tag:theconversation.com,2011:/ca/topics/postnatal-psychosis-19617/articlesPostnatal psychosis – The Conversation2023-08-29T15:34:41Ztag:theconversation.com,2011:article/2073602023-08-29T15:34:41Z2023-08-29T15:34:41ZWhen being a new mum feels overwhelming, here’s some expert advice on what you need to know<figure><img src="https://images.theconversation.com/files/542176/original/file-20230810-11401-f0k38u.jpg?ixlib=rb-1.1.0&rect=11%2C15%2C2544%2C1686&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Being a new mother can take a lot of adjustment. </span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/parents-looking-at-their-baby-3584088/">pexels?nappy</a></span></figcaption></figure><p>We are sold the idea that becoming a new mother is the <a href="https://psycnet.apa.org/record/2016-38769-001">happiest time of your life</a>. But for many women, the reality doesn’t fit that perfect picture. Yes, they may love their baby very much but the broader impact of having a baby and becoming a mother can feel far more complex. </p>
<p>Research shows that when we look at happiness over our lifetime, the year after having a baby can be one of our <a href="https://psycnet.apa.org/record/2013-15090-008">lowest points</a>. It’s not about our relationship with our baby but rather the other parts of our lives that have changed so much. Social media hasn’t helped any of this. We are all tempted to just share the best bits, thinking we need to hide our feelings because we think <a href="https://psycnet.apa.org/record/2018-45585-002">everyone else is so happy</a>. But speaking out helps everyone. </p>
<p><a href="https://www.independent.co.uk/news/health/negative-thoughts-new-parents-baby-pregnant-children-parenting-b694300.html">It’s normal</a> to experience some challenging emotions when you become a new parent. You might not immediately bond with your baby, wondering why that flash of love didn’t appear. You might grieve for your old life and identity. You might feel trapped, wanting to escape yet at the same time feeling you can’t leave your baby. </p>
<p>Worries about not being “good enough” for your baby are also common. But honestly, you don’t need to get it right all the time. You are more than enough for your baby. None of these very normal reactions to change mean that you don’t love your baby.</p>
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
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<p>But knowing when these are normal feelings and when you might need support is important. At least <a href="https://maternalmentalhealthalliance.org/about/perinatal-mental-health/">one in five</a> new mothers will experience a mental health issue after birth. Though this is likely an underestimation because many hide these feelings. But hiding them just prevents you from getting the support you need. So here are some signs to look out for:</p>
<p><strong>Postnatal depression:</strong> <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/postnatal-and-antenatal-depression/">Depression</a> isn’t simply feelings of sadness. In fact, anxiety, about something specific or a general feeling of dread is common. You might lose pleasure in doing things, feel hopeless about the future, or feel very low about yourself. </p>
<p><strong>Anxiety and intrusive thoughts:</strong> We all have moments where we imagine ourselves dropping our baby. Sometimes however these thoughts become <a href="https://www.verywellfamily.com/overcoming-postpartum-ocd-and-intrusive-thoughts-5187982">repetitive, frequent</a> and we can’t make them go away. You might find yourself <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/perinatal-anxiety/">unable to sleep</a> or waking too early. You might feel restless, overwhelmed in public or feel shaky. </p>
<figure class="align-center ">
<img alt="Woman lying in bed with baby." src="https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542180/original/file-20230810-12281-ellk87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">It’s normal for life to seem radically altered and to feel a loss of identity.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-woman-resting-on-the-bed-with-her-baby-on-top-6849528/">pexels rdne stock project</a></span>
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<p><strong>Postnatal rage:</strong> We often don’t talk about rage when it comes to mothers but it’s <a href="https://www.irishtimes.com/life-and-style/health-family/i-was-a-charging-brutal-half-animal-the-ugly-truth-about-postnatal-rage-1.2950662">more common</a> that you think. You might find yourself feeling on edge or irritable and then snap when something small goes wrong. Hormonal fluctuations and a lack of sleep might exacerbate this but more often it’s a reaction to feeling overwhelmed, powerless and unsupported. </p>
<p><strong>Birth or breastfeeding trauma:</strong> Many women have some difficult memories of birth but sometimes, even if you are able to talk them over with friends afterwards, <a href="https://www.youtube.com/watch?v=A43qlYkSMyU">these don’t go away</a>. You might find yourself having flashbacks, feel unable to go near the hospital or anything that reminds you of the birth, or feel very angry about your experience, or blame yourself. </p>
<p>Your sleep or appetite might be affected, or you might feel very jumpy or on edge. Sometimes these feelings are linked to physical events during the birth, but often they’re more about how you felt or were treated.</p>
<p>Increasingly similar feelings of trauma or grief are being recognised around <a href="https://welldoing.org/article/why-breastfeeding-grief-trauma-matter">infant feeding experiences</a>. If you experienced breastfeeding difficulties or had to stop before you were ready, you might be feeling guilt, anger or loss about that, despite your baby thriving. </p>
<h2>Getting support</h2>
<p>If you’re feeling overwhelmed by the emotions you are experiencing or find your sleep, energy or appetite is affected, here are some things to try:</p>
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<img alt="Woman with baby and laptop." src="https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542183/original/file-20230810-24-a9mnpk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Don’t suffer in silence, get as much support and help as you can.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/young-working-mother-cuddling-baby-and-using-laptop-at-home-7282818/">Pexels/sarah chai</a></span>
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<p><strong>Talk to friends:</strong> Sometimes just sharing how we feel and realising that others feel this way can help us realise we are not alone </p>
<p><strong>Discuss with your health visitor or GP:</strong> They can help you understand how you are feeling and discuss different treatments such as counselling and medication</p>
<p><strong>Contact one of the many organisations that can help:</strong> The <a href="https://maternalmentalhealthalliance.org/resources/mums-and-families/">Maternal Mental Health Alliance</a> has a list of contacts. You can talk through difficult infant feeding experiences with a <a href="https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/help-and-support/">breastfeeding charity</a>. Many doulas (a person who can support you through pregnancy, labour and birth) also offer help to explore <a href="https://doula.org.uk">how you are feeling</a> about your birth and caring for your baby. </p>
<p><strong>Focus on looking after yourself, too:</strong> Your diet, activity levels and time outdoors can all affect how you feel. Do not be afraid to ask others for help or to use sources such as childcare to get some time for you to be able to do this. Explain to them how you feel and what you need. </p>
<p><strong>Creativity is good:</strong> The <a href="https://www.maternaljournal.org/">Maternal Journal</a> project holds in-person and online group sessions supporting you to explore how art can help, while also caring for your baby. </p>
<p><strong>Try baby massage:</strong> It can help you to slow down and connect with your baby. And it can help increase <a href="https://pubmed.ncbi.nlm.nih.gov/11246096/">oxytocin levels</a> in you both, calming your system.</p>
<p><strong>Explore some grounding techniques:</strong> <a href="https://www.healthline.com/health/grounding-techniques#physical-techniques">These can help you</a> to manage your anxiety. When you feel symptoms of anxiety, look for things in the environment around you. Try and find five things that are blue. Or five things that are soft. Count them and say them out loud. </p>
<p>Most of all remember that none of these feelings are anything to do with how much you love your baby or how well you care for them. Often mothers experiencing mental health difficulties are highly attuned to their baby’s needs because they are so worried about not getting it right. Your baby will be fine, but it’s important that you are too.</p><img src="https://counter.theconversation.com/content/207360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has received funding from the ESRC, MRC, NIHR, HEFCW, UKRI, Infant feeding charities and Public Health Wales. She is a trustee for First Steps Nutrition Trust.</span></em></p>New motherhood is often portrayed as a time of joy but it can also be filled with fears and complicated feelings. Here’s how you can get help and support.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1702782021-11-11T03:10:17Z2021-11-11T03:10:17ZPostnatal psychosis is rare, but symptoms can be brushed aside as ‘normal’ for a new mum<figure><img src="https://images.theconversation.com/files/431408/original/file-20211111-5078-qdsz8v.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unhappy-woman-suffering-postpartum-depression-sad-1925974949">Shutterstock</a></span></figcaption></figure><p>The period after birth of a child is supposed to be a time of great happiness for women. However, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491613/pdf/WPS-19-313.pdf">a significant number</a> of new mothers will experience a mental illness at this time.</p>
<p>One is <a href="https://www.thewomens.org.au/health-information/pregnancy-and-birth/mental-health-pregnancy/post-partum-psychosis">postnatal psychosis</a> (also known as postpartum or <a href="https://www.cope.org.au/health-professionals/health-professionals-3/perinatal-mental-health-disorders/puerperal-psychosis/">puerperal psychosis</a>). It’s not related to postnatal depression.</p>
<p>Postnatal psychosis affects <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009991.pub2/full">one to two in every 1,000 new mothers</a>, or about 600 women each year in Australia.</p>
<p>But our <a href="https://www.sciencedirect.com/science/article/pii/S026661382100245X">interviews with women</a> who have been diagnosed with this rare but serious condition show their symptoms were often dismissed as a normal part of adjusting to motherhood.</p>
<h2>What is postnatal psychosis?</h2>
<p>Postnatal psychosis affects women across all cultures and geographic areas.</p>
<p>The condition can put a woman at risk of self-harm or suicide and, on rare occasions, of harming others including her new baby or other children.</p>
<p>We don’t know what causes it. But contributing factors may include sleep deprivation, and rapid hormone changes associated with pregnancy and childbirth.</p>
<p>The risk of postnatal psychosis increases if a woman has a history of <a href="https://www.sane.org/information-stories/facts-and-guides/bipolar-disorder#what-is-bipolar-disorder">bipolar disorder</a> or has had postnatal psychosis before.</p>
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<figcaption><span class="caption">One woman tells her story.</span></figcaption>
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<h2>What are the symptoms?</h2>
<p><a href="https://www.cope.org.au/wp-content/uploads/2017/11/Postpartum-Psychosis_Health-Prof-Fact-Sheet.pdf">Symptoms</a> can begin in the first few days after giving birth but may not appear until up to 12 weeks afterwards.</p>
<p><strong>Some women have manic symptoms</strong></p>
<ul>
<li><p>manic symptoms include feeling they do not need to sleep, and are powerful and strong</p></li>
<li><p>women may have unusual experiences, such as seeing or hearing things others cannot. They may believe things that are not true </p></li>
<li><p>they can also make unrealistic and impulsive plans, can be disorganised or forgetful, and talk very quickly</p></li>
<li><p>their moods may change rapidly or they may seem excessively happy.</p></li>
</ul>
<p><strong>Others have depressive symptoms</strong></p>
<ul>
<li><p>depressive symptoms include a loss of energy and an inability to sleep or eat </p></li>
<li><p>women may have thoughts or auditory hallucinations that they are a bad mother and they may say they wish to die. Hallucinations or delusions (false beliefs) point to postnatal psychosis rather than to postnatal depression</p></li>
<li><p>women may find it difficult to complete activities, such as caring for themselves or their baby, or attending to other tasks in the home</p></li>
<li><p>they may believe they are helpless, hopeless and worthless, especially as a mother </p></li>
<li><p>they can become isolated and no longer enjoy activities.</p></li>
</ul>
<h2>Women say it’s traumatic</h2>
<p>Women say postnatal psychosis is traumatic, especially if they do not get help when they first report symptoms. But it can be challenging to diagnose because of the stigma surrounding mental illness around the time of giving birth.</p>
<p>Women say they are <a href="https://link.springer.com/content/pdf/10.1007%2Fs00737-015-0548-6.pdf">reluctant to disclose</a> unusual symptoms as they feel ashamed they are finding motherhood difficult and worry they may lose custody of their baby.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1457172143737741319"}"></div></p>
<p>When we <a href="https://www.sciencedirect.com/science/article/pii/S026661382100245X">interviewed ten women</a>, who had experienced an episode of postnatal psychosis in the past ten years, we discovered another barrier to diagnosis. </p>
<p>Women said they knew they had unusual symptoms, such as not being able to sleep or changes in the way they thought or behaved, but they found it difficult to get help. Often, they were told these symptoms were a normal part of adjusting to motherhood. </p>
<p>Their postnatal psychosis was not identified until their only option was admission to an acute mental health unit and separation from their baby.</p>
<p>So we need more education about the condition for health-care workers. By identifying the condition earlier, this gives women more treatment options.</p>
<h2>There are treatments</h2>
<p>Once diagnosed, the condition can be treated with antipsychotic and mood stabilising medication, prescribed by a psychiatrist or other treating doctor.</p>
<p>This is <a href="https://link.springer.com/article/10.1007/s00737-009-0117-y">very effective</a> but medication is often not started until the symptoms have become very severe and the woman requires hospitalisation in an acute mental health unit, without her baby. This separation can compromise the developing bond between them.</p>
<p>So early diagnosis can potentially reduce the time a woman may spend in an acute mental health unit.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/postpartum-psychosis-as-we-work-to-find-causes-mothers-still-arent-getting-the-support-they-need-118283">Postpartum psychosis: as we work to find causes, mothers still aren't getting the support they need</a>
</strong>
</em>
</p>
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<h2>Admission to a mother-baby unit</h2>
<p>Best practice is to admit women and their babies to a <a href="https://www.cope.org.au/wp-content/uploads/2018/05/COPE-Perinatal-MH-Guideline_Final-2018.pdf">mother-baby unit</a>, which is usually linked to a hospital. This allows women to continue to care for their babies with the support of child and family health-care professionals. </p>
<p>However, publicly funded units are only available in Victoria, South Australia, Western Australia and Queensland. In New South Wales, two public mother-baby units <a href="https://www.smh.com.au/national/nsw/new-unit-provides-mother-and-baby-mental-health-support-to-western-sydney-20210909-p58q9v.html">are being built</a>. In NSW, the only existing one is a <a href="https://www.sjog.org.au/our-locations/st-john-of-god-burwood-hospital/our-services/mental-health-and-therapy/mother-and-baby-unit">private facility</a>, which many families cannot afford.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/historical-hospital-records-can-show-us-what-not-to-do-in-helping-psychosis-patients-46012">Historical hospital records can show us what not to do in helping psychosis patients</a>
</strong>
</em>
</p>
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<h2>Helping others</h2>
<p>The women we interviewed said they developed support networks with each other. One woman told us:</p>
<blockquote>
<p>You feel like, okay, that was such a hard experience, is there a way that we could make that a little less hard for the women who are going to go through it next time?</p>
</blockquote>
<p>Women wanted to tell their stories so others would better understand postnatal psychosis and could find it easier to get help.</p>
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<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, contact the following organisations for more information or support: <a href="https://www.panda.org.au/info-support/postnatal-psychosis">Perinatal Anxiety & Depression Australia</a> (PANDA), 1300 726 306; <a href="https://www.cope.org.au/">Centre of Perinatal Excellence</a>; <a href="https://healthyfamilies.beyondblue.org.au/pregnancy-and-new-parents/maternal-mental-health-and-wellbeing/bipolar-disorder">Beyondblue</a>,
1300 22 4636; Lifeline, 13 11 14. You can also contact your GP or go to your nearest hospital emergency department.</em></p><img src="https://counter.theconversation.com/content/170278/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Diana Jefferies does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Women can be reluctant to report worrying symptoms and when they do, these symptoms can be dismissed, our research shows.Diana Jefferies, Senior lecturer, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/735572017-03-08T09:19:45Z2017-03-08T09:19:45ZDelivering better maternal mental health care: a diagnosis<figure><img src="https://images.theconversation.com/files/158948/original/image-20170301-5492-1d9cxo3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Getting support.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/loving-hands-mothers-hand-holding-her-127196099?src=ols-XsdKc7vVysHzPM3Rsw-1-22">Shutterstock</a></span></figcaption></figure><p>Low mood and anxiety are something we all experience at various points in our lives. And the enormous changes that occur on becoming a new parent means it is a time when these symptoms are particularly common. Dealing with these issues is an important part of caring for new mothers and mothers-to-be. But we need to be wary of turning normal human emotions and experiences into medical diagnoses. </p>
<p>A staggering 81% of women who responded to a <a href="https://www.rcog.org.uk/globalassets/documents/patients/information/maternalmental-healthwomens-voices.pdf">survey</a> by the <a href="https://www.rcog.org.uk/en/">Royal College of Obstetricians and Gynaecologists</a> (RCOG) said they had experienced a maternal mental health problem. This high figure however was widely <a href="https://www.channel4.com/news/concerns-about-womens-mental-health">reported in the media</a> – but it is misleading. As the authors themselves recognised, the self-selecting nature of the survey meant that women with experiences of perinatal mental health problems were far more likely to respond.</p>
<p>There are dangers in reporting such high rates of mental health problems associated with childbirth, or in suggesting that a majority of women need the input of mental health services. An unintended consequence of such high figures is to deflect attention from those women who do require specialist care. It is vital to remember that perinatal mental illnesses, such as <a href="http://www.app-network.org">postpartum psychosis</a>, can be some of the most severe episodes dealt with by mental health services.</p>
<p>We walk a tightrope here though. Because nor should we explain away distressing mental health symptoms as common, expected and what most women experience. The survey found that some women felt their symptoms were not being taken seriously and that they were told it was normal to feel down after having a baby. A related issue is that many women who experienced anxiety or other conditions felt that their symptoms were ignored or not treated seriously enough because they did not fit into the category of postnatal depression (PND). There are many and varied mental health conditions that can occur in pregnancy and the postpartum period – and there are dangers if all are labelled under the catch all category of PND. </p>
<p>But there are positive aspects to the report’s publication. First, whatever the content, the fact that it has come from the Royal College of Obstetricians and Gynaecologists is in itself important and encouraging. As highlighted by the <a href="http://maternalmentalhealthalliance.org/">Maternal Mental Health Alliance</a> campaign, this issue is “<a href="http://everyonesbusiness.org.uk">everyone’s business</a>”. </p>
<p>Although specialist perinatal mental health teams are vital, the mental health of mothers should not be the concern of psychiatric services alone. All health care professionals who come into contact with women in the perinatal period should address both their mental and physical health. Although 85% of women reported that they were asked about their mental health, some felt that through pregnancy and the postpartum only their physical symptoms were assessed and treated.</p>
<p>In maternity services we see no better illustration of the need for “<a href="https://www.rcpsych.ac.uk/pdf/Parity%20of%20Esteem%20briefing%20Feb%202012.pdf">parity of esteem</a>” between mental and physical health. As a society we rightly spend large amounts of time and money ensuring the physical health of mothers and their babies. By comparison, we devote a tiny fraction of this effort and expense to a woman’s mental health. It is incredible that women in around half the UK (including most of Scotland, Wales and Northern Ireland and many parts of England) <a href="http://everyonesbusiness.org.uk/?page_id=349%5D">still have no access</a> to specialist perinatal community mental health teams.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=292&fit=crop&dpr=1 600w, https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=292&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=292&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=367&fit=crop&dpr=1 754w, https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=367&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/158957/original/image-20170301-5525-vstrs3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=367&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Little bundles of mixed emotions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-cute-babies-on-light-background-334090796?src=BZawPy5WReyvchvht8BBrg-2-26">Shutterstock</a></span>
</figcaption>
</figure>
<p>Secondly, through this survey we hear from those with personal experience of perinatal mental illness. Theirs is a powerful voice. It is clear to me, having researched and worked in this area for many years, that those in power do not only want to hear from clinicians and academics (if indeed they want to hear from us at all). The individual stories of those who have experienced perinatal mental illness give a human face to the messages emerging from research. The success of the “<a href="http://everyonesbusiness.org.uk">everyone’s business</a>” campaign has in no small part been due to putting the voice of women and their partners front and centre.</p>
<h2>A mother’s work</h2>
<p>Third, there are a number of very clear and important messages from the women who participated. For example, of the women who reported mental health problems it is a concern that the majority were not referred on to services or given any advice about organisations to contact for further help. More disturbingly perhaps, among women who had pre-existing mental health problems, many reported no consensus from health care professionals on whether to stop, reduce, change or continue with medication, with some describing open disagreements within the health care team. </p>
<p>Although there are undoubtedly examples of world leading perinatal mental health care in the UK, the survey revealed an unacceptably wide variation, with little evidence of the universal delivery of evidence based care on the basis of need rather than postcode. </p>
<p>We know the need. We know what to do – and it is clear that this issue does not benefit from a “one size fits all” approach. We need universal and specialist services that enable the right level of support and treatment to be delivered to the right woman at the right time – no matter what her mental health condition or where she lives. With extra funding for perinatal mental health services being delivered in some parts of the UK we are moving in the right direction. There clearly remains, however, some distance to go.</p><img src="https://counter.theconversation.com/content/73557/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Jones is a Profeesor of psychiatry at Cardiff university and a perinatal psychiatrist
He is Director of the National Centre for Mental Health (NCMH)
He is a trustee and past Chair of Action on Postpartum Psychosis
He is affiliated with the Maternal Mental Health Alliance and Chairs the Campaign Working Group of the Comic Relief funded Everyone,s Business Campaign </span></em></p>Many women are not getting the right kind of attention.Ian Jones, Professor of Psychiatry, Director of National Centre for Mental Health, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/460122015-10-27T03:19:52Z2015-10-27T03:19:52ZHistorical hospital records can show us what not to do in helping psychosis patients<figure><img src="https://images.theconversation.com/files/97387/original/image-20151006-29213-vgsb5i.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Looking at historical records gives us an idea of how we can fail to fully understand medical conditions if the patient is denied a voice.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/usaid_images/16580320022/">Photograph by Neil Brandvold for USAID</a></span></figcaption></figure><p>Looking at historical health-care records can reveal how misunderstanding of a medical condition first came to develop and why it may not be being treated properly.</p>
<p>Conditions such as postnatal psychosis – a serious mental illness affecting new mums – often incorrectly results in the woman being admitted to a general hospital or mental health facility rather than a specialist mother and baby unit. The women are mistakenly admitted because early signs are not recognised and the condition is not diagnosed until it has reached its most extreme form. </p>
<p>Greater awareness of postnatal psychosis could lead to earlier treatment and faster recovery, possibly without hospitalisation.</p>
<p><a href="http://schizophreniabulletin.oxfordjournals.org/content/39/4/748">Current statistics</a> tell us postnatal psychosis affects one to two women in every 1,000 after childbirth. That means every year more than 600 women and their babies experience its effects in Australia. <a href="http://onlinelibrary.wiley.com/enhanced/doi/10.1111/jan.12761">Research</a> into historical health-care records helps us understand how the lack of awareness of this condition developed. </p>
<h2>We’re not treating postnatal psychosis properly</h2>
<p>The <a href="http://www.blackdoginstitute.org.au/public/depression/inpregnancypostnatal/postnatalpuerperalpsychosis.cfm">symptoms of postnatal psychosis</a> appear in the first four weeks after childbirth. These include hallucinations, delusions, confused thinking and rapid mood swings.</p>
<p>There is an increased risk of suicide and, less commonly, infanticide. Another more insidious consequence is the disruption to the bonding process between the mother and child, <a href="http://www.mamamia.com.au/parenting/post-partum-psychosis-diagnosis/">possibly leading to abuse</a> or neglect of the child. This has lifelong psychological consequences. </p>
<p>All these risk factors can be avoided if the condition is diagnosed and managed in an effective and timely manner.</p>
<p><a href="http://ac.els-cdn.com/S0022395613001520/1-s2.0-S0022395613001520-main.pdf?_tid=de31ab36-44ab-11e5-86a4-00000aacb35f&acdnat=1439794246_94d480862679ffd91d08042f270bfbbb">Research recommends</a> that women experiencing postnatal psychosis be admitted to specialist mother and baby units.</p>
<p>However, a lack of awareness about the condition means some states have no publicly funded mother and baby beds, including New South Wales. Mothers experiencing the condition are often admitted to public mental health facilities which struggle to provide a safe environment for the child. </p>
<p>Women diagnosed with the condition <a href="http://link.springer.com/article/10.1007/s00737-015-0548-6">complain</a> that health-care professionals did not understand how the treatment affected them.</p>
<h2>How looking at past records can help affected women</h2>
<p>Historical health records from two former psychiatric hospitals in NSW, <a href="https://www.flickr.com/photos/state-records-nsw/3682753313">Gladesville</a> and <a href="https://en.wikipedia.org/wiki/Callan_Park_Hospital_for_the_Insane#/media/File:Mental_hospital_c_park.jpg">Callan Park</a>, were investigated. </p>
<p>The records chronicled how health-care professionals described the admission of women to the hospitals with a diagnosis of psychosis or mania following childbirth from the late 19th century to the post-WWII period. There was also an overview of each woman’s condition on admission, the progress of her illness, and the outcome of the admission. </p>
<p>There were often vague references to difficulties at home. These were described as financial worries, drink, or even just “worry”. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/97382/original/image-20151006-29213-1wo9vup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/97382/original/image-20151006-29213-1wo9vup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/97382/original/image-20151006-29213-1wo9vup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=511&fit=crop&dpr=1 600w, https://images.theconversation.com/files/97382/original/image-20151006-29213-1wo9vup.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=511&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/97382/original/image-20151006-29213-1wo9vup.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=511&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/97382/original/image-20151006-29213-1wo9vup.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=642&fit=crop&dpr=1 754w, https://images.theconversation.com/files/97382/original/image-20151006-29213-1wo9vup.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=642&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/97382/original/image-20151006-29213-1wo9vup.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=642&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Gladesville Hospital in NSW.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/state-records-nsw/3682753313">State Records NSW/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>How these particular difficulties affected the women cannot be known because one very important element was missing from the records. The voices of the women were only included in their assessment if they provided evidence that they were experiencing hallucinations or delusions. It is therefore impossible to know how the women felt about their illness, their admission, or what they may have believed caused their illness. </p>
<p>Except in a few cases, which mentioned that the baby died or had been sent to a foundling home, there was no reference to the babies.</p>
<p>The records demonstrated how the lack of the woman’s voice affected their treatment and care. </p>
<p>In the earlier records, spanning from the late 19th century to the 1930s, three separate scenarios emerged. </p>
<p>First, there were women who were admitted with a primary mental illness and whose condition steadily improved until they were discharged back to their families in a timely manner, usually in the space of a year. </p>
<p>Second, there were women who were experiencing a mental illness that became chronic and they remained in hospital until they died or were transferred to another hospital.</p>
<p>The final group of women, comprising 17% of the total, were actually physically, not mentally, ill. They experienced delirium presumably caused by an infection from the trauma of childbirth or that developed in the early postnatal period. </p>
<p>The symptoms these women displayed were described in exactly the same manner as the symptoms described in the women who had a primary mental illness. However, the outcome of the admission was very different as these women often died within a week of admission. </p>
<p>These records dated from the era before the introduction of antibiotics, making it very difficult to treat these infections. However, it is still shocking that these women were admitted to a psychiatric hospital rather than being cared for in a general hospital.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/97531/original/image-20151007-7378-1le7m4l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/97531/original/image-20151007-7378-1le7m4l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/97531/original/image-20151007-7378-1le7m4l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/97531/original/image-20151007-7378-1le7m4l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/97531/original/image-20151007-7378-1le7m4l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/97531/original/image-20151007-7378-1le7m4l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/97531/original/image-20151007-7378-1le7m4l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/97531/original/image-20151007-7378-1le7m4l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A photo of the historical records obtained by the author.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The situation changed after World War II. With the introduction of antibiotics, there were no records of women dying after being admitted to hospital with delirium caused by an infection. There was also more information about the women in the records, but again this did not come from the women. This information was provided by relatives who commented on the women’s behaviour, personality and circumstances prior to admission. </p>
<p>In the early post-war years these particular records give a glimpse of the difficulties faced by women left alone while their husbands fought overseas. And in some cases, they remained traumatised by the economic deprivations of the depression.</p>
<p>Later, in the 1950s, women continued to be admitted to Gladesville and Callan Park hospitals (although the full Callan Park health-care records are lost) but in much lower numbers. Records from Gladesville show that most of these women were discharged a little over a year later, but at least three women were discharged with misgivings. Two of the women were considered suicidal and one women was considered to be dangerous when she left the hospital. </p>
<p>In one particularly sad case, a woman fell pregnant while on leave from Gladesville but, on the advice of the medical superintendent, she had an abortion and was sterilised by tubal ligation (known colloquially as having one’s “tubes tied”) at the same time. The reason given for these procedures was that she attempted suicide during her admission. This woman was 25 years old.</p>
<p>Although many of the women described in the hospital records were discharged home, the records contained no details about how they coped at home afterwards. Despite the fact that the women were the centre of the records, we came away knowing nothing about their lives or even who they were. </p>
<p>These records provide a salutary lesson for current health-care professionals – they demonstrate how the needs of women and their children are lost if there is no record of how the women see their experience of illness. </p>
<p>If health-care professionals do not understand how women make meaning of their experience of psychosis or mania after childbirth, how can services be established that cater for the specific needs of the women and their children?</p><img src="https://counter.theconversation.com/content/46012/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Diana Jefferies does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Looking at historical health-care records can reveal how misunderstanding of a medical condition first came to develop and why it may not be being treated properly.Diana Jefferies, Lecturer in Clinical Leadership, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/424222015-10-01T20:13:31Z2015-10-01T20:13:31ZChemical messengers: how hormones affect our mood<figure><img src="https://images.theconversation.com/files/95483/original/image-20150921-19274-2bzqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some women are very sensitive to small shifts in hormones, others aren't. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/gagilas/8117584487/">Petras Gagilas/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>“It’s that time of the month – stay away from her!” </p>
<p>The process of shedding the uterine lining with vaginal bleeding every month has an obvious reproductive focus, but it has also long been linked with changes to mood and behaviour. Unfortunately, this has often been an attempt to consign women to a “biologically” determined place of inferior mental functioning.</p>
<p>In recent times, we have learnt more about the connections between the “reproductive” or gonadal hormones and the brain, and how they affect not only women but men as well. </p>
<p>Gonadal hormones (oestrogen, progesterone and testosterone) are produced by the gonads (the ovaries and testes) in response to other precursor hormones found in the pituitary gland and other brain areas. These gonadal hormones impact brain chemistry and circuitry, and hence influence emotions, mood and behaviour. </p>
<h2>Women’s hormones</h2>
<p>Oestrogen appears to be a “protective” agent in the brain. This may in part explain why some women feel worse, in terms of their mental state, in the low-oestrogen phase of their monthly cycle. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=301&fit=crop&dpr=1 600w, https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=301&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=301&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=378&fit=crop&dpr=1 754w, https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=378&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/96894/original/image-20151001-5869-1ke5waq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=378&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A ‘classic’ 28 day cycle – though many women have shorter or longer cycles.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-162580289/stock-vector-menstrual-cycle-hormone-level-average-menstrual-cycle-follicular-phase-ovulation-luteal-phase.html">Tefi/Shutterstock</a></span>
</figcaption>
</figure>
<p>Oestrogen appears to have direct impacts on dopamine and serotonin, the key brain chemicals associated with the development of depression and psychosis. In fact, animal and <a href="http://www.ncbi.nlm.nih.gov/pubmed/18678800">clinical studies</a> show that administering oestradiol (the most potent form of oestrogen) can improve symptoms of psychosis and depression. </p>
<p>The concept of PMS (premenstrual syndrome) has its believers and non-believers. But essentially, there is a group of women who experience significant mental and physical symptoms in the low-oestrogen phase of their cycle every month. </p>
<p>Then there are women with crushing depression once per month that is known as <a href="http://www.med.unc.edu/psych/wmd/mood-disorders/menstrually-related#md_pmdd">premenstrual dysphoric disorder</a> (PMDD). PMDD is a serious, real depression that can rob a woman of her functioning every month. The tricky part is that it’s not always exactly the week before bleeding, nor does it last exactly a week since many women do not have the “classic” 28-day cycle with ovulation at day 14, and bleeding for five days. If life were that simple!</p>
<p>The impact of gonadal hormones on mood is apparent at many other life stages. Around puberty, a time of major hormonal change, many girls experience various mood swings and other changes in mental health. Some women who take certain types of the combined oral contraceptive experience depressive symptoms with irritability, loss of enjoyment and even suicidal thoughts.</p>
<p>Postnatal depression and <a href="http://www.blackdoginstitute.org.au/public/depression/inpregnancypostnatal/postnatalpuerperalpsychosis.cfm">psychosis</a> are key mental illnesses related to childbirth and have a major hormonal component to the onset and course of illness. This is thought to be triggered by the sudden, rapid drop in the high levels of pregnancy hormones shortly after birth.</p>
<p>During the transition to menopause, women experience major hormonal shifts. At this time, they are 14 times more likely than usual to experience depression. This is known as <a href="http://www.med.unc.edu/psych/wmd/mood-disorders/menstrually-related#md_perimen">perimenopausal depression</a>. It affects women differently than other types of depression, causing anger, irritability, poor concentration, memory difficulties, low self-esteem, poor sleep and weight gain.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=487&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=487&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=487&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=612&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=612&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95488/original/image-20150921-20435-16zhcu2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=612&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Hormones can influence our moods at different stages of life.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-174361181/stock-photo-happy-together-grandmother-with-her-daughter-and-her-granddaughter-outdoor-in-nature.html?src=bf_Yt7mjBIgcJusVoRA0WQ-1-4">Martin Novak/www.shutterstock.com</a></span>
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<p>Perimenopausal depression isn’t well recognised and is often poorly treated with standard <a href="https://theconversation.com/some-antidepressants-work-better-than-others-now-we-know-why-17850">antidepressant therapies</a>. Women with this type of depression generally respond better to hormone treatments, but the link between depression and hormones is not often made.</p>
<p>It’s also important to note that trauma and violence can lead to <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181836/">chronically elevated levels</a> of the stress hormone cortisol, causing significant mental ill health at any time in a woman’s life. High cortisol levels have huge impacts on many brain regions, resulting in rage, suicidal thoughts, obesity and infertility.</p>
<p>There is a great deal of variation in the effects of hormone shifts on mood and behaviour. Some women are very sensitive to small shifts in gonadal hormones; others are not. </p>
<h2>Men’s hormones</h2>
<p><a href="http://www.sciencedirect.com/science/journal/10432760/12/10">Recent research</a> investigating cognition in men suggests that, just like in women, gonadal hormones influence mood and behaviour. In particular, low levels of testosterone can lead to an age-related condition called andropause. </p>
<p>Andropause is sometimes described as the “male menopause”. This is not strictly accurate since unlike female fertility, male fertility does not end abruptly with a fixed hormone decline. Andropause is caused by a significant decline in testosterone levels to below the normal range for young men. This <a href="http://www.growthhormoneigfresearch.com/article/S1096-6374(03)00061-3/abstract">can result</a> in erectile problems, diminished libido, decreased muscle strength and decreased bone mass. </p>
<p>To complicate matters, testosterone is converted to oestradiol (the most potent form of oestrogen) in men. Altered testosterone/oestradiol ratios can cause problems with memory function, depression, irritability, sleep, fatigue and occasionally even <a href="http://www.npjournal.org/article/S1555-4155(08)00522-9/abstract">hot flushes</a>.</p>
<p>There is controversy about how much of these changes are a normal part of ageing. Many other factors such as obesity, diabetes and excessive alcohol consumption can also cause low testosterone levels. So andropause should not be viewed as a disease, but as a clinical syndrome with a great deal of variability. </p>
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<img alt="" src="https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/96895/original/image-20151001-5873-k73jgi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Testosterone levels reduce with age.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-303241304/stock-photo-senior-hands-resting.html?src=GZ9pbd1c2opZCvLnDXfSrg-1-97">carballo/Shutterstock</a></span>
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<p>In some men, testosterone-replacement has been used successfully to treat andropause. But this needs to be done under strict medical supervision because of the many potential side effects including prostate problems, elevated cholesterol and increased rage. </p>
<p>A great deal more research is required in both men and women on the role of gonadal hormones and mental health. But the era of splitting the mind from the body should be long gone. </p>
<p><em>This article is part of an occasional series, <a href="https://theconversation.com/au/topics/chemical-messengers">Chemical Messengers</a>, on hormones and the body.</em></p><img src="https://counter.theconversation.com/content/42422/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jayashri Kulkarni receives funding from the NHMRC, ARC, several pharmaceutical companies for clinical trials research. This article is independently written and has no source of funding and no conflict of interest.</span></em></p>In recent times, we have learnt more about the connections between the “reproductive” or gonadal hormones and the brain, and how they affect not only women but men as well.Jayashri Kulkarni, Professor of Psychiatry, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.