When I spoke to the “gynaechiatrist” Dr Michael Craig, a psychiatrist with a background in gynaecology and a particular interest in how hormonal change affects mental health, I had a lot of questions for him, but they all amounted to the same thing. Am I depressed, or just a new mother?
Let’s take a moment to play that game, shall we? It works exactly the same as "pregnant or fat?", “UKIP or fascist?”, where you have to identify whether a quote came from modern Britain or 1930s Europe, and my personal favourite, “man milk or moo milk?” (don’t Google this unless you have a strong stomach). For example: is it normal to feel like my life is worse than before I had a baby? If I feel that I can’t cope and am failing my baby, am I depressed? If I don’t know who I am any more, do I need medication?
While I’m thrilled to be a mother, I’ve had all those thoughts on more than one occasion. Just after my daughter was born, things were particularly bad. I would cry every day, several times a day, and my husband suggested a couple of times that I might be depressed.
Obviously, I didn’t talk to any professionals about this. “Have you bonded with the baby?” asked the health visitor who came to my house in the first week. “Of course!” I said brightly. The actual answer was closer to: “Are you F***ING kidding me? I know I was supposed to love her immediately, but she seems like a stranger. Plus, she frightens me more than anyone I’ve ever met in my life.” But I didn’t say that, because I thought the health visitor might try to take her away from me, and that was unthinkable.
I still wouldn’t trust that health visitor, because she seemed like an idiot. But I trust Dr Craig, a clinical psychiatrist at two London hospitals - the Nightingale, where he has pioneered depression treatments such as repetitive transcranial magnetic stimulation (rTMS), and the Maudsley, where he is clinical lead of the female hormone clinic.
For a start, he understands immediately the unique combination of s*** that a new mother is dealing with. Starting with getting over the shock of childbirth. “I’ve certainly had some women who have come to see me because they’ve been suffering from the consequences of a traumatic labour,” Dr Craig says. “Clearly there are some events which would be stressful for almost anybody, but there are some people who are more vulnerable to post-traumatic stress disorder in the first instance. So if you’ve been slightly depressed in pregnancy or having other social difficulties a traumatic delivery might be the straw that breaks the camel’s back, whereas for other people that particular delivery may not necessarily have led to such significant effects.”
Then there are hormonal changes. I knew about the baby blues, which kick in a few days after the birth, but hadn’t realised that there was a second shift in hormonal levels that can cause a lot of women to experience low mood at around the four to six week mark (which could explain a lot of my tears). “From most research to date done in postnatal depression there does seem to be a subgroup of women who are vulnerable to the change in sex hormones. There’s a big dip in progesterone and oestrogen after birth, and some women are sensitive to the fluctuation,” Dr Craig explains. “But social and environmental factors are also very important, it’s not just due to a hormonal cause. There are very significant factors like not having a supportive partner; housing or financial problems; work issues; the usual things that would be considered stressful.”
But have you ever met a new mother who doesn’t think that her partner could be doing more, or feel that her house is unsatisfactory, or worry about money and career? What sets apart the one in ten women who are estimated to have diagnosable postnatal depression? “The main difference between PND and depression at other times that I see is an increased overlap with anxiety symptoms,” says Dr Craig. “That’s not present in everybody, but it does seem to be a particularly prevalent trademark of PND.”
I reckon there’s a lot to be anxious about when you’re responsible for a tiny, fragile life. However the psychiatrist believes there is a cutoff where that worry goes beyond what’s considered normal: “I think everybody’s felt low and everybody’s felt anxious and everybody understands what those feelings are. But there’s clearly a point that you cross where those feelings and thoughts are beyond what would be considered to be normal. The general way of understanding that is the degree to which that affects your day to day functioning. So if your anxiety is so bad that you can’t even leave the house for a minute for fear of something happening to the baby, you can see how that might slip into more than just being a bit anxious.”
Sleep deprivation is another factor that makes it difficult to diagnose postnatal depression ( “Am I sleep-deprived or losing my mind?” would make a great variation of our game). But overall Dr Craig seems fairly sure about where the line is drawn. “It’s not normal to think about ending your life, or to self-harm. To feel that you’re worthless and useless,” he says. “Lots of people feel that way occasionally, but for most of us after a few days or a week or two the feelings would start to disappear. In people who are depressed, they don’t disappear.”
If you think you might be depressed, Dr Craig advises speaking to a health visitor or GP about it. From here you might be able to get a referral for some CBT treatment (his preferred first option), or in extreme cases medication. There’s also some evidence that taking oestrogen can help, and if you can afford the private Nightingale Hospital, rTMS is available.
This seems like a good moment to point out that having gotten to know my tiny stranger, I do find everything much easier nowadays. I know how lucky I am to be a mum, much as I play up the downsides in this column (if you didn’t laugh at the fact that you peed yourself when you laugh , you’d have to cry. Although come to think of it, I never pee when I cry, so perhaps that option would involve fewer changes of underwear).
Having spoken to Dr Craig, I don’t think I was ever clinically depressed. But more than a year after becoming a mother, I am still coming to terms with it in some ways. There are still questions that pop into my head from time to time that I can’t explain away with hormonal drops or sleep deprivation. Things like, am I happy? Am I getting this right? Could I be working more? Should I be working less? Will my daughter hate me when she’s older because of mistakes I’m making now? Sadly, I’m not sure there’s a doctor who can help me with the answers to these. But the next time I have a baby, if I’m lucky enough to go through all this craziness again, at least I'll know where the line is between down and depressed.