Let's Talk About PPD: Interview with Tina George

Hi Tina, can we start with an explanation of what postpartum depression is exactly?

Postpartum depression (PPD; also called postnatal depression) is similar to normal depression, and can occur during or up to six weeks after pregnancy. It may not be diagnosed immediately, though – that can happen up to a year after the birth.

The symptoms include difficulties with sleep, feelings of worthlessness or guilt, loss of energy or fatigue, impaired concentration or indecisiveness, loss of or no interest in the baby, depressed mood, irritation or anger at yourself or those around you, and recurrent thoughts of death, or suicidal ideation/attempts. Some women also experience anxiety symptoms such as excessive worries and fears, panic attacks, and even physical symptoms like nausea or headaches.

Most importantly, do these symptoms adversely affect your life and relationship with your baby and others around you? After a baby’s arrival, it’s likely your sleep, mood, and concentration will be affected in any case as you adjust to the change, but that doesn’t mean you have PPD. Many women suffer from the “baby blues,” which shares symptoms with PPD, but this is completely normal and resolves within a couple of weeks, especially with support from family, friends, and support groups. With PPD, however, these symptoms persist for much longer.

Is PPD treatable?

Yes! It’s a good idea to seek professional support if you’re struggling to cope on your own – especially if you have suicidal thoughts, or thoughts of harming your baby. The sooner you get help, the quicker the recovery process will be. You’re not weak or incapable if you seek help. It’s the opposite – you’ve recognised a problem, and you’re taking steps to address it.

How is PPD treated?

PPD exists on a spectrum – it can be mild, severe, or anywhere in between. Treatment will vary depending on the severity of the depression.

With milder cases, professional support in the form of psychotherapy may be enough to help, especially if you already have a good support system in the form of family and friends. If you have a really great personal support system, you may not even need professional support (though you shouldn't hesitate to reach out if you want an outsider’s/professional's perspective).

For moderate to severe depression, it’s important to seek professional help as soon as possible. You may be prescribed medication in conjunction with individual psychotherapy. You may also be recommended support groups, which is a great way to connect with other mums who are going through the same thing as you. Support groups can really help validate your experiences, and help you feel less alone.

Where can I find professional help?

There are many avenues to seek help in Singapore.

If you’re a citizen or PR, you can go to a polyclinic and get a referral to KKH (Women’s Mental Wellness Service) or NUH (Women’s Emotional Health Service). You’ll pay subsidised rates, but you may have to wait longer for the first appointment. If you make an appointment as a private patient (just call up the hospitals directly), you may be able to get an appointment quicker, though you’ll have to pay non-subsidised rates.

If you go the hospital route, you can expect to see a psychiatrist for your first appointment. They will continue to see you thereafter, but will also refer you to a psychologist for psychotherapy, and other allied health professionals as needed.

Here are some private clinics you can also consider:

• Silvia Wetherell from More Mindful Me

• Fernhill Clinic

• Tammy Fontana from All in the Family Counselling

You may also be interested in the free Mindful Mums support group. KKH also has a support group for patients at its clinic.

If at any time you have serious thoughts of harming yourself or your baby, you can head straight to the A&E department of any hospital (preferably NUH/KKH), and you’ll be seen as a priority patient.

Does taking medication mean I have to stop breastfeeding? Will I get addicted, or have to take it long-term?

There are lots of options for medications that are compatible with breastfeeding. Make it clear to your doctor that you want to continue breastfeeding, so that they can prescribe the appropriate medication. If you’re seeing a doctor who’s not well-versed in this issue (e.g. a GP), they may not be aware of which medicines are safe for you; in that case, consider seeing a psychiatrist who’s familiar with PPD.

You will not get addicted to these medications; their chemical make-up cannot cause addiction.

It usually takes 2-4 weeks to start seeing effects after taking anti-depressants, so don’t stop taking your medication prematurely. Your doctor will decide on the course that’s best for you; the course of medication will usually last 6-9 months on average, but you won’t have to be on it permanently.

What are the risk factors for PPD? Is there anything I can do to prevent it?

The risk factors for PPD are as follows:

• A previous history of depression/PPD, or other mental illnesses

• A family history of depression/PPD, or other mental illnesses

• Unplanned/unwanted pregnancy

• Poor support from family/friends

• Marital difficulties/recent separation or divorce

• Stress from external events or major life event (e.g. breastfeeding difficulties, financial difficulties, negative confinement experience, death in the family)

• Obstetric complications/difficulties with delivery

Genetics seems to play the largest role – but of course, having these risk factors doesn’t mean you absolutely will get PPD, as it’s caused by a complicated combination of many factors. Conversely, you may still get PPD even if you don’t have these risk factors. It’s key to pay attention to yourself and how you’re coping with the change the baby brings.

There’s no way to prevent PPD; if you have any of the risk factors, it may help to prepare for the possibility by ensuring you have a support system in place, and knowing where to get professional help if necessary. It can also help to start engaging in calming practices (e.g. prayer, yoga, mindfulness) during pregnancy, as this will help set the pattern for post-pregnancy. In the same vein, take the time out to do things you enjoy.

Will hiring a confinement nanny or domestic helper help?

It depends on the support the nanny or helper provides. A local study has shown that most mums feel instrumental support is most crucial. In other words, assistance around the house (e.g. with household chores, etc.), is more important than simply focusing on controlling diet and activity.

Hiring a nanny does not improve the symptoms of PPD, but can help reduce stress around the house as long as your nanny is working with you to meet your needs. If this is not the case, you may actually find your stress levels increasing, which certainly isn’t helpful.

It’s useful to make your expectations clear even before the birth, so that anyone helping you knows what your desires are (e.g. regarding breastfeeding, caring for the baby, etc.). Do interview confinement nannies or helpers to ensure you have a good fit with someone who will pay attention to your specific needs, rather than imposing their own beliefs on you. Try and have your partner or someone from your support system with you so that they are also clear on your desires, and can act as an advocate for you after the birth.

This also applies to those who may be depending on family to help care for you and the baby.

My partner/friend has PPD. How can I help?

Be supportive.

There’s nothing you can do to fix the problem. It’s normal to feel helpless and to want a straightforward solution, but the simple fact is that there isn’t one. It may help to do further research into PPD to educate yourself about the illness, treatment, and so on. This may help you to better understand what your partner is going through. The best thing you can do is to listen, and just be there for her. It may be tempting to offer suggestions on how she can improve her mood, but know that these are unhelpful, and may in fact cause her more stress.

Remember that a mental illness is an illness. She cannot simply “cheer up,” any more than a cancer patient can “feel better”.

Encourage her to get professional help, especially if her symptoms are impairing her ability to cope on a day-to-day basis. If she voices thoughts of harming herself or her baby, it’s especially important to ensure she gets professional help. Offer to accompany her if she wishes; she may want your support especially during the initial sessions.

Be mindful of her needs. Everyone reacts differently to PPD: one may need space and time to herself, while another may need someone constantly with her. Ask her what she needs, and try and arrange for that. Don’t push her when she’s not ready, but be ready to listen and help when she is.

Take time out for yourself as well. Caring for someone with PPD can also take an emotional toll on you, and it’s important to give yourself space and time so that you don’t burn out. Try and schedule regular breaks for yourself; arrange for someone else (family or friends) to be with her in the meantime.

Above all, remember that this too shall pass.

Further reading:

• For a great explanation on what psychotherapy is, and what to expect from it, please refer to this website: http://www.apa.org/helpcenter/understanding-psychotherapy.aspx

• Chee, C.Y.I., Lee, D.T.S., Chong, Y.S., Tan, L.K., Ng, T.P., & Fones, C.S.L. (2005). Confinement and other psychosocial factors in perinatal depression: A transcultural study in Singapore. Journal of Affective Disorders, 89, 157-166.

ABOUT THE INTERVIEWEE

Tina George is a clinical psychologist, with a Masters in Clinical Psychology from the University of Tasmania, Australia. She has worked with children, adolescents, and adults in various clinical settings. She is particularly interested in paediatric psychology, neuropsychology, mindfulness-based therapies, and eating disorders. In her spare time, she also volunteers as admin for a few Facebook parenting groups.