Postnatal depression

Introduction

Postnatal depression is a type of depression that many parents experience after having a baby.

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

It’s important to seek help as soon as possible if you think you might be depressed, as your symptoms could last months or get worse and have a significant impact on you, your baby and your family.

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

Symptoms of postnatal depression

Many women 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 two weeks after giving birth. 

If your symptoms last longer or start later, you could have postnatal depression. Postnatal depression can start any time in the first year after giving birth.

Signs that you or someone you know might be depressed include:

• a persistent feeling of sadness and low mood
• lack of enjoyment and loss of interest in the wider world
• lack of energy and feeling tired all the time
• trouble sleeping at night and feeling sleepy during the day
• difficulty bonding with your baby
• withdrawing from contact with other people
• problems concentrating and making decisions
• frightening thoughts – for example, about hurting your baby

Many women don’t realise they have postnatal depression, because it can develop gradually.

Read more about the symptoms of postnatal depression.

Getting help for postnatal depression

Speak to your GP or health visitor if you think you may be depressed. Many health visitors have been trained to recognise postnatal depression and have techniques that can help. If they can’t help, they’ll know someone in your area who can.

Encourage your partner to seek help if you think they might be having problems.

Don’t struggle alone hoping that the problem will go away. Remember that:

• a range of help and support is available, including therapy
• depression is an illness like any other 
• it’s not your fault you’re depressed – it can happen to anyone
• being depressed doesn’t mean you’re a bad parent
• your baby won’t be taken away from you – babies are only taken into care in very exceptional circumstances

Treatments for postnatal depression

Postnatal depression can be lonely, distressing and frightening, but support and effective treatments are available.

These include:

• self-help – things you can try yourself include: talking to your family and friends about your feelings and what they can do to help; making time for yourself to do things you enjoy; resting whenever you get the chance and getting as much sleep as you can at night; exercising regularly; eating a healthy diet
• psychological therapy – your GP may be able to recommend a self-help course, or may refer you for a course of therapy, such as cognitive behavioural therapy (CBT)
• antidepressants – these may be recommended if your depression is more severe or other treatments haven’t helped; your doctor can prescribe a medicine that’s safe to take while breastfeeding

Local and national organisations, such as the Association for Post Natal Illness (APNI) and Pre and Postnatal Depression Advice and Support (PANDAS), can also be useful sources of help and advice.

Read more about treating postnatal depression.

What causes 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
• a history of mental health problems during pregnancy
• having no close family or friends to support you
• a poor relationship with your partner
• recent stressful life events, such as 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.

Can postnatal depression be prevented?

Although there have been several studies into preventing postnatal depression, there is no evidence that there’s anything specific you can do to prevent the condition developing, apart from maintaining as healthy a lifestyle as you can for yourself.

However, if you have a history of depression or mental health problems, or if you have a family history of mental health problems after childbirth, tell your GP or mental health team if you’re pregnant or thinking of having a baby. This is so they can offer you appropriate monitoring and treatment, if necessary.

If you have had a mental health problem while pregnant, your doctor should arrange for you to be seen regularly in the first few weeks after birth.

Symptoms

Postnatal depression can affect women in different ways. It can start at any point in the first year after giving birth and may develop suddenly or gradually.

Many women 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 two weeks after giving birth. 

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

Common symptoms of postnatal depression

The main symptoms include:

• 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 you pleasure
• lack of energy and feeling tired all the time
• trouble sleeping at night and 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 with a feeling of indifference and no sense of enjoyment in his or her 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.

If you think you may be depressed, talk to your GP or health visitor as soon as possible so you can access the support you need.

Don’t struggle on alone and hope the problem will go away. It can continue for months or years if not addressed.

Fathers and partners can also become depressed after the birth of a baby. You should seek help if this is affecting you.

Read more about treating postnatal depression.

Spotting the signs in others

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 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, looking after them only as a duty and not wanting to play with them
• withdrawing from contact with other people
• speaking negatively all the time and claiming that they’re hopeless
• neglecting themselves, such as not washing or changing their clothes
• losing all sense of time, such as being unaware whether 10 minutes or two hours have passed
• losing their sense of humour
• constantly worrying that something is wrong with their baby, regardless of reassurance

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

Treatment

Speak to your GP or health visitor as soon as possible if you think you might have postnatal depression.

With appropriate treatment and support, most women make a full recovery, although it can take time.

The three main types of treatment are self-help strategies, therapy and medication, which are all described in more detail below. 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 instance, you may be anaemic after having given birth and that could add to any feelings of depression you might have.

Self-help

Looking after a baby can be stressful and challenging for anyone, and it can be even tougher if you’re dealing with postnatal depression as well.

There are a number of things you can try yourself to improve your symptoms and help you cope. These include:

• talk to your partner, friends and family – try to help them understand how you’re feeling and what they can do to support you
• don’t try to be a “supermum” – accept help from others when it’s offered and ask your loved ones if they can help look after the baby and do tasks such as housework, cooking and shopping
• make time for yourself – try to do activities that you find relaxing and enjoyable, such as going for a walk, listening to music, reading a book or having a warm bath
• 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 and 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 and don’t go for long periods without eating
• don’t drink alcohol or take drugs, as this can make you feel worse

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 women who are going through something similar.

Find postnatal depression support and information in your area.

Psychological treatments

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

The main types used are described below.

Guided self-help

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

The course materials focus 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 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, some women have unrealistic expectations about what being a mum is like and feel they should never make mistakes. As part of CBT, you’ll be encouraged to see that these thoughts are unhelpful and discuss ways to think more positively.

CBT can be carried out either one-to-one with a therapist or in a group. Treatment will often last three to four 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 and how they might relate to your feelings of depression.

Treatment also usually lasts three to four months.

Antidepressants

Antidepressants may be recommended if you have moderate or severe depression and you don’t want to try psychological treatment or psychological treatment doesn’t help.

They may also be used if you have mild postnatal depression and a previous history of depression.

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.

Antidepressants usually need to be taken for at least a week before the benefit starts to be felt, so 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 six months after you start to feel better. If you stop too early, your depression may return.

Antidepressants and breastfeeding

If you’re breastfeeding, talk to your doctor about suitable medicines, as not all antidepressants are safe to take while breastfeeding.

Your doctor should explain any risks of taking antidepressants and you should be offered the type with the least risk for you and your baby.

Side effects

General side effects of antidepressants include:

• feeling sick
• blurred vision
• a dry mouth
• constipation
• dizziness 
• feeling agitated or shaky

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

Severe postnatal depression

If your postnatal depression is very severe and it doesn’t respond to the treatments above, you’ll probably be referred to a specialist mental health team.

Your team will be able to try additional treatments, such as:

• more intensive CBT
• other psychological treatments, such as psychotherapy
• therapies such as baby massage to help you bond better with your baby, if this has become a problem
• different medications
• electroconvulsive therapy (ECT) – where electrodes are placed on your head and pulses of electricity are sent through the brain, which may improve your mood by changing the balance of chemicals in your brain

If it’s thought that your depression is so severe that you’re at risk of harming yourself or others, you may be admitted to hospital or a mental health clinic.

Your baby can either be looked after by your partner or family until you’re well enough to return home, or you can stay in a specialised “mother and baby” mental health unit.