Postnatal depression

Postnatal depression affects many new mums. This article discusses what causes postnatal depression, common symptoms as well as options for treatment.

Here we explore questions most commonly asked about postnatal depression:
What is postnatal depression?
What causes it?
Common symptoms
How does postnatal depression affect relationships?
Seeking help
What can you do?
Treatment for postnatal depression
Getting better
Further information

Postnatal depression (PND) can seem very isolating and women who experience it often feel unable to make sense of their own feelings or seek help. Feeling down and admitting that you might need treatment for depression does not mean you’re a failure or a bad parent.

Watch the video below and see NCT member, Annie Meier, from London, bravely talk about her experience of postnatal depression; the symptoms she experienced, how it made her feel and how she coped.

What is postnatal depression?

This is a form of depression that can happen gradually or all of a sudden, and can range from being relatively mild to very hard-hitting. It is estimated that at least one in 10 women suffer from PND, and it can start within one or two months of giving birth, although it can also be several months after having a baby before symptoms start to appear.

Partners' mental and emotional health can also be affected at this time. Both parents may also be affected by concern for the other.

Not all depression experienced by women who have given birth is defined as PND. Women with young babies may be diagnosed with depression that is not related to her having given birth, for instance.

Some new mums can experience a short period of feeling emotional and tearful, which has become known as the 'baby blues'. The ‘baby blues’ can start a couple of days after birth and last a few hours or days with weepiness and sad feelings being the most common symptoms.

The baby blues, unlike PND, does not normally require special treatment. Understanding and emotional support will help.

Very rarely, a new mum may experience an extremely severe form of postnatal depression, known as puerperal psychosis.

What causes postnatal depression?

PND can affect a new mum regardless of her family or personal circumstances. You may have managed happily with your first baby and yet become depressed after your second, or the other way around. There is no single answer as to why some new mums are affected by PND and not others but there are a number of different possibilities.

Strain of becoming a parent

Becoming a parent can be both rewarding and fulfilling. However, the stress and daily pressures of being a new parent and suddenly being responsible, 24-hours a day, for another human being can be daunting. New mums can find themselves alone at home, with no adults to talk to. Feeling totally exhausted at the same time as getting to grips with a new baby can be a shock to the system.

Anxiety

Some women say they don’t feel depressed but have high anxiety levels. Anxiety can have an effect on both your body and mind. It’s worth talking to your GP or health visitor to see whether what you are experiencing is anxiety rather than depression.

Additional strain

Being under additional strain for any reason, can also increase the likelihood of becoming depressed - more so than biological or hormonal factors. The cause could be an illness or death in the family, or moving house or changing job. It could also be the result of longer-term difficulties, such as being unemployed, financial worries, general lack of support or relationship difficulties.

Difficult labour

Some women, unfortunately, can have a difficult labour with a long and painful delivery, an unplanned caesarean section or emergency treatment. As a result, they may suffer from a form of post-traumatic stress disorder (PTSD) rather than PND.

A new mum can feel disappointed that childbirth was not the experience she was hoping for. Women who suffer traumatic childbirth should be treated for trauma and helped to deal with their experience, to minimise the risk of developing long-term depression.

Antenatal depression

If you have had feelings of low mood, depression or anxiety before or during pregnancy, you are also more likely to experience depression after birth.

Common symptoms

Women experiencing PND may go through one or more of the following experiences, although it's extremely unlikely that they will go through all of them. They might:

  • Feel very low, or despondent, that life is a long, grey tunnel, and that there is no hope. Feel tired and very lethargic, or even quite numb. Not want to do anything or take an interest in the outside world.
  • Feel a sense of inadequacy or unable to cope.
  • Feel guilty about not coping, or about not loving their baby enough.
  • Be unusually irritable, which makes their guilt worse.
  • Want to cry/cry a lot or even constantly.
  • Have obsessive and irrational thoughts which can be very scary.
  • Lose their appetite, which may go with feeling hungry all the time, but being unable to eat.
  • Have difficulty sleeping: either not getting to sleep, waking early, or having vivid nightmares.
  • Be hostile or indifferent to their partner and/or baby.
  • Have panic attacks, which strike at any time, causing rapid heartbeat, sweaty palms and feelings of sickness or faintness.
  • Have an overpowering anxiety, often about things that wouldn't normally bother them, such as being alone in the house.
  • Have difficulty in concentrating or making decisions.
  • Experience physical symptoms, such as headaches.
  • Have obsessive fears about the baby's health or wellbeing, or about themselves and other members of the family.
  • Have disturbing thoughts about harming themselves or their baby.
  • Have thoughts about death.

How does postnatal depression affect relationships?

In the same way as other forms of depression, depression after childbirth can affect a new mum’s personal relationships with her baby, partner, older children, family and friends.

It can be a tough time - not just for mum - but for those closest to her. If everyone is aware that she needs support - and they have support too – it can make a big difference to everyone’s wellbeing.

It may be difficult, upsetting and frustrating to live with someone who has PND, but it's important not to blame them for how they are feeling and avoid being judgemental.

Perhaps the most important thing to recognise is that someone suffering from PND may need encouragement to seek help, and support to get it. Help them to find someone to talk to in depth, and reassure them that they will feel better.

Seeking help

After having a baby, if you feel low and think you might be suffering from depression, it can be particularly hard to talk about those feelings – especially at a time when everyone else expects you to be happy despite the challenges of being a new parent.

You might feel reluctant to seek help and reveal any negative feelings because of the fear of what people might think of you and what might happen to you or your baby. Attitudes to mental health have changed in recent years and new parents should always be supported and listened to. Sharing your worries and feelings is an important first step and can make a positive difference to how you feel.

If you are concerned that you are depressed, talk to your GP or health visitor. You may be asked to fill in a multiple choice questionnaire, called the ‘Edinburgh Postnatal Depression Scale (EPDS)’, about how you are feeling. It can help assess your situation by focusing on certain symptoms and any difficulties you are facing.

What can you do?

These suggestions are relevant for all parents but especially for those who think they might be experiencing depression.

  • Share your feelings with people you trust. It's important to feel understood and supported. A sympathetic listener, who can hear about your feelings and worries without judging, can bring enormous relief. It could be a health visitor, a friend or a counsellor.
  • Give yourself time to adjust to motherhood and recover from giving birth.
  • One of the most helpful things is to talk to other mums and dads – it can be very reassuring to find that all new parents share the same anxieties and frustrations. Meeting others in the same position will give you a chance to share skills and experiences, to realise you are not alone, and above all get some emotional and practical support. Call NCT to find out what’s happening in your area on 0300 330 0700.
  • Try and get help with the childcare and take some time for yourself, even an hour here and there can make a difference.
  • Take some exercise each day, like a walk with the buggy or swimming: exercise has a positive effect on mood and sense of wellbeing.
  • Maintain a healthy diet; eating badly or skipping meals can make you feel tired and irritable, so try to eat simple and nutritious meals.
  • Accept help and support from your partner, family and friends. Try to share as many jobs around the house as possible, for instance. Allowing people to support you and your partner through this time will make things easier.

Find out if there is a PND support group in your area, talking to others who are feeling similar to yourself can be very helpful and reassuring.

Treatment for postnatal depression

There are a range of approaches for treating PND which include:

  • Counselling and therapy
  • Medication

Your GP should be able to give you any information you need to help you make a choice that feels right for you. Some people respond better to one method rather than another. Talk about it with your GP, or other specialist services and organisations, such as: Mind (in England and Wales), Well Scotland or Niamh (in Northern Ireland). Details for contacting these organisations can be found at the end of this page.

Counselling and therapy
Talking treatments, such as counselling and psychotherapy, offer you the opportunity to look at the underlying factors that have contributed to PND, as well as helping you to change the way you feel.

If a friend or someone you know recommends a therapist, this can be a great way to find someone. If you don't feel that the method of therapy or the therapist isn't working for you, you can always change and try someone else. Private practitioners will charge a fee for their services so this will probably be another factor in your decision.

Whoever you choose, make sure your therapist is registered with an accredited body, such as the British Association for Counselling and Psychotherapy (BACP), United Kingdom Council for Psychotherapy (UKCP) or British Psychoanalytic Council (BPC). You could also contact your Community Mental Health Team.

Medication
Your GP may prescribe antidepressants which can help to ease many of the symptoms of moderate or severe PND and give you some breathing space to adjust to the changes involved in becoming a parent.

Antidepressants are prescribed for at least six months, often longer, as it may take several weeks to reach their full effectiveness. During this time they may initially heighten some of your symptoms, such as insomnia and anxiety. In addition, when you stop taking them, it’s advisable to do so slowly in order to avoid any withdrawal side effects.

Women with symptoms of PND can often be reluctant to take medication, due to the fear of becoming dependant and possible effects if they are breastfeeding. If you are prescribed antidepressants for PND and you are breastfeeding, check with your GP that they are appropriate to take.

Getting better

Recognising you might be experiencing PND and seeking help can be hard; but it is the first step towards feeling better. No new parent should feel embarrassed or ashamed about feeling low or depressed or that they can’t talk about it. The recovery from PND is gradual but with help and support it can get better.

Further information

NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700. See also NCT's evidence based briefings on mental health before, during and after childbirth.

You might find attending one of NCT's Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

You might also like to try one of our Relax, Stretch and Breathe classes, which aim to help improve your physical and emotional wellbeing, as well as feel more confident and positive.

Mind, a leading mental health charity, provides information on a range of mental health topics including postnatal depression and has an infoline for support: 0300 123 3393.

See also The Association for Postnatal Illness and Postnatal Depression.

NHS Choices has information on postnatal depression.

The Royal College of Psychiatrists has information on postnatal depression.

Effective psychotherapeutic treatments may be found in your area. Check out the British Association for Counselling & Psychotherapy, the United Kingdom Council for Psychotherapy (UKCP) and the British Psychoanalytic Council (BPC) for a list of recommended therapists. Well Scotland or Niamh (in Northern Ireland), leading providers of mental health information in their regions, for further information on PND.