Postnatal Depression is what happens when you become depressed after having a baby. There may be an obvious reason, but often there is none. It can be particularly distressing when you have looked forward to having your baby through the months of pregnancy. You may feel guilty for feeling like this, or even feel that you can't cope with being a mother. It can last for weeks or several months.

Mild PND can be helped by increased support from family and friends, more severe PND will need help from your GP, health visitor or, in some cases, mental health professionals.

 

How common is it?

Around 1 in every 10 women has PND after having a baby. Without treatment it can last for months, or rarely years.

What does it feel like to have PND?

Depressed - You feel low, unhappy and wretched for much or all of the time. You may feel worse at particular times of the day, like mornings or evenings. Occasional good days give you hope but they are followed by bad days which make you despair.

Irritable - You may get irritable with other children, occasionally, with your baby, but most often with your partner. He or she may well not understand what is happening.

Tired - All new mothers get pretty weary, but depression can make you feel so utterly exhausted that you feel physically ill.

Sleepless - Even though you are tired, you can't fall asleep. You wake at the crack of dawn, even if your partner has fed the baby overnight.

Not hungry - You lose your appetite and forget to eat, which can make you feel irritable and run down. Some people eat for comfort and then feel bad about putting on weight.

Unable to enjoy anything - You find that you can't enjoy or be interested in anything.

Sex - Your partner may want the comfort and intimacy of sex again but you're just not interested. Of course, there are other reasons to lose interest in sex after having a baby - it may be painful, you may be too tired, or you may be just trying to adjust to the new situation - but PND will take away any desire or enthusiasm. If your partner does not understand this, they may feel rejected.

Unable to cope - PND can make you feel that you have no time, can't do anything well, and that you can't do anything about it. You may find it hard to organise a routine with your baby.

Guilty - Depression changes your thinking and makes you see things negatively. You may feel guilty, useless or that you are responsible for feeling like this.

Anxious - You may worry so much that your baby might scream, or choke, or be harmed in some way that you are afraid to be alone with him or her. Instead of feeling close to your baby, you may feel detached. You can't work out what your baby is feeling, or what your baby needs. Even if you have strong loving feelings for your baby, you can still feel anxious. Most new mothers worry about their baby's health, but PND can make this overwhelming.

You may worry:

That you might lose your baby through an infection, mishandling, faulty development or a 'cot death'

About 'snuffles', or how much weight your baby is putting on

If your baby is crying or is too quiet, or if they have stopped breathing

That you might harm your baby

About your own health

- You may find that you need reassurance all the time from your partner, the health visitor, the GP, your family or a neighbour.

- You may feel panicky - your pulse races, your heart thumps and you may feel that you have heart disease or are on the brink of a stroke.

- You may wonder if you have some dreadful illness, or if you will ever have any energy again.

The fear of being left alone with all this can cause even the most capable person to cling desperately to their partner, not wanting to be left alone.

Doesn't everybody get depressed after having a baby?

 No. About half of new mothers will feel a bit weepy, flat and unsure of themselves on the third or fourth day after having a baby. This is known as the 'baby blues', and it passes after a few days.

When does PND happen?

Most cases of PND start within a month of giving birth, but it can start up to six months later.

What causes PND?

We don't know enough to be sure who will or won't get it. There is probably no single reason, but a number of different stresses may add up to cause it.

You are more likely to have PND if you:

have had depression (especially PND) before

do not have a supportive partner

have a premature or sick baby

lost your own mother when you were a child

have had several recent life stresses - bereavement, unemployment, housing or money problems

Even so, PND can start for no obvious reason, without any of these stresses. And having these problems does not mean that you will definitely have PND.

What about hormones?

Levels of oestrogen, progesterone (and other hormones to do with conception and birth) drop suddenly after the baby is born. It's not clear exactly how they affect your mood and emotions. No real differences have been found between women who do and do not get PND, and research does not suggest that this is a major reason for depression. Hormone changes may be more important in the baby blues and puerperal psychosis.

Do women with PND harm their babies?

Depressed mothers often worry that they might do this, but it is rare. Occasionally, through utter tiredness and desperation, you might feel like hitting or shaking your baby. Many mothers (and fathers) occasionally feel like this, not just those with PND. In spite of having these feelings at times, most mothers never act on them. The problem is more likely to be a crippling worry that you might harm your baby. If you do feel like this, tell someone. Your health visitor or doctor will be able to help.

Women with special needs:

Mothers who have a mental illness or a physical or learning disability, do face extra difficulties. Professionals should try to make sure that they get the help and support they need to stay well and look after their baby.

What can be done? The first thing is to recognise the depression for what it is and not to dismiss it as the 'baby blues'. You may not realise what is wrong, or feel ashamed to admit that you are less than thrilled by being a mother. You may worry that, if you do, your baby may be taken away but your doctor, health visitor or midwife are most concerned with helping you get better so you can enjoy and care for your baby at home. People are now more aware of depression in general, so PND shouldn't be missed so often. A questionnaire, such as the Edinburgh Postnatal Depression Scale, can be used to help health visitors and GPs to spot the signs of PND.

Self-help

 We don't yet know enough about PND to prevent it in the first place, but certain principles make sense:

During pregnancy:

DON'T try to be 'superwoman'. Try to do less and make sure that you don't get over-tired. If you are working, make sure you get regular meals and put your feet up in the lunch hour.

DON'T move house (if you can help it!) while you are pregnant or until the baby is six months old.

DO make friends with other women or couples who are expecting or have just had a baby; among other things, this could lead to baby-sitting arrangements.

DO find someone you can talk to. If you don't have a close friend you can turn to, the National Childbirth Trust or MAMA - their local groups are very supportive both before and after childbirth (see page 17).

DO go to antenatal classes - and take your partner with you.

DO keep in touch with your GP and your health visitor if you have suffered PND before. Any signs of PND can be recognised early.

After the baby has arrived:

DO tell someone about how you feel. Many other women have gone through the same experience. If you don't feel you can talk to your family or friends, talk to your health visitor or GP. They will know that these feelings are common and will be able to help.

DO take every opportunity to get your head down. See if you can cat-nap. Your partner can give the baby a bottle-feed at night. If you like, you can use your own expressed breast milk for this.

DO eat well. Healthy foods like salads, fresh vegetables, fruit, fruit juices, milk and cereals are all nice, packed with vitamins and don't need much cooking.

DO find time to have fun with your partner. Try to find a baby-sitter and get out together for a meal, a show or to see friends.

DO let yourself and your partner be intimate if you can: at least kiss and cuddle, stroke and fondle. This will comfort you both and lead to the return of full sexual feelings sooner. Don't feel guilty if this takes some time.

DON'T blame yourself or your partner: life is tough at this time, and tiredness and irritability on both sides can lead to quarrels. 'Having a go' at each other will weaken your relationship when it needs to be at its strongest.

Don't be frightened by the diagnosis. You know what is wrong, that many others have had the same experience and that you will get better in time. Your partner, friends or family can be more helpful and understanding if they know what the problem is.

Ways for other people to help

Don't be shocked or disappointed if your wife, partner, sister or girlfriend confesses that she has felt awful since the birth of her baby. Take the time to listen and make sure that she gets the support and help she needs. Try not to be shocked or disappointed by a diagnosis of PND - it is common and can be effectively helped. Do all you can to help with the practical things that need to be done, while your partner does not feel up to doing them - shopping, feeding and changing the baby, or housework. Make sure that you are clear about what is happening. Get advice on how to help, especially if you are the mother's partner. Make sure that you have some support yourself. If this is a first baby, you may feel pushed to one side, both by the baby and by your partner's needs. Try not to feel resentful. Your partner needs your support and encouragement. Practical help with the baby, sympathetic listening, patience, affection and being positive will go a long way. Your partner will appreciate this even when the depression is over.

Getting Help

Doctors and nurses should regularly ask about the mental health of mothers to be. So, they may ask three questions: During the last month, have you been bothered by feeling down, depressed or hopeless? During the last month, have you been bothered by having little interest in pleasure or in doing things? Is this something you feel you need or want help with? If you are referred for psychological help while pregnant, you should be seen within a month. Professionals should take into account the needs of your partner and any children you have. There should be a specialist service a perinatal mental health service for women who are pregnant or who have given birth.

What if I don't want treatment?

Most women will get better without any treatment after a period of weeks, months or sometimes longer. However, this can mean a lot of suffering. PND can spoil the experience of new motherhood, and strain your relationship with your baby and partner. So the shorter it lasts, the better. It's important to get help as soon as possible, to relieve the depression, to support your relationship with your baby, and to help your baby's development in the long run. You should be told about all the likely benefits and risks of treatment so you can make the best choice for you.

What about talking treatments?

It can be a great relief just to talk to a sympathetic, understanding, uncritical listener - this could be a friend, a relative, a volunteer or a professional. Many general practices now have a counsellor, and trained health visitors can help treat PND. There are more specialised psychological treatments. Cognitive Behavioural Therapy can help you to see how some of your ways of thinking and behaving may be making you depressed and help you to change them. Other psychotherapies can help you to understand the depression in terms of your relationships or what has happened to you in the past. These can be arranged through your GP with a community psychiatric nurse, a psychologist or a psychiatrist.

Are there problems with these treatments?

These treatments are usually very safe, but they can have unwanted effects. Talking about things may bring up bad memories from the past and this can make you low or distressed. Psychotherapy can put a strain on a relationship with their partner. Make sure that you can trust your therapist and that they have the necessary training. Another problem with talking therapies is that they are still hard to get in some areas. There are long waiting lists, so you may not get any treatment for quite a while.

What about medication?

If you have a more severe depression, or it has not improved with support and reassurance, one of the antidepressant drugs will probably help. Antidepressants take two weeks or so to start working and should be taken for around six months after you start to feel better. How do they work? It is not entirely clear, but antidepressants affect the activity of two chemicals in the brain, serotonin (also called 5HT) and noradrenaline.

Do antidepressants have side effects?

Some may cause nausea or an increase in anxiety at first, but these usually wear off. Others can make you sleepy or give you a dry mouth. Make sure that your doctor knows that you are breast-feeding. For many antidepressants, there is no evidence that they cause problems for breastfed babies, so breastfeeding is usually possible. However, such a decision is an individual one for each woman and your doctor can provide additional advice. Some people get withdrawal symptoms when they stop these medicines, so it's best to come off them slowly. For more information, see our fact sheet on antidepressants. Hormones have been suggested as a treatment for PND. However, there is little evidence that they work, and they have their own dangers, particularly if you have had thromboses (blood clots in the veins) of any sort.

Are there alternatives?

There is some evidence that regular exercise can boost your mood and help you to feel less isolated. You may find it easier to do this with other people.

So which treatment is best?

Everyone can try the simple measures outlined in this leaflet. Talking treatments and antidepressants are equally effective, but antidepressants are more likely to be recommended if the depression is severe or has gone on for a long time. They also work a bit quicker than talking treatments. Talking treatments and antidepressants can be given together. Your GP or health visitor can give information and advice.

FINALLY, even if you have been depressed for a while, support, counselling and medication can all help you to get better. It's never too late.

 

 

References Antidepressant treatment for post-natal depression (2001) Hoffbrand S., Howard L. and Crawley H., Cochrane Review. This article compares antidepressant treatment and counselling, find it at: www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002018/pdf_fs.html Depression in postpartum and non-postpartum women: prevalence and risk factors (2002) Eberhard-Gran, M. et al. Acta Psychiatrica Scandinavica, Vol 106, 426-433. Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression 2: Impact on the mother-child relationship and child outcome (2003) Murray L. et al. British Journal of Psychiatry, Vol 182: 420-427 Edinburgh Postnatal Depression Scale (EPDS) (1987) Cox J. L., Holden J. M., Sagovsky R., British Journal of Psychiatry, Vol. 150 : 782-786 Find this article at: www.wellmother.com/articles/edinburgh.htm Antenatal and postnatal mental health: clinical management and service guidance. NICE Clinical Guideline 45. (2007) National Institute for Clinical Excellence: London Find this document at: www.nice.org.uk/CG45 Can we identify mothers at risk for postpartum depression in the immediate postpartum period using the Edinburgh Postnatal Depression Scale? (2004) Dennis C. L., Journal of Affective Disorders, Vol. 78, no. 2, p. 163-169 Oestrogens and progestogens for preventing and treating postnatal depression (1999) Dennis, CL., Ross, LE., Herxheimer, A. Cochrane Database of Systematic Reviews, Issue 3. The Cochrane Collaboration, John Wiley & Sons, Ltd. Find this article at: www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001690/pdf_fs.html t PND. Ref: RCP