your progress by looking back at your answers every couple of weeks.
How to avoid recurrence of depression
It is very important that you follow your doctor's advice
Take your medication as directed without skipping any days
Never reduce or stop taking medication without first talking to your doctor
If you have stopped doing things you used to do, gradually increase what you do and include activities you enjoy
Use the problem solving approach to deal with problems, stresses and worries
Work on identifying your negative thoughts and changing them to positive ones. .
Assess your symptoms regularly and consult your doctor and/or counsellor if you have any problem
FINALLY
Doing the exercises when you are depressed and when you are looking after your baby can be difficult
It might be useful to work through them with a trusted friend or family member.
If you need extra help you can always talk to your doctor and/or your counsellor.
You can overcome your depression
Ask your health worker if you want more information about any of the topics mentioned in this brochure.
