What is postnatal depression?

Postnatal depression is a treatable medical illness that affects about 1 in 7 women in the UK after giving birth. It can develop anywhere from a few weeks to a year after delivery, but it’s most common in the first four to six weeks after birth. Postnatal depression can be hard to spot, because the symptoms can be similar to the effects of just being a parent.

Symptom: Depressed mood

It's normal to feel emotional when you’ve just had a baby. Hormone shifts, lack of sleep and adjusting to life with a newborn can seem overwhelming. If you've been feeling sad, moody, guilty or hopeless for more than a couple of weeks, it could be postnatal depression. Some women also report that they don't feel any joy or excitement about their new baby and they get no pleasure from things they once enjoyed.

Symptom: Sleep problems

Caring for a newborn disturbs every new mother's sleep, but postnatal depression can cause greater sleep issues. It may be hard to sleep when you get the chance. Or you may sleep too much. Not getting enough sleep can turn into a vicious cycle - poor sleep can contribute to depression and then depression can interfere with sleep.

Symptom: Appetite changes

A common symptom of depression is eating less or more than usual. While some women turn to food for comfort when they're depressed, others lose interest in it completely. Good nutrition is especially important if you're breastfeeding, and nursing a baby does make you more hungry than usual. If your appetite changes dramatically - up or down - and you feel sad or overwhelmed, talk to your GP or health visitor about it.

Symptom: Anxiety

Not all women experience anxiety as a symptom of postnatal depression, but some do. You may feel nervous, frightened, restless or stressed. Some women have intense worry about their baby's health or safety. If you constantly feel overwhelmed by the responsibility of caring for your newborn, or if nerves interfere with your ability to handle everyday tasks, it could be a sign of postnatal depression.

Symptom: Frequent ups and downs

Mood swings are a normal part of life after a baby arrives, especially in the first two weeks after delivery. Don’t be surprised if you find yourself laughing one minute and crying the next. If these emotional highs and lows continue for more than two weeks or start to get worse, they may be a sign of postnatal depression.

Depression or baby blues?

What sets postnatal depression apart is how long it lasts and the severity of symptoms. The baby blues - having mood swings, feeling sad or anxious, crying for no reason - usually go away on their own after about a week or two. If your symptoms persist or get worse over time, you should seek help. Often postnatal depression starts one to two months after childbirth, with feelings of depression, lack of energy, and no pleasure, and sometimes thoughts of hurting yourself or your baby.

When to seek help

Call your GP or health visitor if:

• Baby blues last longer than two weeks
• Your symptoms get worse
• You're having trouble caring for yourself or your baby
• You're having thoughts of harming yourself or your baby

Support from social workers, counsellors or self-help groups may be helpful. Ask your heath visitor about services in your area. If you are thinking about hurting yourself, call the Samaritans on 08457 90 90 90

Depression or thyroid disorder?

In some women, the butterfly-shaped thyroid gland becomes temporarily underactive during the postnatal period. Symptoms of an underactive thyroid (hypothyroidism) include low mood, fatigue, weight gain, dry skin, forgetfulness and constipation. If you notice any of these symptoms, ask your GP to do a blood test to check your hormone levels. If it's an underactive thyroid, medication can help.

What causes postnatal depression?

No one knows for certain why some women get postnatal depression and others don't. The sharp drop in the hormones oestrogen and progesterone after childbirth is no longer thought to be the sole cause, although this may play a part. Lifestyle changes, such as new responsibilities, are more likely to be responsible. Genetics may also play a part. If you've had depression in the past, you're more likely to develop postnatal depression.

What is postpartum psychosis?

Postpartum psychosis is a rare, but serious mental illness. It's more common in women with a personal or family history of bipolar disorder or schizophrenia. Symptoms include irritability, restlessness, rapidly changing moods, confusion, erratic behaviour and delusional thoughts. A woman with postpartum psychosis is at risk of harming herself or her baby, so it's important to seek help right away if a new mother is experiencing any of these symptoms.

How is PND diagnosed?

If you're having trouble coping with all the changes that new motherhood brings, see your GP or health visitor. They can determine if you're experiencing postnatal depression or refer you to a mental health team. Many new mothers feel embarrassed or ashamed and keep it to themselves, but having postnatal depression doesn’t make you a bad mother. Help is available and there’s no reason to suffer.

PND treatment: Therapy

Many women with moderate postnatal depression find relief through talk therapy. A therapist is there to listen and give you strategies to cope with the negative thoughts and feelings you're having. One type, called cognitive behavioural therapy (CBT), can be very effective.

PND treatment: Medication

Your GP may recommend antidepressants to help treat depression. With antidepressants, the NHS says 50-70% of women with moderate to severe PND improve within a few weeks, but they don't work for everyone. They also don't work overnight, Ask your GP how long it will take before you feel better, what side effects you might experience, how long you’ll need to take the medication and how to taper off the treatment when you're ready.

Antidepressants and breastfeeding

If you’re breastfeeding, it's important to know that some antidepressants can be passed to your baby through your breast milk. Research and tests have identified which types of antidepressants are least likely to be harmful. It's best to discuss the options with your doctor. Bear in mind postnatal depression may pose risks to an infant, if a new mum goes without needed treatment - and babies can grow and thrive on infant formula, if that's the best choice for everyone's wellbeing.

Complications

Swift action to treat postnatal depression is important for a healthy mother and child. Without treatment, depression can last for many months and may have long-term consequences for you and your baby. Research suggests that postnatal depression can interfere with bonding between mother and child, which can lead to developmental delays and behaviour problems as your child gets older.

Tips to feel better

If you’re feeling depressed, the following tips may help you feel better.

• Accept help from family and friends.
• Rest when you can.
• Spend time with other new mothers who can relate to what you’re going through.
• Find a babysitter and take time for yourself.

Diet and exercise can help

Make an effort to get a little exercise every day. Even something as simple as pushing the pram around the park can improve your mood. Eating a healthy, balanced diet and drinking plenty of water can also help you start to feel more like yourself again. Another benefit of eating well and exercising: you’ll get your pre-baby body back quicker and that will give your self-esteem a much-needed boost.

Note to family members

Lack of support is a major factor in postnatal depression. There are several ways family members can help:

• Check regularly to see how she's getting on.
• Make her a nutritious meal.
• Watch the baby so she can have a nap or a shower.
• Help with housework and other chores.

Outlook

When you're depressed, it can feel like things will never get better. Adjusting to motherhood is one of the biggest challenges a woman will face in her life. It's normal to feel overwhelmed, but with the right help, you can feel better. Without the cloud of depression hanging over your head, you’ll be able to enjoy your new baby and take the challenges in your stride.

Related reading

• What is postnatal depression?
• Types of depression
• Oestrogen and women’s emotions
• The bond between mum and baby
• Depression in women