Postnatal depression (PND) affects many new mums. If you are wondering if you have postnatal depression; read about the causes, signs, symptoms and treatment for PND here.
Here we explore questions most commonly asked about postnatal depression:
- What is postnatal depression?
- What causes postnatal depression?
- Signs and symptoms of postnatal depression
- What can you do if you think you have PND?
- Seeking help
- Postnatal depression treatment
- How does postnatal depression affect relationships?
- Getting better: postnatal depression recovery
- 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. And don't forget that you are not alone.
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.
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.
Sadly, some mums suffer from postpartum psychosis, which is a more serious (and very different) illness that affects around one in every 1,000 women. The symptoms include hallucinations, delusional thinking and disruption of perception, emotions and behavior. Medical help should be sought as a matter of urgency if this is suspected.
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.
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.
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.
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.
Post-traumatic stress disorder (PTSD)
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), which is different to PND. If you or your partner are suffering from trauma following childbirth (symptoms include flashbacks, nightmares, anxiety and avoiding things which remind you of what happened), it’s important to seek help. If the symptoms persist for more than four weeks, you may have developed PTSD. This can be treated with various forms of talking therapy. If left untreated, it can have a negative impact on people’s lives and relationships for many years, so do seek help.
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. Symptoms can include:
- Feeling very low, or despondent, that life is a long, grey tunnel, and that there is no hope. Feeling tired and very lethargic, or even quite numb. Not wanting to do anything or take an interest in the outside world.
- Feeling a sense of inadequacy or unable to cope.
- Feeling guilty about not coping, or about not loving their baby enough.
- Being unusually irritable, which makes the guilt worse.
- Wanting to cry/cry a lot or even constantly.
- Having obsessive and irrational thoughts which can be very scary.
- Loss of appetite, which may go with feeling hungry all the time but being unable to eat.
- Comfort eating.
- Having difficulty sleeping: either not getting to sleep, waking early, or having vivid nightmares.
- Being hostile or indifferent to their partner and/or baby.
- Having panic attacks, which strike at any time, causing rapid heartbeat, sweaty palms and feelings of sickness or faintness.
- Having an overpowering anxiety, often about things that wouldn't normally bother them, such as being alone in the house.
- Having difficulty in concentrating or making decisions.
- Experiencing physical symptoms, such as headaches.
- Having obsessive fears about baby's health or wellbeing, or about themselves and other members of the family.
- Having disturbing thoughts about harming themselves or their baby.
- Having thoughts about death and/or suicide.
Every mum experiences PND differently and some specific symptoms may not be listed here but if you're aware that you don't feel quite ‘right’ within yourself, seek professional help.
These suggestions are relevant for all parents but especially for those who think they might be experiencing depression.
- Seek professional help to talk through how you're feeling.
- 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.
- You could try mindfulness, which is a way of paying more attention to the present moment – to your own thoughts and feelings, and to the world around you – which can improve your mental wellbeing.
- 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.
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 which is a postnatal depression test 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. It's so important to be honest when you feel in this questionnaire as it can help you get the support and treatment you might need.
There are a range of approaches for treating PND which include:
- Counselling and therapy
- Cognitive behavioural therapy (CBT)
- Peer support groups
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.
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. The risk of insomnia might be reduced by taking medication earlier in the morning – but never stop or change medication without medical advice.
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.
Peer support in the right environment can be of great benefit to mothers affected by antenatal depression and PND. Speaking to someone who has been through what you’re going through and who has recovered allows mums to see they can get better (see #PNDHour below). However, do check that these groups are properly safeguarded with well-trained staff and volunteers, who have access to clinical supervision and support for themselves.
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. Both parents may also be affected by concern for the other.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.
It's also important to say that a partner's mental and emotional health can also be affected at this time.
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.
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.
#PNDHour is an online peer support group that runs every Wednesday at 8pm via the Twitter account @PNDandMe. Anyone can join in to discuss topics about antenatal and postnatal depression, such as self-care, medication and seeking help. It’s run by a mum called Rosey who also blogs about her own experiences with antenatal and postnatal depression, as well as raising awareness of perinatal mental illness, at PND and me.
We are grateful to Dr Andrew Mayers, a psychologist specialising in child and family mental health (particularly perinatal mental illness) and sleep (especially children), for his help in reviewing the information on this page.
The Association for Postnatal Illness is a charity that provides support to mothers suffering from postnatal illness and increases public awareness of the illness.
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.