Fact Sheet 9: Postnatal Depression
- what it's like to have postnatal depression
- how to help yourself
- how partners, families and friends can help
- when to seek help from your GP or mental health services
- further sources of help and information
What is postnatal depression?
Postnatal Depression is a depressive illness which affects between 10 to 15 in every 100 women having a baby. The symptoms are similar to those in depression at other times. These include low mood and other symptoms lasting at least two weeks. Depending on the severity, you may struggle to look after yourself and your baby. You may find simple tasks difficult to manage.
Sometimes there is an obvious reason for PND, but not always. You may feel distressed, or guilty for feeling like this, as you expected to be happy about having a baby. However, PND can happen to anyone and it is not your fault.
It's never too late to seek help. Even if you have been depressed for a while, you can get better. The help you need depends on how severe your illness is. Mild PND can be helped by increased support from family and friends.
When does PND happen?
The timing varies. PND often starts within one or two months of giving birth. It can start several months after having a baby. About a third of women with PND have symptoms which started in pregnancy and continue after birth.
What does it feel like to have PND?
You may have some or all of the following symptoms:
You feel low, unhappy and tearful for much or all of the time. You may feel worse at certain times of the day, like mornings or evenings.
All new mothers get pretty tired. Depression can make you feel utterly exhausted and lacking in energy.
Even though you are tired, you can't fall asleep. You may lie awake worrying about things. You wake during the night even when your baby is asleep. You may wake very early, before your baby wakes up.
- Appetite changes
You may lose your appetite and forget to eat. Some women eat for comfort and then feel bad about gaining weight.
- Unable to enjoy anything
You find that you can't enjoy or be interested in anything. You may not enjoy being with your baby.
- Loss of interest in sex
There are several reasons why you lose interest in sex after having a baby. It may be painful or you may be too tired. PND can take away any desire. Your partner may not understand this and feel rejected.
- Negative and guilty thoughts
Depression changes your thinking:
- you may have very negative thoughts
- you might think that you are not a good mother or that your baby doesn't love you
- you may feel guilty for feeling like this or that this is your fault
- you may lose your confidence
- you might think you can't cope with things
Most new mothers worry about their babies' health. If you have PND, the anxiety can be overwhelming. You may worry that:
- your baby is very ill
- your baby is not putting on enough weight
- your baby is crying too much and you can't settle him/her
- your baby is too quiet and might have stopped breathing
- you might harm your baby
- you have a physical illness
- your PND will never get better
When you feel anxious, you may have some of the following:
- racing pulse
- thumping heart
- fear that you may have a heart attack or collapse
- Avoid other people
You may not want to see friends and family. You might find it hard to go to postnatal support groups.
You may feel that things will never get better. You may think that life is not worth living. You may even wonder whether your family would be better off without you.
- Thoughts of suicide
If you have thoughts about harming yourself, you should ask your doctor for help. If you have a strong urge to harm yourself, seek urgent help (see list of doctors with admitting rights).
- Psychotic symptoms
A small number of women with very severe depression develop psychotic symptoms. They may hear voices and have unusual beliefs. If this happens, you should seek help urgently.
How does PND affect how I feel about my baby?
- You may feel guilty that you don't feel the way you expected to.
- You may or may not love your baby.
- You may not feel close to your baby.
- You might find it hard to work out what your baby is feeling, or what your baby needs.
- You may resent the baby or blame the baby for the way you feel.
Do women with PND harm their babies?
Depressed mothers often worry that they might do this, but it is very 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. If you do feel like this, tell someone.
Doesn't everyone get depressed after having a baby?
Having a baby is a time of huge change. It is common to feel many different emotions. Not everyone gets a depressive illness.
Over half of new mothers will experience the 'baby blues'. This usually starts 3 to 4 days after birth. You may have mood swings. You may burst into tears easily. You can feel irritable, low and anxious at times. You may also over-react to things. It usually stops by the time your baby is about 10 days old. Women with baby blues do not need treatment. If it continues for more than 2 weeks, seek help.
Other mental health problems around childbirth
Depression and anxiety are the most common mental health problems in pregnancy. They affect 10-15 in every 100 women. Depression in pregnancy can be helped in much the same way as postnatal depression. Women also experience a range of other mental health problems during pregnancy, just like at other times.
Postpartum (puerperal) psychosis
This is the most severe type of mental illness that happens after having a baby. It affects around 1 in 1000 women and starts within days or weeks of childbirth. It can develop in a few hours and can be life-threatening, so needs urgent treatment.
There are many symptoms that may occur. Your mood may be high or low and there are often rapid mood swings. Women often experience psychotic symptoms. They may believe things that are not true (delusions) or see or hear things that are not there (hallucinations).
This illness always needs medical help and support. You may have to go into hospital. Ideally, this should be to a specialist mother and baby unit where your baby can go with you.
Women who have had previous episodes of severe mental illness, particularly bipolar disorder, are at a high risk of postpartum psychosis. Women, who have had a severe episode of illness following a previous delivery, are also at very high risk. Let your doctor or midwife know about this. You can discuss with them ways to increase the chances of you staying well.
Although puerperal psychosis is a serious condition, the vast majority of women make a full recovery.
Other mental health problems after childbirth
You may have had a mental illness before pregnancy. Your symptoms may get worse or return after your baby is born. Just as at other times, women can experience many types of mental health problems. If you are worried about any type of mental illness, discuss this with your doctor. They can make sure you get the help and support you need.
What causes PND?
Many possible causes for PND have been suggested. 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 mental health problems, including depression before
- have had depression or anxiety during pregnancy
- do not have support from family or friends
- have had a recent stressful event - e.g. death of someone close to you, relationship ending, losing a job
PND can start for no obvious reason, without any of these causes. Also having these problems does not mean that you will definitely have PND.
Can postnatal depression be prevented?
We don't know enough about PND to prevent it in the first place. The following suggestions seem sensible and may help to keep you well.
- Don't try to be 'superwoman'. Try to do less and make sure that you don't get over-tired.
- Do make friends with other women who are pregnant or have just had a baby. It may be more difficult to make new friends if you get PND.
- Do go to antenatal classes. If you have a partner, take them with you. If not take a friend or relative.
- Don't stop antidepressant medication during pregnancy without advice. Around 7 in 10 women who stop antidepressants in pregnancy relapse if they stop the medication. You need to discuss the risks and benefits of continuing treatment in pregnancy and breastfeeding.
- Do make sure that you have treatment for depression in pregnancy. This may be a talking therapy or medication.
- Do accept offers of help from friends and family.
Recognising postnatal depression
The first thing is to recognise you have had a depressive illness. Don't dismiss it as the 'baby blues'. Don't assume it's normal to feel like this when coping with a baby.
There are lots of reasons why women delay seeking help. You may:
- not realise what is wrong
- worry about what other people think
- feel ashamed to admit that you are not enjoying being a mother
People are now more aware of depression in general. This means PND shouldn't be missed so often.
Where to get help
The help and treatment you need depends on how severe your PND is.
Everyone can try the self-help suggestions below. If this is not enough, you might benefit from a talking therapy. For more severe depression, you may need medication, with or without talking therapy.
Only a few women will need to go into hospital for treatment of PND. In that case, you should usually be admitted with your baby to a specialist Mother and Baby Unit.
If you cannot look after yourself or your baby, or if you have plans to harm yourself, you should be seen urgently by:
- your doctor;
- a mental health service - your doctor can arrange this.
- Don't be frightened by the diagnosis. Many women have postnatal depression and you will get better in time. Your partner, friends or family can be more helpful and understanding if they know what the problem is.
- Do tell someone about how you feel. It can be a huge relief to talk to someone understanding. This may be your partner, a relative or friend. If you can't talk to your family or friends, talk to your health visitor or doctor. They will know that these feelings are common and will be able to help.
- Do take every opportunity to get some sleep or rest during the day or night. If you have a helpful partner, relative or friend, ask them to feed the baby at night sometimes. You can use your own expressed breast milk, or formula milk for this. If you are on your own, try and rest when the baby sleeps.
- Do try to eat regularly, even if you don't feel like eating. Eat healthy food.
- Do find time to do things you enjoy or help you relax - e.g. go for a walk, read a magazine, listen to music.
- If you have a partner, do try to enjoy some time together. If you are a single mother, try to do something enjoyable with a friend or family member.
- Do go to local groups for new mothers or postnatal support groups. Your health visitor can tell you about groups in your area. You may not feel like going to these groups if your are depressed. See if someone can go with you. You may find the support of other new mothers helpful. You may find some women who feel the same way as you do.
- Do let others help you with housework, shopping and looking after other children.
- Do some exercise. Walking with your baby in the pram is good exercise. Regular exercise can boost your mood.
- Do use self-help books and websites.
- Do contact organisations that support women with Postnatal Depression.
- Don't blame yourself, your partner or close friends or relatives. Life is tough at this time, and tiredness and irritability can lead to quarrels. 'Having a go' at your partner can weaken your relationship when it needs to be at its strongest. The same can happen with other close family or friends who are trying to support you.
- Don't use alcohol or drugs. They may make you feel better for a short time, but it doesn't last. Alcohol and drugs can make depression worse. They are also bad for your physical health.
How partners, family and friends can help
- Don't be shocked or disappointed if your partner, friend or relative says she has postnatal depression. It is common and can be effectively helped.
- Make sure that you understand what postnatal depression is.
- It's helpful just to spend time with someone who is depressed. It is important to listen and to offer encouragement and support. Reassure her that she will get better.
- Take your partner, relative or friend seriously if she talks about not wanting to live or about harming herself. Make sure she seeks help urgently (see section above on Urgent Help).
- Encourage your partner, relative and friend to get the help and treatment she needs. If you have any worries about treatment, discuss these with the doctor.
- Do all you can to help with the practical things. This includes feeding and changing the baby, shopping, cooking or housework.
- 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 help and support.
- Fathers can also get depressed after the birth of a baby. This may be more likely if the mother also has postnatal depression. If you are a father and think you may have depression, talk to your doctor. It is important for you and your family that you get the help you need.
Why is treatment important?
Most women will get better without any treatment within 3 to 6 months. 1 in 4 mothers with PND are still depressed when their child is one-year-old. However, this can mean a lot of suffering. PND can spoil the experience of new motherhood. It can strain your relationship with your baby and partner. You may not look after your baby, or yourself, as well as you would when you are well. PND can affect your child's development and behavior even after the depression has ended. So the shorter it lasts, the better.
Which treatments are available?
The treatment you need depends on how unwell you are. You should be told about all the likely benefits and risks of treatment so you can make the best choice for you.
- talking treatments
Talking about your feelings can be helpful, however depressed you are. Sometimes, it's hard to express your feeling to someone close to you. Talking to a trained counselor or therapist can be easier. It can be a relief to tell someone how you feel. It can also help you to understand and make sense of your difficulties.
There are also more specialised psychological treatments. Cognitive Behavioral Therapy can help you to see how some of your ways of thinking and behaving may be making you depressed. You can learn to change these thoughts which have a positive effect on other symptoms. Other psychotherapies can help you to understand the depression in terms of your relationships or what has happened to you in the past.
Are there problem with talking treatments?
Talking treatments are usually very safe, but they can have unwanted effects. Talking about things may bring up bad memories from the past. This can make you low or distressed. Psychotherapy can put a strain on relationships with people close to you.
Make sure that you can trust your therapist and that they have the necessary training.
If you have a more severe depression, or it has not improved with support or a talking therapy, an antidepressant will probably help.
There are several types of antidepressants. They all work equally well, but have different side-effects. They are not addictive. They can all be used in PND, but some are safer than others if you are breastfeeding.
Antidepressants take at least 2 weeks to start working. You will need to take them for around 6 months after your start to feel better.
Are antidepressants safe in breastfeeding?
Make sure that your doctor knows that you are breastfeeding. For many antidepressants, there is no evidence that they cause problems for breastfed babies, so breastfeeding is usually possible.
However, the decision is an individual one for each woman. Some antidepressants have been used in breastfeeding for many years. There is less information about newer medications. You doctor can provide up-to-date information and advice.
To decide whether to breastfeed when taking an antidepressant, you need to think about:
- how severe your illness is (or has been in the past)
- treatments which have helped you before
- up-to-date information about the safety of medication in breastfeeding
- the benefits of breastfeeding
- whether your baby is very premature or has any health problems
- the impact of the untreated illness on your baby
What about hormonal treatments?
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 thrombosis (blood clots in their veins).