The voicemail message when you ring the Postnatal (PND) and Antenatal Depression Support Group is very warm – and detailed.

Madge Fogarty’s voice gives information about the hours that the phone is answered and how the website’s forum can be helpful, how you should go to your GP if necessary and if you are ringing in the middle of the night to consider contacting the Samaritans.

It’s a warm message, directional, helpful, acknowledging how serious postnatal depression can be. You get the impression that the speaker knows what she is talking about and she does.

Madge, a farmer’s daughter, developed PND after having her second child in 1992. A difficult birth was the trigger for her depression, she believes.

“My baby was taken away to the neo-natal unit immediately, so it was two hours before I saw him and I spent that time imagining the worst.”

Women are at their most vulnerable after giving birth, she says.

“You’re in your head so two hours is a long time when you’re lying there. All that’s changed now in hospitals, thank goodness. If a baby has to go to the neo-natal unit the partner can go with it and take photos and report back to the mum, which is much better.”

Having experienced normal responses with her first child, aged three at this time, Madge knew that the way she was feeling this time round wasn’t right.

“Initially I put my low mood down to being tired, but I was full of anxiety and fear and wasn’t sleeping,” she says. “I hadn’t been like that before so I knew something was wrong. There was a huge taboo around postnatal depression then as well, so I hadn’t heard of it. The GP was the only person you had to turn to in those days and that isn’t enough. You need support outside that as well.”

Keeping it hidden

Madge’s depression lasted for nearly a year and she admits to trying to keep it hidden during that time.

“That put extra stress on us. I’d be at home on my own and finding it really hard to cope when my husband was at work. I remember so distinctly being so afraid of being on my own. I felt I needed someone to be there, a presence, not doing the work, but being in the house. It took me a long time to realise that those feelings were part of the illness. I used to say ‘what the hell is wrong with me, I’m 30, this is ridiculous, I’m behaving like a child’. It was only years later that I discovered it was all part of the illness.”

Treatment wasn’t easy. As her GP had prescribed anti-depressants – something that scared Madge, she says, as she knew nothing about them – she had to stop breastfeeding straight away.

“It was a case of literally stop now, no weaning. That was very stressful.”

It took about three weeks before the anti-depressants began working, she found, although it’s now generally around 10 days that such medication kicks in.

“The side effects initially made me feel worse. Sometimes women aren’t told that and they give up the medication. You have to remember that they take a while to work and that you’re never supposed to stop taking anti-depressants without medical supervision.”

The medication doesn’t solve everything, however. She describes them as ‘taking the edge off’.

“Recovery is a lot slower than that. You’re not going to be better in a week.”

Madge Fogarty.

Talk it through

While, as Madge has pointed out, anti-depressants are often helpful and in many severe cases may be necessary in treating PND, it is important to remember that counselling or talk therapy can also be a treatment option for mild to moderate post-natal depression. Talk to your GP about the other options if you’re not sure that medication is for you.

As part of talk therapy, CBT or Cognitive Behavioural Therapy (CBT) strategies are often recommended to help people with depression identify, challenge and manage negative thinking patterns. For a list of accredited counsellors in your area see www.iacp.ie

Stressful for partners too

It was a very lonely time for the couple, she remembers.

“My husband didn’t know what he’d be facing when he came home in the evening. A lot of men don’t understand – women as well, who’ve never gone through it. I heard ‘you have everything – a healthy baby, good job, a good husband, a lovely house – what have you to be depressed about?’ The thing was I was thinking the same thing.”

Madge came off the medication at one point thinking she was better, but relapsed.

“I hit rock bottom again. You feel you want to get off them, not be reliant on them. Then when I really was better I was afraid to come off them thinking am I really better or is it the medication? There’s always that worry. There’s nothing worse than falling back down,” she says.

Get help

She also advises any mother whose ‘baby blues’ is lasting longer than 10 days to get checked out, as it could be postnatal depression.

Within a year of recovering Madge had set up the support group, knowing that there must be other mothers like her who need help.

“I was hoovering one day and made the decision,” she says. “I thought it was vitally important for women to hear other women’s stories and get advice, to know they are not on their own, that there is light at the end of the tunnel.”

Setting up the group wasn’t an easy journey either, she says.

“I called a meeting in a hotel, did the publicity, everything myself… When I think of it… A good few women who’d had PND in the past turned up though. Over time we got more members and moved meetings from a parish room to the Bons Secours hospital, to St Finbarr’s and now to Cork University Hospital where volunteers run the helpline.

“We’ve a small committee and we work to a roster. We are involved in the antenatal classes there for the past 10 years too.”

The fact that PND is talked about openly now means a lot to Madge.

“It’s not hidden away any more, there is help and support. That is so fantastic. It took 15 years to get to that, constantly fighting the system, but we got there.”

She is glad that the stigma is lifting and that people talk more openly about PND – partners too.

“We get a good few phone calls from worried partners who don’t know what to do,” she says. “Another difficulty for partners can be that women are afraid to seek help themselves because they don’t want to admit that there is something wrong,” she says.

The Postnatal and Antenatal Depression Group can be contacted at 021-4922083. A book that offers lots of good advice – Recovering From Post Natal Depression – is available on the www.pnd.ie website and also by post.

How others can help

Madge has a list born of experience – by listening, by encouraging them that they will get better, by distracting the mother: taking them out for a walk or coffee, for example.

“That’s because a lot of women hide and won’t go out, and that exacerbates the condition. Distraction is so vitally important – and getting out of the house.”

Not diminishing what is happening is important too.

“I used to meet people when I had it who would either cross the road or talk about the weather. They wouldn’t ask me how I was.”

She would also advise being kind, not judgmental and please don’t pretend it isn’t happening. “Small things make such a big difference. I remember one friend who used to praise the smallest thing I did when I was recovering and I’d come off the phone feeling a bit more positive and that she had really listened to me.”

That son now has a small baby himself and Madge says that she is reliving the joy of a small baby now and how she should have felt when her second son was born. She mentions that she has very few photos from that time.

“When you’re not well you don’t want to take photos. Postnatal depression is an awful illness because it robs you of so much.”

Symptoms of postnatal depression

  • Severe anxiety.
  • Worrying all the time.
  • Unable to sleep properly.
  • Panic attacks.
  • Crying a lot.
  • Feelings of hopelessness.
  • “Most women would have four of those symptoms,” she says. “The sleep thing is a torture. Your mind is racing with negative thoughts so you’re exhausted and can’t cope the next day. Mothers with PND need help with the baby during the night so that they can get some sleep.”

    Puerperal psychosis – most severe form

    The severity of PND can vary too.

    “Some will get it very mild, and if caught early, will only last about three months. If you don’t get help early it can get hold and be hard to shift.”

    There is also a very severe kind of PND called puerperal psychosis, which affects about one in 500 women.

    “This can be very frightening for them and everyone around them as the person can lose touch with reality. Women generally go on a bit of a high after childbirth and then their mood drops with the ‘baby blues’ but picks up again, but a woman with puerperal psychosis usually goes higher and higher (in mood), doesn’t need sleep, talks all the time, and may have great ideas of taking over the world. It’s a very pronounced condition.

    “Sometimes it’s caught in hospital if it happens straight after delivery or soon after, but if it develops at home people may not know what’s happening. The advice is to seek advice very early.”