Jane - Interview 07

Age at interview: 39
Age at diagnosis: 29
Brief Outline: Jane was at university when she first experienced mental health problems in the form of anxiety and panic attacks. Therapy helped these subside, but she then went on to experience postnatal depression (undiagnosed) with her first child, and both antenatal and postnatal depression with her second child. During her second pregnancy, Jane's depression was diagnosed and treated, and she made a full recovery.
Background: Jane is married with two children. She works as a consultant. Ethnic background' Anglo Australian.

More about me...

Jane attributes her experiences with anxiety and perinatal depression to a mix of factors including genetics, hormone fluctuations, personality, and life transitions. Her father has battled severe depression for much of his life, which she thinks has given her a propensity for the condition. Jane first experienced anxiety in her early 20s, linked to trying to fit in at university while balancing study, and some unresolved feelings about her parents’ divorce when she was young. Symptoms included breathing difficulties and panic attacks, which Jane dealt with by quitting her part-time job, cutting back on social activities and moving back home. Her mother encouraged her to seek professional help and Jane saw a counsellor for a few months, which helped her get ‘back on track’.
Several years passed during which Jane established her career and got married. In her late 20s she became pregnant, one of the first of her friends to have a baby. While pregnant Jane was preoccupied with work, and not focused on the impending change to her life. She had hoped for a natural birth, but had an emergency caesarean under general anaesthetic due to serious concerns about her baby. The shock and confusion of the experience overwhelmed Jane, and she recalls not coping as early as the first night in hospital. Back at home, her daughter slept little and was very unsettled; breastfeeding was difficult and after three months had to be abandoned; the family was socially isolated; and Jane was unable to discuss what she was going through with anyone outside of her mothers’ group. Her maternal and child health nurse didn’t pick up on these issues and Jane was reluctant to ask for help, thanks to a determination to ‘succeed’ at motherhood as she had in other areas of her life. She coped by drinking (once her baby was fully bottle-fed) and shopping. Jane’s postnatal depression lasted 12 months and she emerged from it on her own. Although she regrets having ‘lost’ the first year of her daughter’s life, she quickly bonded with her after her symptoms had disappeared. 
About halfway through her second pregnancy Jane was diagnosed her with antenatal depression. Her GP helped her develop a range of strategies to manage her symptoms as Jane didn't want to take medication. These strategies included diet, exercise and asking for help as soon as she felt she needed it. The diagnosis shed light on what Jane had been through with her daughter, and meant that this second experience of perinatal depression was very different. She got through the rest of her pregnancy and the birth (an elective caesarean) with little difficulty, but her new baby also didn’t sleep well, and after about three months the ‘panicky feelings’ and ‘circular, confusing thought patterns’ she had experienced previously returned. Jane’s maternal & child health nurse booked her in to a mother and baby unit for two weeks and upon discharge, she started taking antidepressants (sertraline), joined a PND support group led by a psychologist, and saw a psychiatrist. After another three months, the support group had ended, her psychiatrist had moved away, and Jane was feeling well enough to stop her medication. Soon after, she felt she was back to her old self (before having children), but also changed by the experience. 
Jane has been well ever since, but as her two episodes of depression were triggered by pregnancy, birth and becoming a parent, she sees hormonal changes as significant, and wonders how menopause will affect her. Looking back, she sees transition to parenthood as involving the ‘death’ of the ego. This was a difficult experience and one that challenged both Jane’s relationship with her first child and her marriage, but ultimately allowed her to grow and mature significantly as a person, and in this sense she regards her depression as a gift. 



Jane’s first episode of perinatal depression went undiagnosed. When she was diagnosed the second...

Okay. So I've had two rounds of depression. One wasn’t diagnosed but looking back it was depression, and the second one was diagnosed. Both of them were to do with small children and giving birth. So both – the second one was diagnosed as antenatal depression, I was diagnosed at five months with my second child, five months pregnant. 
I was diagnosed with antenatal depression and that diagnosis then seemed to just carry over. So because I'd been diagnosed with depression during pregnancy and the symptoms hadn't alleviated then I got rolled in. So it wasn't - the diagnosis of antenatal depression, my stomach fell and I thought, oh great, because I'd been there. And so, yeah, I wasn't very happy. In fact, I got quite cross at the doctor at the time. And it took me a few days to get my head around it, that, you know, things were going to have to change and I was going to have to become active and actually do something about managing myself. And I wasn't very happy about, you know, it wasn't fair.
It really didn't feel fair about why, I've already been through this once and managed to get through it, why does this have to happen again? And then the guilt started. Well, if I'd, you know, tried to get help the first time would I be going through it the second time and blah, blah, blah. And I really wasn't going to go through another year of what I'd been through with [daughter]. 

Jane found counselling helpful for dealing with issues from her past and addressing relationship...

It was basically, basically talking therapy. So a lot of it was to do with my parents' divorce when I was quite young and it seemed to stem from the relationship, or lack thereof, I had with my father. So when I went and found a, a counsellor, and she wasn't a psychologist she was a counsellor but she came very highly recommended, she had me talking about how I felt and journaling and doing the - you know, talking to the chair and writing letters and doing all those sorts of sort of therapeutic I guess practices. 
And I saw her for about three months, about 12 sessions, and that seemed to help me get it under control. So she also worked with me on my breathing. So we didn't do any cognitive behaviour therapy, which I’d done like, I did that later on, so I didn’t do, it wasn't that. It was more getting out what appeared to be the issue and it really helped.

Jane, who lacked family support, found sharing her experiences of struggling with early...

I didn't want to have a conversation about how wonderful it was to be a mother. So my mother's group was actually full of women who really didn't want to be mothers which is quite ironic really. And so we would bond over red wine and moaning over our children not sleeping. So that was quite fun, you know, I quite enjoyed their - but there's only so much of that you can do without sending yourselves mad. So we'd probably only meet once a month, I guess, but I mean that was great, they were very, very honest about what they were going through. While my, the work colleague I'd mentioned before, he mother's group weren't like that, so she - her experience was quite - so it was interesting comparing the two. 
In some ways mine helped in the sense that I could still be - I could at least be honest with somebody, but I didn't want to join - I mean, I had met other women with babies and they were saying come to play group and I just - if they were in la la land, as I called it, about, you know, how wonderful it was to be a mother of a small baby then I didn't want to know about it. 
When I came out [place name] Council was running a pilot program of postnatal depression support group run with [NGO name] and a qualified psychologist. So there were 10 of us, I think, and we met on a weekly basis for an hour and a half to talk about, you know, what was happening for us and how we were coping. 
They taught us some cognitive behaviour therapies. And we kept - I think that was a 12 week program, or 14 week program, and we kept it going. We employed the psychologist that had been part of the pilot, we kept her going for another 12 weeks I think after that and, just - that got most of us over the hump.

Jane returned to part-time work while still experiencing perinatal depression, but balancing...

And a lot of that came along with - well, it really started - I mean, I got back to work and I'd been promoted. I mean, the company had done a very, very good job really and saw me as quite ungrateful, and I probably was, because they’d bent over backwards really to do everything they thought they should do to show me how much they supported me and how much they wanted me back. And I basically think I was back for, I don't know, six month and said, right, I'm off to [country name], see you later. 
But it became perfectly clear to me, I was, I can't remember what I was - I was sitting at my desk for whatever reason and my manager had said to me, we need to do X, Y and Z. I had – I was project managing, was my part-time job. Part-time. Yeah anyway. So that was what I was doing and he said something or other. I can remember thinking, it's the job or my child. Now that wasn't – he hadn’t - I mean, that wasn't what he was asking me to do but that's what it felt like. 
I could either focus on her or I could focus on my job but I couldn't do both. Now that could be - I mean, a lot of that's me, that’s, I get very intense about particular things that I'm doing. But it felt like I couldn't do both. I couldn't give them what they needed in terms of my buy in and energy and give my child what she needed. And at that point I decided that she was more important and then really started in on [husband] about we need to go overseas, you know, there's this opportunity, you know, blah, blah, blah. So yes, solved it by running away which, you know, that's a strategy, works in the short term [laughs].

Jane was happy to answer direct questions about her perinatal depression and antidepressants but at the same time did not tell people voluntarily.

I didn't go around telling - well, I mean, now, there – most people don't know that I've had postnatal depression, so I wasn't going around shouting from the roof tops, yee hee, look, I've got Zoloft (sertraline), wee hee!
I wasn't. But at the same time, if anyone had asked me directly I wasn't uncomfortable with saying I was on it. It did get in the way, I didn't feel like me, I felt like I lost a lot of my higher cognitive functions. I found thinking abstractly or highly abstractly very difficult. So if it was a concrete train of thought or if it was about sort of general sort of political issues or whatever, I could deal with it. If it was thinking about, you know, philosophy of – anything, I couldn't. So it was that next level of I just couldn't go there, my brain wouldn't do it, and I didn't like that. 
So, yeah, and as I said before, I lived a long, lived a lot in my head and so it felt, it felt like part of my - I didn't have access to everything really. But it also, I mean, it did help. That's the other thing, it really, once I stabilised the dosage it got rid of most of the symptoms, if not all of them. Every so often I'd still get a bit of anxiety but I could manage that with breathing and visualisation. And also, – my stomach’s really rumbling here, this is going to be a very interesting soundtrack. It’s yeah it, yeah so got rid of most of it, you - the anxiety was manageable, and there wasn't really, I didn't get any physical side effects of it. Every so often I'd get a headache, that'd be about the most. Yeah. But it had to be done. 

Jane appreciated her maternal and child health nurse’s efforts to have her admitted to a mother...

And we told her what had happened and because I'd had antenatal depression obviously they were keeping a much closer eye on me. And [son] had silent reflux, again wasn't sleeping, and as he continued to not - he fed really well though, but as he continued to not sleep I could feel myself sliding in and I couldn't stop it. And at that point we threw up red flags and said we need help. Our maternal child health nurse - because we didn't have - I'd have private health insurance but I hadn't had it for long enough to get health care, or mental health care, under that system. 
So we actually went to [hospital name], and they did a - pulled a swiftie and got me in on [son] having silent reflux. So we were in the mother/baby unit there for two weeks with his silent reflux. Which he did have but they kept me there for an extra week for me so he could be treated. And they were fabulous. They were just excellent. 

Jane discussed treating perinatal emotional distress as a normal part of having children, as a...

I don't think anything could have been done. I mean, I think this is one of the problems I think with postnatal depression, especially in women that have been successful. I don't mean successful as in other people think you're successful. You've been successful because you think you're successful. So in highly competent strong women who've always done what they wanted to do, no matter what that is, and I wouldn't think it would make any difference what walk of life you came from, to me this feels and sounds like an attitudinal thing. If that competence and control is being undermined I don't know how you get them - I don't, I don’t know that anyone could have got me to admit except after a very long period of really trying hard. 
Because I then tried with - well, I mean, I have tried with people that I could see my - similarities with my experience, and they wouldn't admit it, and they wouldn't admit it til a very long time afterwards that there was even a problem. And yeah, so I mean, I think that's an issue. And maybe the only thing that can be done is to normalise is, which is what's happening is, for a lot of women. A normal part of being a mother is that you have some kind of postnatal experience and the more people talk about it the more normal it is.
Now it mightn't - it's not for everybody but if it's just a normal part of, you know, this could happen to you the same way as you could get stretch marks or you could get tearing, or you - then it's not such a big deal. So. But I think women won't call it postnatal depression either, they'll just call it something else. You know, it'll be a normal part, a bit down and a bit whatever. 

Jane’s depression experience helped her to focus on the things she really wanted to do.

Just progressively feeling more and more like myself really.
And, you know, I've changed careers, I now run my own business. I've done things I, you know, done things I never thought I'd do, travelled, so since the kids have been born I've been going overseas by myself regularly.
So I've seen a lot of the world that I hadn't seen previously. So life is very, very different to what it would have been even if I'd just - if I'd never had the depression life would be very different. And so the depr – the PND really helped me be very clear about who I am and what I want to do I guess. So in that way it was good.
I'm much clearer on who I am and who I'm not. I'm – I mean, it's hard, because I haven't got access to the person I would have been if I'd continued on that trajectory, it's hard to know how I would have turned out but I'm much more adult. I take responsibility for myself and my actions, I talk in ‘I’ language about, ‘I feel, I want, I think’. 
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