medicalcareTalk and be honest with your doctor or health nurse or therapist.
Remember you are not going to shock them with your feelings, they are not going to judge you badly nor will they think you are a bad mother nor will they take your baby away from you. They speak with pregnant and postpartum women all the time and are the best persons to evaluate how you are doing and how they can help, but only providing that you are honest about where you are at. It is important to remember that you are not alone in your feelings, emotional distress and mental health illnesses are very common illness both before and after giving birth.

It may be a medical condition
Your doctor or health nurse will probably order medical tests first to ensure there is nothing physically wrong with you as some medical conditions such as iron or thyroid imbalances can cause depression or anxiety like symptoms.  If physical conditions are identified and treated the feelings of depression or anxiety may stop.

If something physical is really bothering you, don’t be afraid to ask for help. Your GP may be able to suggest treatment or refer you to a specialist or an obstetric physiotherapist, who can help with back and bladder problems and other birth effects.

Write it down and ask questions
It is vital you get correctly diagnosed so that you can get the correct treatments.  You should write down how you have been feeling and also if you have any questions as it can be hard to remember them.

Medication, in conjunction with support, counselling and self care, is the most successful treatment for depression or anxiety to bring about a change in mood, especially if the depression has been long term or severe.  Medication can reverse some of the effects of depression, such as low mood and lack of motivation, and can provide the energy for re-engagement with life, socialising etc which helps combat other depressive effects.  Medication is most useful when forming part of a combined strategy to tackle the various effects of the depression habit spiral.  Taking medication is not a weakness, one person we talked to thought of antidepressants in the same way as having a plaster cast on when you have a broken leg, they helped support them and get around while they did other things like using crutches for more mobility and having physiotherapy to help repair their broken leg.

Myths & Truths about Medication
Unfortunately there are many misconceptions about antidepressants and many women who could benefit from them refuse to take them because they are afraid the medication is harmful to themselves or their baby. Antidepressants are not addictive and some can be safely taken while pregnant and breastfeeding.  Antidepressant medication corrects the chemical imbalances in the brain that are thought to be responsible for the symptoms of depression and anxiety.  Antidepressants do not change your personality or give you a false feeling of happiness, they help to adjust abnormally low levels of brain chemicals to lift mood to more normal levels. It is very important that you comply with any medication treatments. Remember it can take 4-6 weeks for antidepressants to start working fully.

When you first go on medication.
Finding the correct medication and the correct dose can sometimes be a trial and error process.  Most antidepressants are commenced on the minimum dose and can have a range of side effects during the first few weeks, including increased levels of anxiety, agitation and physical symptoms.  During this time you need to stay in touch with your doctor for ongoing support and monitoring.  It is also important to be aware, if you have been having suicidal thoughts, that when you first take antidepressants your energy and motivation can improve before your mood – you can remain suicidal but now have the energy to do it. It is important to look out for increased negativity and hopelessness or sudden changes in mood, as well as suicidal thoughts, and to have regular check ups with your doctor and good support systems in place and it is vital you speak up and ask for help if you are feeling suicidal during this time.

Follow your doctor’s instructions.
Once the correct dose and type of medication is found and you experience a sense of feeling more like yourself it is vital you do not come off these medications without the support and monitoring by your doctor.  Stopping suddenly or missing doses can cause unpleasant symptoms such as dizziness, nausea, pins and needles, anxiety and headaches. Expert psychiatric doctors say that once you are feeling like yourself again you should stay on antidepressants for six months after this state of wellbeing before starting to gradually come off your medications under their guidance.

Becoming Pregnant again.
If a woman becomes pregnant again before recovering from maternal mental health illnesses like postnatal depression, the condition may continue through the pregnancy and may worsen.  It is recommended that another pregnancy can be delayed for at least a year after discontinuing medication or she has recovered.

HSE Mental Health Services
There are various types of HSE community-based mental health services, click here to read more about them.

Hospitalisation
Sometimes in patient hospitalisation is needed for some cases. Hospitalisation means that a woman will get many focused and different types of care and treatment in a faster period of time with mental health professionals.

The length of stay will depend on the care and treatment a women needs for recovery, it may be weeks, months but as the majority of mental health illnesses like depression, anxiety and psychosis are treatable the sole purpose of the hospital team is to treat you so you can be discharged.  Women will get an individualised care plan which focuses solely on their recovery and emotional wellbeing.  A team of mental health professionals will be assigned to her, the team may consist of a psychiatrist, mental health nurse, occupational therapist, counsellortherapist, clinic psychologist and social worker and this team will work with the woman, partner and family.  You can learn what each of these types of mental health professionals are on the HSE Website.  Women will be taught life skills to deal with all areas of wellbeing – emotional, physical, cognitive, creative and social skills and part of your care plan will be to ensure that when you leave hospital that the necessary supports and contacts have been put in place to manage your future care.  The hospital team will also work closely with your gp, public health nurse and community social worker.

For some women mental health illnesses can seriously affect her wellbeing, that of her baby, or her ability to function. If her medication has not stabilized her mental health status, if she is suffering from psychosis, if she is suicidal, at risk of harm or a risk to her baby or others  it may be recommended that she be admitted to hospital either by becoming a voluntary in patient or for some patients who do not want to be hospitalised by being an involuntarily detained in-patient.  Occasionally someone may have to be admitted for mental health treatment and care against their will, this is called ‘involuntary admission’. You can only be admitted against your will if it is considered you meet the conditions for involuntary admission. These conditions are the rules set out in the law to ensure you are only admitted involuntarily if it is absolutely necessary. A mental health tribunal will review this decision. Further information on involuntary admissions is available from the Mental Health Commission website. You can read more on Mental Health Law on the HSE Website.

Care for your child andor children when you are in hospital.
Unfortunately there is no mother and baby unit currently in Ireland so care for your baby andor other children will need to be done outside of the hospital by your partner, family or friends.  If no supports are not available your community family support services will organise for your childchildren to be cared for while you are recovering.  Please remember that the majority of mental health illnesses including psychosis are treatable and you can recover from them and your family support services will work with you and your mental health team to return your childchildren to you once you have recovered.

Don’t be afraid to ask for help
You should never be afraid to ask for help from a mental health illness out of fear that your childchildren will be taken from you.  Please remember that the majority of mental health illnesses including psychosis are treatable and you can recover from them and help is there to will work with you and your family to help you recover and get you back to living a healthy and happy life and caring for your childchildren.

Read more on looking after your Mental Health & Emotional Wellbeing.