Postnatal depression

Postnatal depression

Postnatal depression is a type of depression. Many parents experience it after having a baby.

It’s a common problem, affecting more than 1 in every 10 mothers within a year of giving birth. It can also affect fathers and partners, although this is less common.

With the right support, which can include self-help strategies and therapy, most people make a full recovery.

Symptoms of postnatal depression

Postnatal depression affects everyone differently. It can start at any point in the first year after giving birth. It can continue from depression in pregnancy. It may develop suddenly or gradually.

Many people feel a bit down, tearful or anxious in the first week after giving birth. This is often called the ‘baby blues’ and is so common that it’s considered normal. The baby blues don’t last for more than 2 weeks after giving birth.

If your symptoms last longer or start later, you could have postnatal depression.

The main symptoms of postnatal depression include:

• a persistent feeling of sadness and low mood
• loss of interest in the world around you
• no longer enjoying things that used to give you pleasure
• lack of energy and feeling tired all the time
• trouble sleeping at night
• feeling sleepy during the day
• feeling that you’re unable to look after your baby
• problems concentrating and making decisions
• loss of appetite or an increased appetite (comfort eating)
• feeling agitated, irritable or very apathetic (you ‘can’t be bothered’)
• feelings of guilt, hopelessness and self-blame
• difficulty bonding with your baby – feeling of indifference and no sense of enjoyment in their company
• frightening thoughts, for example, about hurting your baby – these can be scary, but they’re very rarely acted upon
• thinking about suicide and self-harm

These symptoms can affect your day-to-day life and your relationships with your baby, family and friends.

Speak to your GP or health visitor as soon as possible if:

• you think you have postnatal depression

Don’t struggle on alone and hope the problem will go away. It can take a lot longer to feel better if it’s not addressed.

Spotting the signs of postnatal depression

Postnatal depression can develop gradually and it can be hard to recognise. Some parents may avoid talking to family and friends about how they’re feeling. This may be because they worry they’ll be judged for not coping or not appearing happy.

Signs for partners, family and friends to look out for in new parents include:

• frequently crying for no obvious reason
• having difficulty bonding with their baby
• getting no pleasure from playing with them or feeling no good as a parent
• withdrawing from contact with other people
• speaking negatively all the time and claiming that they’re hopeless
• neglecting themselves, like not washing or changing their clothes
• losing all sense of time, like being unaware whether 10 minutes or 2 hours have passed
• losing their sense of humour
• constantly worrying that something is wrong with their baby, regardless of reassurance from others

If you think someone you know is depressed, encourage them to talk about their feelings. This could be to talk to you, a friend, their GP or their health visitor.

Causes of postnatal depression

The cause of postnatal depression isn’t completely clear. Some of the factors it has been associated with include:

• a history of mental health problems, particularly depression, earlier in life or during pregnancy
• having no close family or friends to support you
• a poor relationship with your partner
• recent stressful life events, like a bereavement
• experiencing the ‘baby blues’

Even if you don’t have any of these symptoms, having a baby is a life-changing event that can sometimes trigger depression.

It often takes time to adapt to becoming a new parent. Looking after a small baby can be stressful and exhausting.

Treating postnatal depression

Postnatal depression can be lonely, distressing and frightening. But, support and treatments are available. With the right treatment and support, most people make a full recovery, although it can take time.

Talk to your GP about the pros and cons of different treatments so you can decide together what’s best for you.

Your GP might also want to check your physical health to see if there are any problems that may need to be addressed as well. For example, you may be anaemic after giving birth. This could add to any feelings of depression you might have.

Psychological treatments for postnatal depression

Psychological therapies are usually the first treatment recommended for postnatal depression.

Guided self-help

Guided self-help involves working through a book or an online course. You can do this on your own or with some help from a therapist.

It focusses on the issues you might be facing, with practical advice on how to deal with them.

The courses typically last 9 to 12 weeks.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a type of talking therapy. It’s 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.

CBT can be carried out either one-to-one with a therapist or in a group. Treatment will often last 3 to 4 months.

Interpersonal therapy

Interpersonal therapy (IPT) involves talking to a therapist about the problems you’re experiencing.

It aims to identify problems in your relationships with family, friends or partners. It then looks at how they might relate to your feelings of depression.

Treatment also usually lasts 3 to 4 months.

Antidepressants

Antidepressants may be recommended if:

• you have moderate or severe depression
• you don’t want to try psychological treatment
• psychological treatment doesn’t help
• you have mild postnatal depression and a previous history of depression

They can help ease symptoms like:

• low mood
• irritability
• lack of concentration
• sleeplessness

This helps you to function normally and helps you cope better with your new baby.

Antidepressants usually need to be taken for at least a week before the benefit starts to be felt. This means it’s important to keep taking them even if you don’t notice an improvement straight away. You’ll usually need to take them for around 6 months after you begin to feel better. If you stop too early, your depression may return.

If you’re breastfeeding, talk to your doctor about suitable medicines. Some types of antidepressants are safe to take while breastfeeding.
Your doctor should explain any risks of taking antidepressants. You should be offered the type with the least risk for you and your baby.

Self-help

There are many things you can try yourself to improve your symptoms and help you cope.

Do

• talk to your partner, friends and family to help them understand how you’re feeling
• talk to your loved ones about what they can do to support you
• accept help from others when it’s offered
• ask your loved ones if they can help look after the baby and do tasks like housework, cooking and shopping
• make time for yourself – try to do activities that you find relaxing and enjoyable
• rest when you can – although it can be difficult when you’re looking after a baby, try to sleep whenever you get the chance
• follow good sleeping habits
• ask your partner to help with the night-time work
• exercise regularly – this has been shown to help boost mood in people with mild depression
• eat regular, healthy meals

Don’t

• do not go for long periods without eating
• do not drink alcohol or take drugs, as this can make you feel worse

Support groups

Ask your health visitor about support services in your area. They may be able to put you in touch with a social worker, counsellor or local support group. It can be reassuring to meet other people who are going through something similar.

Find postnatal depression support and information in your area

Treatments for severe postnatal depression

You might be referred to a specialist perinatal mental health team if your depression:

• is very severe
• doesn’t respond to treatment like antidepressants, self-help or therapy

Your team might be able to offer other treatments, like:

• more intensive CBT
• other psychological treatments, like psychotherapy
• therapies such as baby massage which can improve depression and help build your relationships with your baby
• different medications
• electroconvulsive therapy (ECT) where electrodes are placed on your head and pulses of electricity are sent through the brain

For a small number of people, coming into hospital can help speed up recovery.

You may be offered a place in a Mother and Baby Unit, where you can continue to look after your baby while you get the best treatment for your illness.