Postnatal depression

Introduction

Find everything you need to know about postnatal depression including causes, symptoms, diagnosis and treatment, with links to other useful resources.

Postnatal depression is a type of depression some women experience after they have had a baby.

It usually develops in the first four to six weeks after childbirth, although in some cases it may not develop for several months.

There are many symptoms of postnatal depression, such as low mood, feeling unable to cope and difficulty sleeping, but many women are not aware they have the condition.

Its common to experience mood changes, irritability and episodes of tearfulness after birth – the so-called baby blues. These normally clear up within a few weeks. But if a woman experiences persistent symptoms, it could well be the result of postnatal depression.

It is important for partners, family and friends to recognise signs of postnatal depression as early as possible and seek professional advice.

Read more information about the signs and symptoms of postnatal depression.

Its very important to understand that postnatal depression is an illness. Having it does not mean you do not love or care for your baby.

Treating postnatal depression

Postnatal depression can be lonely, distressing and frightening, but there are many treatments available.

As long as postnatal depression is recognised and treated, it is a temporary condition you can recover from.

It is very important to seek treatment if you think you (or your partner) have postnatal depression.

The condition is unlikely to get better by itself quickly and it could impact on the care of the baby.

Treatment for postnatal depression includes:

Read more about the treatment of postnatal depression.

Why do I have post natal depression?

The cause of postnatal depression isnt clear, but its thought to be the result of several things rather than a single cause. These may include:

  • the physical and emotional stress of looking after a newborn baby
  • hormonal changes that occur shortly after pregnancy; it is thought some women may be more sensitive to hormones than others
  • individual social circumstances such as money worries, poor social support or relationship problems

Women might be more at risk of developing post natal depression if they:

  • have a previous history of depression or other mood disorders such as bipolar disorder
  • have a previous history of postnatal depression
  • experience depression or anxiety during pregnancy

Read more about the causes of postnatal depression.

Who is affected

Postnatal depression is more common than many people realise and cases can often go undiagnosed.

It is estimated around one-in-seven women experience some level of depression in the first three months after giving birth.

Rates of postnatal depression are highest in teenage mothers and is thought to affect all ethnic groups equally.

Depression
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.

Symptoms of postnatal depression

The key symptoms of postnatal depression are a persistent feeling of sadness and low mood, lack of energy and lack of interest and enjoyment

Postnatal depression can affect women in different ways. They can begin to have symptoms soon after the birth which can last for months, or in severe cases for more than a year.

Key symptoms are:

  • a persistent feeling of sadness and low mood
  • loss of interest in the world around you and no longer enjoying things that used to give pleasure
  • lack of energy and feeling tired all the time (fatigue)

Other symptoms can include:

  • disturbed sleep, such as not being able to fall asleep during the night (insomnia) and then being sleepy during the day
  • difficulties with concentration and making decisions
  • low self-confidence
  • poor appetite or an increase in appetite (comfort eating)
  • feeling very agitated or alternatively very apathetic (can’t be bothered)
  • feelings of guilt and self-blame
  • thinking about suicide and self-harming

Postnatal depression can interfere with your day-to-day life. Some women feel unable to look after their baby, or feel too anxious to leave the house or keep in touch with friends.

Frightening thoughts

Some women who have postnatal depression get thoughts about harming their baby. This is quite common, affecting around half of all women with the condition. You may also have thoughts about harming or killing yourself. These thoughts do not mean you are a bad mother, and it is very rare for either mother or baby to be harmed.

However, it is vital you see your GP if you have these or other symptoms of postnatal depression. Treatment will benefit both your health and the healthy development of your baby, as well as your relationship with your partner, family and friends.

Seeking help for postnatal depression does not mean you are a bad mother or unable to cope.

Spotting the signs in others

Many mothers do not recognise they have postnatal depression, and do not talk to family and friends about their true feelings.

Its therefore important for partners, family members and friends to recognise signs of postnatal depression at an early stage. Warning signs include:

  • They frequently cry for no obvious reason.
  • They have difficulties bonding with their baby.
  • They seem to be neglecting themselves – for example, not washing or changing clothes.
  • They seem to have lost all sense of time – often unaware if 10 minutes or two hours have passed.
  • They lose all sense of humour and cannot see the funny side of anything.
  • They worry something is wrong with their baby, regardless of reassurance.

If you think someone you know has postnatal depression, encourage them to open up and talk about their feelings to you, a friend, GP or health visitor. 

Postnatal depression needs to be properly treated and isnt something you can just snap out of.

Postnatal psychosis

A rarer and more serious mental health condition that can develop after birth is known as postnatal psychosis, thought to affect around 1 in 1,000 women.

Symptoms of postnatal psychosis include:

  • bipolar-like symptoms – feeling depressed one moment and very happy the next
  • believing things that are obviously untrue and illogical (delusions) – often relating to the baby, such as thinking the baby is dying or that either you or the baby have magical powers
  • seeing and hearing things that are not really there (hallucination) – this is often hearing voices telling you to harm the baby

Postnatal psychosis is regarded as an emergency. If you are concerned someone you know may have developed postnatal psychosis, contact your GP immediately. If this is not possible, call NHS Direct on 0845 46 47 or your local out-of-hours service.

If you think there is a danger of imminent harm to you, your partner or your baby, call your local A&E services and ask to speak to the duty psychiatrist.  

Postnatal OCD

Some women develop a mental health condition called obsessive compulsive disorder (OCD) after giving birth. People with OCD experience unwanted (and often unpleasant) thoughts, images or urges (obsessions) that cause them to feel a need to carry out repetitive behaviours (compulsions) to avoid the realisation of these obsessions.

OCD can often be treated with behavioural therapy or medication.

You can find out more about this type of OCD on the Maternal OCD website and the OCD-UK website.

Causes of postnatal depression

Most experts think postnatal depression does not usually have a single cause, but is the result of a combination of factors

The cause of postnatal depression is not completely clear. Most experts think postnatal depression is the result of a combination of things.

These may include:

  • depression during pregnancy
  • a difficult delivery
  • lack of support at home
  • relationship worries
  • money problems
  • having no close family or friends around you
  • physical health problems following the birth, such as urinary incontinence (loss of bladder control), or persistent pain from an episiotomy scar or a forceps delivery

Even if your life is free of these problems and you had a straightforward pregnancy or labour, simply having a baby can be a stressful and life-changing event that can trigger depression.

People often assume they will naturally adapt to parenthood overnight. But it can take months before people begin to cope with the pressures of being a new parent. This is true even for those who already have children.

In addition, some babies are more difficult and demanding than others, and dont settle so easily. This can lead to exhaustion and stress.

Whos at risk

Factors that can increase your risk of having postnatal depression include:

  • a family history of depression or postnatal depression (genetics appears to play a role in both of these conditions but exactly how is still unclear)
  • having experienced depression or postnatal depression previously, or other mood disorders such as bipolar disorder

The role of hormones

Huge changes in hormone levels during and after pregnancy were once believed to be the sole cause of postnatal depression. This is no longer thought to be the case, although hormonal changes may still play a part.

One theory is that some women are more sensitive to the effects of falling hormone levels after they have given birth. All mothers will experience hormonal changes but only some mothers will be affected emotionally.

Its possible that this, as well as the stress of looking after a baby or money problems, may trigger the depression.

Depression
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.
Incontinence
Incontinence is when you pass urine (urinal incontinence), stools or gas (faecal incontinence), because you cannot control your bladder or bowels.

Diagnosing postnatal depression

Your GP will want to know about how you have been feeling over the past month

Your GP should be able to diagnose postnatal depression by asking two questions:

  • During the past month, have you often been bothered by feeling down, depressed or hopeless?
  • During the past month, have you often been bothered by taking little or no pleasure in doing things that normally make you happy?

If the answer to either of these is yes, then it is possible you have postnatal depression. If the answer is yes to both, postnatal depression is probable.

Depending on your answers, you may also be asked whether you feel you need or want help.

Some mothers, especially those without a partner or relative to help care for their baby, can be reluctant to provide honest answers to these questions. This is because some worry that a diagnosis of postnatal depression will mean they are seen as a bad mother and that there is a chance their baby will be taken into care.

It should be stressed that a baby will only be taken into care in the most exceptional of circumstances. One of the prime goals of treatment of postnatal depression is to help you care for and bond with your baby.

Even if symptoms of your postnatal depression are so severe you require treatment at a mental health clinic, specialist mother and baby clinics are available.

Other tests

Sometimes, your GP may carry out a blood test to make sure there is not a physical reason for symptoms like tiredness and low mood, such as an underactive thyroid gland or anaemia (lack of red blood cells which can lead to tiredness). These conditions often occur after having a baby.

Sometimes your GP or health visitor may ask you to complete a questionnaire, such as the Edinburgh Postnatal Depression Scale (EPDS). This can help assess your situation by focusing on certain symptoms and difficulties commonly encountered in postnatal depression. It can also help to track your response to treatment as you get better.

Assessing the severity of postnatal depression

If your GP suspects postnatal depression, they will want to know your symptoms so they can assess how severe it is.

They will want to know if you have:

  • disturbed sleep
  • problems concentrating or making decisions
  • low self-confidence
  • a loss of appetite or increased appetite (comfort eating is often a symptom of depression)
  • been feeling anxious
  • been feeling tired, listless and reluctant to undertake physical activity
  • been feeling guilty or self-critical
  • been experiencing suicidal thoughts

Honesty is important when answering these questions as providing your GP with accurate information will ensure you receive appropriate treatment.

If you have three of the above symptoms, it is likely you have mild depression.

If you have five or six symptoms, it is likely you have moderate depression. People with moderate depression will have great difficulty carrying out normal activities.

The number of symptoms you have in total, and above all their severity and persistence, will help your doctor decide whether your depression is mild, moderate or severe.

If you have all of the above symptoms, it is likely you have severe depression. People with severe depression are unable to function at all, and almost always need help from a dedicated mental health team.

Blood test
During a blood test, a sample of blood is taken from a vein using a needle, so it can be examined in a laboratory.
Depressed
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.
Thyroid
The thyroid is a jointed piece or cartilage that encloses the vocal cords and forms the Adam’s apple in men.

Treating postnatal depression

Treatment options for postnatal depression include cognitive behavioural therapy and antidepressants

If you think you have postnatal depression speak to your GP, midwife or health visitor as soon as possible.

It is important for you and your family to remember it can take some time to recover fully from the condition.

Common treatments and help for postnatal depression are detailed below.

Support and advice

The most important first step in managing postnatal depression is recognising the problem and taking action to deal with it. The support and understanding of your partner, family and friends plays a big part in your recovery.

However, to benefit from this, it is important for you to talk to those close to you and explain how you feel. Bottling everything up can cause tension, particularly with your partner, who may feel shut out.

Support and advice from social workers or counsellors can be helpful. Self-help groups can also provide good advice about how to cope with the effects of postnatal depression, and you may find it reassuring to meet other women who feel the same as you.

Ask your health visitor about the services in your area.

Exercise

Exercise has been proven to help depression, and is one of the main treatments if you have mild depression.

Your GP may refer you to a qualified fitness trainer for an exercise scheme or you can find out more about starting exercise here.

Read more about exercise for depression.

Psychological treatments

Psychological therapies are usually recommended as the first line of treatment for mild-to-moderate postnatal depression for women with no previous history of mental health conditions.

Some common ones are discussed below.

Guided self-help

Guided self-help is based on the principle that your GP can help you to help yourself.

For example, your GP can provide self-help manuals detailing types of issues you might be facing and practical advice on how to deal with them. They also contain information on using cognitive behavioral techniques to help combat feelings of helplessness (see below for more information).

Your GP may also give details about an interactive computer programme, available via the internet, called Beating the Blues. This again takes a cognitive behavioral approach to battling depression.

Talking therapies

Talking therapies are where you are encouraged to talk through problems either one-to-one with a counsellor or with a group.

You can then discuss ways to approach problems in a more positive manner.

Two widely used talking therapies used in the treatment of postnatal depression are:

  • cognitive behavioural therapy
  • interpersonal therapy

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a type of therapy based on the idea that unhelpful and unrealistic thinking leads to negative behaviour.

CBT aims to break this cycle and find new ways of thinking that can help you behave in a more positive way.

For example, thinking there is a perfect ideal of motherly behaviour is both unrealistic and unhelpful. All mothers are human and humans make mistakes. It is neither necessary nor helpful to try and be “Supermum”.

CBT is usually provided in four-to-six weekly sessions.

Interpersonal therapy

Interpersonal therapy (IPT) aims to identify whether your relationships with others may be contributing toward feelings of depression.

Again, IPT is usually provided in four-to-six weekly sessions.

Antidepressants

The use of antidepressants may be recommended if:

  • You have moderate postnatal depression and a previous history of depression.
  • You have severe postnatal depression.
  • You have not responded to counselling or CBT, or would prefer to try tablets first.

A combination of talking therapies and an antidepressant may be recommended.

Antidepressants work by balancing mood-altering chemicals in your brain. They can help ease symptoms such as low mood, irritability, lack of concentration and sleeplessness, allowing you to function normally and helping you cope better with your new baby.

Contrary to popular myth, antidepressants are not addictive. A course usually lasts six-to-nine months.

Antidepressants take two-to-four weeks to start working, so it is important to keep taking them even if you dont notice an improvement straight away. It is also important to continue taking your medicine for the full length of time recommended by your doctor. If you stop too early, depression may return.

Between 50% and 70% of women who have moderate to severe postnatal depression improve within a few weeks of starting antidepressants. However, antidepressants are not effective for everyone. 

Antidepressants and breastfeeding

The selective serotonin reuptake inhibitors (SSRI) types of antidepressants are usually recommended for women who are breastfeeding. 

Tests have shown the amount of these types of antidepressants found in breast milk is so small it is unlikely to be harmful.

Side effects of SSRIs include:

  • feeling sick
  • blurred vision
  • diarrhoea or constipation
  • dizziness  
  • feeling agitated or shaky
  • insomnia (not sleeping well) or feeling very sleepy

These side effects should pass once your body gets used to the medication.

Discuss feeding options with your GP when youre making decisions about taking antidepressants.

Many mothers are keen to continue breastfeeding because they feel it helps them to bond with their child and boosts their self-esteem and confidence in maternal abilities. These are important factors in combating symptoms of postnatal depression.

Treating severe postnatal depression

Referral

You may be referred to a mental health team if your postnatal depression is severe, or does not respond to treatment. These teams are usually made up of a range of specialists, including psychologists, psychiatrists, specialist nurses and occupational therapists, and can provide intensive talking treatments such as psychotherapy.

If it is felt your postnatal depression is so severe you are at risk of harming yourself or your baby, you may be admitted to hospital or referred to a mental health clinic. If you have support available from your partner or family, it may be recommended they care for your baby until you are well enough to return home.

If you do not have support available to help you care for your baby, or your mental health team feels separation from your baby would adversely affect your recovery, you may be recommended for transfer to a specialised mother and baby mental health clinic.

Your baby may have to sleep in a separate nursery until you are well enough to look after them. Once your symptoms begin to respond to treatment, your baby will sleep in your room.

Medication

A small number of women develop symptoms of psychosis after birth (being unable to tell the difference between reality and their imagination).

If this happens to you, you may be treated with a combination of:

  • mood-stabling medications such as lithium or an anti-epileptic drug
  • an antipsychotic (this helps combat the symptoms of psychosis)
  • a tranquiliser, such as a benzodiazepine to help relax you

You cannot breastfeed while taking these types of medications, so your baby will have to be bottle-fed.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) may be recommended if you have severe postnatal depression, but is only used when antidepressants and other treatments have not worked.

If ECT is recommended, you will be given a general anaesthetic and medication to relax your muscles. Electrodes are placed on your head and a pulse of electricity passed through your brain. Most people have either six or twelve sessions of ECT, normally with two sessions a week.

For most people, ECT is effective in relieving severe depression, but it is necessary to take antidepressants afterwards to keep symptoms under control. Its unclear how ECT works, but the generally agreed view is that electricity changes the chemical composition of the brain in such a way as to elevate mood.

Some people experience unpleasant side effects after having ECT, including headaches and both short-term and long-term memory loss. Due to the risk of memory loss, your memory will be assessed at the end of each ECT session.

If it looks like your memory is being affected, or you experience other adverse side effects, then the ECT sessions will be stopped.

However, most people tolerate ECT very well.

Antidepressants
Antidepressant medicine is used to treat depression. For example fluoxetine, paroxetine.
Anxiety
Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen.
Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Counselling
Counselling is guided discussion with an independent trained person, to help you find your own answers to a problem or issue.
Depression
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.
Dose
Dose is a measured quantity of a medicine to be taken at any one time, such as a specified amount of medication.

Preventing postnatal depression

To try to prevent postnatal depression you should inform your GP about any previous periods of depression that you have had or if you have felt very low

To try to prevent postnatal depression, tell your GP about any previous depression you have had or if you have felt very low or anxious during your pregnancy.

Also speak to your GP if you have had postnatal depression in the past and are pregnant or considering having another baby, as there can be a risk you will develop postnatal depression again.

Keeping your GP informed will ensure they are aware of the possibility of postnatal depression after your baby is born. This helps prevent delay in diagnosis, and allows treatment to begin earlier. In the early stages, postnatal depression can be easy to miss.

It is difficult to estimate the exact risk of a women developing postnatal depression as many factors are involved, including:

  • previous medical history
  • individual social and psychological circumstances
  • current relationships
  • complications during labour

Even if you have a high risk of developing postnatal depression, it can be avoided. Getting support from your GP, midwife and other healthcare professionals will help reduce your risk of developing postnatal depression.

The following self-help measures can also be useful:

  • Get as much rest and relaxation as possible.
  • Take regular gentle exercise.
  • Dont go for long periods without food because low blood sugar levels can make you feel much worse.
  • Dont drink too much alcohol because heavy drinking can make you feel worse.
  • Eat a healthy, balanced diet.
  • Dont try to do everything at once. Make a list of things to do and set realistic goals.
  • Talk about your worries with your partner, close family and friends.
  • Contact local support groups or national helplines for advice and support.
  • Dont try to be Supermum. Avoid extra challenges either during pregnancy or in the first year after your baby is born. A new baby is enough of a challenge for most people.
  • Dont despair. Postnatal depression can affect anyone. You are not to blame.

Preventative treatment

If your risk of developing postnatal depression is thought to be especially high, your GP or the doctor in charge of your care may recommend you start taking antidepressants as a precaution shortly or soon after giving birth.

Similarly, if you have a history of bipolar disorder or psychosis, you may be advised to start taking lithium shortly before or after the birth. Lithium has a mood-stabilising effect and can often help prevent psychosis reoccurring.

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Depression
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.

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