A note about depression…

Depression is a serious concern both during pregnancy and after, with 10-13% of women experiencing depression during pregnancy (1) and an even higher percentage at risk of post natal depression, especially within the first three months (2,3) . That for me is a scary percentage and I felt very strongly about putting a section on this website about recognising the signs of depression and how exercise positively impacts that risk. Exercise has positive impacts on self-esteem, physical strength, weight-loss and improving energy levels. Regular exercise also improves sleep, reduces stress and improves general wellbeing. Even if you come from a sedentary background, exercising in a group or at home reduces the risk of developing depression (4). It’s never too late to start and jump into a program.

Q: How can you recognise the signs & symptoms of Post Natal Depression (PND)?

PND is caused by a number of variables. Aside from hormonal changes that affect the limbic system and other regions in the brain responsible for our mental health, there are also psychosocial factors that affect how we feel. These might include weight gain, sleep deprivation, changes in lifestyle, lack of social support, stress, and perceived sense of control (5).

The Edinburgh Postnatal Depression Scale (EPDS) (6) is a great questionnaire used to evaluate how you have been feeling and can be used during pregnancy and after. The questionnaire asks you to select the most appropriate answer that represents how you have been feeling over the past seven days. There are four options and answers may include 'all the time, some of the time, not very often, and not at all'.

  1. I have been able to laugh and see the funny side of things.

  2. I have looked forward with enjoyment to things.

  3. I have blamed myself unnecessarily when things go wrong.

  4. I have been anxious or worried for no good reason.

  5. I have felt scared or panicky for no good reason.

  6. Things have been getting on top of me.

  7. I have been so unhappy that I have had difficulty sleeping.

  8. I have felt sad or miserable.

  9. I have been so unhappy that I have been crying.

  10. The thought of harming myself has occurred to me.

The EPDS is not a diagnostic tool but rather a screening test for the risk factors in developing PND. To get a score you complete the test online but usually it is best to have a health practitioner assess your score and discuss the results with you. The international cut-off score is 13 (out of 30) for depression, but many publications suggest that a score above 9-10 should warrant further review and assessment from a trained medical practitioner. If after reading this information you are beginning to wonder if you suffer symptoms of PND, I would urge you to seek a professional opinion from your doctor.

While exercise is effective in reducing the risk of developing postnatal depression, the most “promising intervention is the provision of intensive, professionally based postpartum support” (7). If you feel that you are experiencing symptoms of PND or now recognise that a close friend or relative might be, reach out for support from your doctor or treating healthcare practitioner. Mothers who develop PND are at much higher risk of future episodes and it also has an impact on child development through impairment of the mother-child bond. PND is not something to be ignored or overlooked.  

In 2010 a study was published by Physical Therapy (8), and it was the first high quality research trial to demonstrate how exercise reduces the risk of developing postnatal depression. It was a study conducted in Melbourne, Australia, that looked at the impact of an 8-week supervised exercise program combined with education for new mothers, compared to education alone. The participants were healthy mothers with no history of mental health conditions. The program consisted of 1 hour a week of exercise combined with 30 minutes of education about toys, baby massage, nutrition for mothers and other topics. The results were extremely positive. They showed that the number of women identified ‘at risk’ of developing PND reduced by 50% in the group that had exercise and education. What this means is that exercise has a very positive impact on mental health and physical wellbeing.

As motivated as you might be to exercise at home, please never forget the importance of surrounding yourself with a social network. The most ideal situation is to be involved in a group exercise class that allows for babies to be present, mothers to interact and socialise, and an opportunity to learn about safe and suitable exercises after childbirth.

Personally, I’ve witnessed the positive impact of this program design. For the study by Norman et al (2010) I was one of the therapists guiding this program for several months during my Women’s health rotation at the Angliss Hospital, Ferntree Gully. It was encouraging to see so many mothers transform over the eight weeks and they all left the program with valuable knowledge and skills for running their individual and independent exercise. Many of the mothers stayed in contact and would run their exercise groups long after they finished the program. Many of the exercises that I use in my Women’s health programs today come from the experience I gained while teaching on this program.

Participation in regular exercise has such a positive impact on physical and mental health. Hopefully the information presented here reinforces how important it is. Both Julia and I are here to support you on the journey to a strong and healthier you. So now it is time to get started. Let’s take a look at where we are starting in this 36 week exercise program. 

References:

1. Daley, A. J., Foster, L., Long, G., Palmer, C., Robinson, O., Walmsley, H., & Ward, R. (2015). The effectiveness of exercise for the prevention and treatment of antenatal depression: systematic review with meta‐analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 122(1), 57-62.

2. Dennis, C. L. (2005). Psychosocial and psychological interventions for prevention of postnatal depression: systematic review. Bmj, 331(7507), 15

3. Norman, E., Sherburn, M., Osborne, R. H., & Galea, M. P. (2010). An exercise and education program improves well-being of new mothers: a randomized controlled trial. Physical Therapy, 90(3), 348-355.

4. Songøygard, K. M., Stafne, S. N., Evensen, K. A. I., Salvesen, K. Å., Vik, T., & MØRkved, S. I. V. (2012). Does exercise during pregnancy prevent postnatal depression?. Acta obstetricia et gynecologica Scandinavica, 91(1), 62-67

5. Pivarnik, J. M., Chambliss, H. O., Clapp, J. F., Dugan, S. A., Hatch, M. C., Lovelady, C. A., ... & Williams, M. A. (2006). Impact of physical activity during pregnancy and postpartum on chronic disease risk. Medicine & Science in Sports & Exercise, 38(5), 989-1006. 

6. Edinburgh Postnatal Depression Scale http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf accessed September 22nd, 2015.

7. Dennis, C. L. (2005). Psychosocial and psychological interventions for prevention of postnatal depression: systematic review. Bmj, 331(7507), 15.

8. Norman, E., Sherburn, M., Osborne, R. H., & Galea, M. P. (2010). An exercise and education program improves well-being of new mothers: a randomized controlled trial. Physical Therapy, 90(3), 348-355