Postnatal depression

What is postnatal depression (PND)?

Postnatal depression (PND) is more than just feeling a bit low, it is a persisting depressed mood that in severe cases can become overwhelming, making it hard to look after yourself and your baby. It usually occurs within the first six weeks of the birth, but it can start several months after having a baby and may last for more than a year.

What are the common causes of postnatal depression?

There is no single cause, but it is thought that women are more likely to have PND if they:

• Have had previous mental health problems, including depression
• Suffered from antenatal depression or anxiety during pregnancy
• Lack support from their family and friends
• Have had a recent stressful event such as bereavement or a broken relationship.

How common is PND?

PND is more common than many people realise with 10-15 women in every 100 being affected after having a baby. It can often go undiagnosed, as some women don’t recognise that they have PND even though they are feeling very low, or they choose to ignore their symptoms because they are worried that people will think badly of them.

What are the signs and symptoms of postnatal depression?

PND has many similar symptoms to general depression. Signs to look out for include:

• Feeling low, unhappy and tearful most of the time
• Loss of interest and enjoyment in things that used to give pleasure
• Lack of energy and feeling exhausted all the time being unable to sleep, even when exhausted
• Feeling anxious and irritable
• Appetite changes
• Wanting to avoid people
• Feelings of guilt and self-blame
• Lack of concentration
• Low self-esteem
• Thinking about self-harming or suicide
• Feeling hostile or indifferent to your partner
• Feeling hostile or indifferent to your baby
• No interest in sex   

How is the severity of postnatal depression assessed?

Your GP will want to know about your symptoms and will ask you questions about how you are feeling. It’s important that you give honest answers as knowing about your symptoms, along with their severity and persistence, will help your GP decide whether your depression is mild, moderate or severe.

What is the treatment for postnatal depression?

Talk to your health visitor or GP if you think that your feelings are more than just the “baby blues” we hear about. Don’t feel ashamed or scared to be honest about how you feel. It’s the first step to getting better if you have PND.

Your doctor will talk to you about what treatment is available, including the risks and benefits, so that you can decide together what is right for you. The good news is that with the right help and support your mood will improve which is why you should always talk to your health care professional.

There are 3 main treatment options for postnatal depression (PND):

• Self-help measures
• Therapy
• Medication

Self-help measures

If your symptoms are mild or moderate, your doctor may suggest the following things you can try yourself:

• Talk to your partner, family or close friends—be honest about how you’re feeling so they can understand and support you
• Accept help when offered and ask for help from loved ones—practical things like food shopping or looking after baby so that you get a much-needed rest can help share the load
• Find some “me time”—anything you enjoy or that relaxes you is great, maybe a walk, reading, watching a favourite film, an indulgent bubble bath, etc
• Rest when you can—take a nap when baby sleeps (rather than worrying about the state of the house) and ask your partner or a family member to help when baby is awake at night
• Enjoy regular exercise—great for release of mood-boosting hormones and general well-being
• Eat healthily at regular intervals—don’t skip meals
• Don’t drink alcohol or take drugs—They can worsen your mood and affect your ability to care for your baby.

Therapy

These are called psychological treatments and include:

Guided self-help

This could be an online course or book that you work through on your own or with help from a therapist. Courses can last 9–12 weeks and offer advice on how to cope with the issues you might be facing.

Cognitive behavioural therapy (CBT)

CBT is a talking therapy that combines examining both what you think and what you do. How you think about certain situations can affect how you feel and behave, often negatively. And this can become a cycle.

A therapist will work with you to identify and ultimately change negative thinking and behaviour patterns to help you feel differently and then behave differently, in a more positive way.

Sessions might be one-to-one with a therapist, in a small group, using a self-help book or online. A course may consist of a 1-hour weekly session lasting 6-12 weeks. 

Interpersonal therapy (IPT)

In IPT you talk to a therapist one-to-one about things you’re finding difficult. You’ll examine past and current relationships with family, your partner or friends to identify any issues and how they may be affecting how you feel. This course of treatment may last 3–4 months.

Medication

Your doctor may recommend antidepressants if you have moderate or severe PND. This could be instead of therapy if you don’t want that, or if therapy hasn’t worked for you.

Your doctor may also suggest that you try antidepressants as well as therapy if you’ve tried both on their own and they haven’t worked.

How do antidepressants for postnatal depression work?

Certain chemicals in your brain (e.g. noradrenalin and serotonin) are thought to help regulate mood and emotion. Antidepressants boost these levels of chemicals, which may improve mood. They can help you function normally so that you are better able to look after yourself and your baby.

Your doctor should prescribe the lowest effective dose that will treat your depression. You should take them every day and remember you may not feel any better until several weeks after you start taking them. It’s really important to stick with them if you don’t feel an immediate improvement. Once you start to feel better it’s typical that you’ll take them for another 6 months.

Types of antidepressants

There are different types of antidepressants, all doing pretty much the same thing but with potentially different effects. Your doctor will choose an antidepressant which best suits your needs. Factors include whether you suffer from anxiety as well as low mood, if your sleep is especially poor or if you have had depression in the past what worked for you then.

Antidepressants and breastfeeding

With many antidepressants there is no evidence that they cause problems for breastfed babies. Your doctor should explain the risk of the medicine passing to your baby through breast milk and possible side effects weighed against the benefits of breastfeeding. Discuss any worries you have with your doctor or midwife and they advise which antidepressant is most suitable for you while breast feeding.

What are talking therapies for postnatal depression?

Counselling, cognitive behavioural therapy (CBT) or interpersonal therapy (IPT) may also be suggested. Talking to a counsellor can help you deal with the negative thoughts that can come from depression. CBT is a talking therapy that helps you to manage problems better by thinking and behaving in a different way.

What medication is used for postnatal depression?

 

If your depression is more severe, antidepressants may be prescribed. Your GP will choose the best one for you and if you are breastfeeding will take this into account. Antidepressants are taken every day and can take two weeks or more before they start to work. You may need to take them for a length of time but they are not addictive. Your GP will monitor you to see how you are getting on.

Whatever treatment you have, it’s really important that you tell the people closest to you how you are feeling so that they can understand and help and support you.

Is PND treatment important?

 

If you don’t get treatment you could suffer from PND for months. Some mothers who haven’t had treatment still suffer from postpartum depression after a year. This can mean that the enjoyment of being a new mother is spoilt and your relationship with the baby and your partner is put under a great deal of strain.

When should I seek urgent help for postnatal depression?

If you have thoughts of suicide or planning to harm yourself, or cannot look after yourself or your baby you must seek help at once. Ask for a same day appointment with your GP. They can arrange for you to see a mental health professional that day. If it is out of hours contact the GP ‘On Call service’ or go to the local Emergency Department.

Other mental health problems around childbirth

Postpartum (Puerperal) Psychosis 

This is a very serious illness that affects one in 1000 women after childbirth. It usually starts within days or weeks of childbirth and can develop in a few hours. It often leads to rapid mood swings, both high and low. Some sufferers believe things are not true (delusions) and see and hear things that are not there (hallucinations).

Women who have had a previous history of mental illness or who have had a severe illness following a previous delivery are at higher risk of postpartum psychosis, so it is important to discuss any previous history with your healthcare professionals during pregnancy.

Postpartum psychosis can be life threatening so urgent treatment is required. Hospital treatment may be needed, ideally in a specialist mother and baby unit. With the right treatment the vast majority of women make a full recovery.

Postnatal Anxiety

Postnatal anxiety is something that many new mothers experience after having their baby. You can find out more about postnatal anxiety here.

Help and advice that's available

There are a number of organisations that offer information and support to women and their families who are suffering from antenatal and postnatal depression.

Pre and Postnatal Depression Advice and Support (PANDAS) opens in a new window

Association of Post Natal Illness opens in a new window

MIND (the mental illness charity) opens in a new window

Best beginnings opens in a new window