What is PND and how is our understanding of this illness changing?

New Zealand

Many of us have heard of Post-Natal Depression (PND) or Post-Partum Depression (PPD). Not only is it a recognised disorder listed in the Diagnostic and Statistical Manual of mental disorders (DSM 5), but the term has made it into popular culture, with high-profile women like Brooke Shields, Gwyneth Paltrow, Drew Barrymore and Celine Dion revealing their experiences of maternal disconnect, overwhelm and symptoms of depression after giving birth to their children. Shields’s book Down Came The Rain (2005) let readers glimpse into her life as she struggled with despair and thoughts of suicide brought about by the emotional and hormonal upheavals of her life at that time.

The rise in awareness of PND is fantastic, hopefully empowering multitudes of women to recognise the condition and seek help before the symptoms become too severe. There is, however, one gaping void in the communal consciousness of PND, and this omission means many women still fall between the cracks of diagnoses and don’t get the help they need.

Not all women experience the typical symptoms of depression. Many assume that because they are not lying in bed all day crying, they cannot have PND. They may think that, because they are holding things together – putting on makeup, meeting deadlines, caring for children, getting dinner on the table – they cannot possibly be depressed. In fact, many women deny or delay relief because they feel that they are “coping” on a daily basis, even though they may be falling apart on the inside.

They don’t realise that there are several symptoms they may be missing: increased self-criticism, obtrusive thoughts, having trouble concentrating, feelings of worthlessness and – in the most severe cases – thoughts of harming herself and/or her children. Physiologically, a woman may experience shortness of breath, heart palpitations, nausea and light-headedness. These can be symptoms of severe anxiety and panic attacks, and can be brought on by a combination of physical and psychological factors.

As our understanding of the illness changes and develops, so the name must adapt to convey this new understanding. Consequently, there is a growing movement towards re-terming Post-Natal Depression “Peri-Natal Distress” as the medical fraternity recognises that it can occur both during and after pregnancy, as either depression or anxiety.

Although PND is highly treatable and curable, it is generally under-diagnosed in our society. This means many women struggle unnecessarily, with repercussions that can negatively affect marriages, families, careers and communities. If more people – in particular healthcare practitioners – were familiar with the signs of PND, we could drastically reduce the complications that occur when the illness is not treated timeously.

For example, when I experienced PND while pregnant with my third child, I had no idea what was coming. I missed the signs. My family missed the signs. My psychologist even missed the signs. By the time I was diagnosed, I required hospitalisation to treat it. At one time, it felt like I might not have made it through.

It was a long, hard road to recovery. Now that I am well again, I am committed to raising awareness of the comprehensive, complex nature of PND in the hope that fewer women will have to suffer as I did.                                                                   

The best way to truly understand another person is to empathise with them, and this cannot be done if you do not know what they have been through. For this reason, I decided to write a book about my experience to give readers a look into what it is like to live with and through PND. Feedback has been extremely positive, with many readers confessing that they had had no idea of the mental or physical symptoms of the illness. Several people have said that, had they known previously what they know now, they would have been better able to support the women in their lives who have walked this arduous path.

The narrative takes readers on the complete journey through PND, from pre-pregnancy through to full recovery, immersing them vicariously in the process. It focuses on my individual experience of pre-natal anxiety disorder, whilst still allowing readers to understand the broader issues surrounding perinatal distress in general.

The book is endorsed by the South African Depression and Anxiety Group (SADAG) and features a foreword and afterword by Cape Town psychiatrist and mother Bavi Vythilingum, as well as footnotes and resources to help the reader to identify symptoms and treatment options.

Through the Window: How I Beat PND is available at www.laurenshapiro.co.za/books

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