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Postnatal depression: symptoms, support and treatment

PND is a type of depression that affects as many as one in 10 women during the perinatal period. Here's what you need to know.

By Mumsnet HQ | Last updated Jul 15, 2021

postnatal depression

The Maternal Health Alliance confirms that a staggering one in 10 women will develop a mental illness during pregnancy or within the first year of having a baby. Many of those will struggle on in silence without recognising that they need help or being able to access support.

Maternal mental health issues comes in many different shapes, sizes and forms meaning it's not always easy to spot or to realise you've been affected. Maternal mental health is not just about the most common 'labelled’ conditions and involves other symptoms such as anxiety, depression and insomnia. It can look and feel very different to different people.

To provide women with the best possible advice on what signs to look out for and where to seek support when it comes to postnatal depression, we've written this guide with the help of medical experts, including Hannah Travis, a senior solicitor at Bolt Burdon Kemp who specialises in medical negligence relating to women’s health.

Read on as we take you through the symptoms, treatment options and possible risk factors of PND, plus the real-life testimonies of Mumsnet users who have experienced it first-hand.

Short on time? Watch our video for PND advice from an expert

What is postnatal depression?

Postnatal depression or PND (sometimes called postpartum depression or PPD) is the most common postnatal mental health disorder women experience in the first year after having a baby.

The National Childbirth Trust says that between 10% and 20% of women have depression and anxiety in pregnancy and after birth.

It is a form of depression that varies in severity and can come on gradually or appear all of a sudden.

What are the signs of postnatal depression?

The main symptoms can include:

  • Continual feelings of sadness and low mood

  • Loss of enjoyment of daily life

  • Difficulty bonding with your baby

  • Tiredness and loss of energy

  • Feeling irritable

  • Difficulty sleeping

  • Inability to enjoy or look forward to anything

  • Change in eating habits

  • Feelings of isolation and detachment

  • Anxiety

  • Loss of self-confidence

  • Feelings of worthlessness, hopelessness, failure or guilt

  • Foggy brain

  • Loss of libido

  • Paranoia

  • Mood swings

  • Feelings of changed personality

  • Thoughts of harming yourself or your baby

"All of my symptoms were physical – so much so that I terrified myself into thinking I had some awful illness and it took months for the doctor to persuade me it was depression."

There are many signs of postnatal depression and it can be hard to work out how you feel when so much is already in flux. How do you know if your sleep is disturbed by depression or simply by a baby waking you every two hours? Are you irritable or would you be irritable anyway while coping on too-little sleep with cracked nipples and piles while trying to establish breastfeeding?

It is, however, important to notice when there is a difference and a mum or concerned family member should trust their gut and seek some help from a midwife, health visitor or a GP if they feel that a lack of sleep or life with a newborn is not the cause of these symptoms.

How common is postnatal depression?

PND is more common than many people realise, with experts believing it affects approximately 20% of mothers in the UK. Among teenage mothers, the figure is even higher – estimated at around 40%. What's more, it could hit you quite suddenly or come on very gradually, meaning it can be difficult to spot. It can also occur at any time in the first year after birth.

In most areas of the UK, health visitors will speak to mums about their feelings and wellbeing a few weeks after birth, and try and ascertain if they need any additional support for this common, but often little-spoken about, condition.

Liz Wise, specialist postnatal depression counsellor and PND support coordinator for the National Childbirth Trust, says: “I ask two questions when supporting mums with PND – are you able to look forward to anything and are you enjoying anything? If these are both answered with a 'no', then discussion around other feelings and thoughts needs to take place.”

"Be kind to yourself and almost certainly things will fall into place. I needed the first six weeks to adjust to being a parent. And, remember, postnatal depression is a chemical imbalance and not a character defect."

What are the chances of getting postnatal depression twice?

PND can happen with your first born, second born or even skip a baby and come completely out of the blue when you haven’t had issues before. This is important to remember and can often be a common misconception with mums questioning whether they have PND this time around because they didn’t with a previous child or children.

If you have experienced PND before and become pregnant again, raise your concerns with your midwife and ask to be referred to the perinatal mental health team. Do what you can to put in place help that will be there if you need it but – and the ‘but’ is very important – remain open to the fact that you might not need it at all.

Mum baby

Obstacles to seeking help for postnatal depression

"Once you've spoken to somebody about how you're feeling, you'll feel a whole load better. It helps to know that the way you're feeling is part of an illness and not just you not being able to cope as a mum."

For many women, maternal mental health conditions are worryingly under-reported with many not wishing to seek treatment out of embarrassment or for fear of being made to look like a bad mum. But the earlier help is sought, the easier it is to make things better.

Our survey of 631 Mumsnet users found that nearly a third of women who experienced PND did not seek professional healthcare advice. Over 80% of respondents were concerned their symptoms were not 'bad' enough to warrant medical help, and almost three quarters (74%) were worried that a diagnosis would raise concerns about their ability to care for their baby.

Many people may assume that you can’t possibly have a maternal mental health condition unless you have gone through a difficult birth or had a hard pregnancy. This isn’t the case at all and this is why some mums may not feel that they should be seeking help as they don’t want to make a fuss.

For most women, it will be loved ones around them that will spot these signs. They, too, shouldn’t be embarrassed about tackling it head on whilst remaining sensitive and supportive.

Suffering in silence can be so very damaging to a mum’s health and it is so important that women feel like they can be heard and listened to at such a dramatically life-altering time in their lives. Maternal mental health conditions are exactly that – a health condition. Getting help takes strength and courage, and needs to be applauded and supported.

Where can I go for help?

"Having a baby is totally overwhelming and relentless. The early days can feel like the longest days in all of time and groundhog day every day. Your hormones are all over the place. You're tired out. It's how millions of women feel after having a baby. But tell your husband, or someone close, how you feel. If you find your GP or health visitor helpful, then speak to them."

When it comes to seeking medical help, it’s important to remember that, just as symptoms vary from person to person, so does the support and treatment for PND. Medical professionals will help you to make informed choices about support and treatment. Any of these people will be able to offer help and advice:

1. GP

They can give you medication and/or a referral to a health visitor, community mental health team, counsellor or support group. A GP will also be able to look at other possible causes – you may have a vitamin or iron deficiency (very common after birth), both of which can be addressed easily.

2. Health visitor

They can offer to visit you on a regular basis and make a referral on your behalf to a support group, such as a Home Start. Home Start will provide you with a volunteer who visit regularly to give you support and practical help.

"I've suffered from depression on and off throughout my adult life. Having a child was, at first, quite a difficult time for me. But with the help of Home Start, plus the right antidepressants, I felt better in time."

3. Midwife

It's very useful if your midwife is aware if you've had PND (or any other form of depression) previously as they’ll be able to spot the signs quickly and make sure you’re offered help early on.

4. Community mental health team

You may need to see a psychiatrist or a community psychiatric nurse. This is standard procedure, so don't be frightened or alarmed by a referral to the CMHT.

"When I had my first son I thought we'd made a mistake. I was ashamed of thinking that. With my second son I was terrified he was going to die. I'm well now and love my boys. My recovery was quicker because I asked for help and did what I was advised."

Can I take a PND test?

Your health professional may use something called the Edinburgh Postnatal Depression Scale to assess your mental wellbeing in the postnatal period and decide on the best treatment for you.

"How did I know I had PND? I felt miserable, didn't want to go out and didn't feel any joy. I did one of those health visitor's tests which give you are a mark out of 10 or 20 and scored low."

woman at doctor

How do you treat PND?

There is a range of treatments available, from antidepressants, cognitive behavioural therapy or counselling to changes in your diet and taking more exercise. Your doctor will be able to advise you on the best treatment for you. The important thing is to make that first contact with your doctor, midwife or health visitor so that you can start to get the support you need.

You might find one or more of the following can help you cope with and recover from PND. Your GP will be able to advise you on which might be best for you:

1. Counselling

A counsellor is someone you could approach for impartial advice and who will be able to help you unpack what you're feeling and provide you with some coping mechanisms.

It may be useful to talk to someone who has experience of PND, too, and counselling may be in the form of one-to-one sessions or groups. Your GP or health visitor should be able to refer you. See for further information.

2. PND support groups

Ask your GP and health visitor if they know of a specific PND support group in your area. Meeting other mothers in the same boat can help to reduce your sense of isolation.

Support groups also help with normalising your feelings and give you a focus from week to week. If you want to chat to other women, Mumsnet's postnatal health forum is available 24/7. Get support, empathy and help from other people who know what you're going through.

3. Cognitive Behavioural Therapy (CBT)

A form of talking therapy based on the idea that unhelpful thinking leads to negative behaviour. CBT is designed to break the cycle of negativity and help you think and act more positively.

With PND, it could be that unrealistic expectations about what parenthood will be like are a factor in your happiness. CBT can help you be kinder to yourself and overcome PND. Therapy can take place one-to-one or in groups.

"CBT worked wonders for me. It's not so much about dragging up past issues but about retraining your brain to think about situations in an alternative way."

4. Antidepressants

These can play a very useful role in your recovery. They will be carefully monitored by your GP and should be taken for a minimum of six months before they are gradually reduced. Make sure you let your GP know if you’re breastfeeding as they will be able to prescribe medication that’s suitable. There is some medication you need to avoid while breastfeeding.

Other treatments for PND

1. Rest

Sleep deprivation will make your depression feel worse, so if possible try to rest when you can and accept offers of help so that you can have time to yourself if you feel like it. Doctor's orders.

2. Exercise

You may not feel up to running a marathon when you have PND, but a short walk each day, if you can manage it, will aid your recovery. As you begin to feel better, you may gradually feel like taking more and more exercise.

"I took up running and found that having something else to focus on and getting exercise really made a difference for me."

3. Regular eating

This is one of the most effective things you can do to help your recovery. Eat little, often and healthily – five small meals a day is ideal – to keep your blood sugar levels stable.

When blood sugar levels drop, your mood and anxiety levels can be affected. But remember – while your diet can make a significant difference to your mood, eating healthily is not a cure for PND. You still need to seek medical help.

Fruit and Veg

The following foods may help your mood and can all be used to make simple, healthy meals:

  • Avocados

  • Linseed, pumpkin and sunflower seeds – try sprinkling on salads

  • Apples

  • Rye bread

  • Rice cakes

  • Porridge with oat milk

  • Tahini

  • Root vegetables (not white potatoes)

  • Organic eggs and cheese

  • Hummus

  • Nuts

  • Local or manuka honey

4. Avoid alcohol

It might help you relax in the moment but, long-term, alcohol is a depressant and therefore best avoided.

5. Complementary therapies

Some PND sufferers find cranial osteopathy, reflexology, massage and homeopathy helpful, but more often as a complementary therapy alongside medical treatment.

How to support someone with postnatal depression

If your partner, friend or family member is suffering, there are some things you can do to support them:

1. Encourage them to see their GP or Health Visitor if they haven't done so already

The task of arranging an appointment may feel quite overwhelming, so ask them if they need help booking one. If they are the baby's main caregiver, offer to look after the baby while they visit the doctor.

2. Make sure that they do not have to cope by themselves

Unless they are happy being alone, rally around other friends and family to make sure they aren't on their own.

3. Let them talk about their feelings and worries

No matter how irrational they may seem to you, their feelings are very real so don't dismiss them.

4. Allow them plenty of time to rest

Depression can be incredibly tiring so, when you add a new baby and other responsibilities into the mix, they will no doubt be exhausted.

5. Give gentle reminders

Gently and constantly remind them that they are extremely loved, the depression is in no way their fault and better days will come – no matter how hard they may find it to believe you at that moment in time.

6. Provide practical help

Prepare meals, do the cleaning and take the baby out for a while if they are happy for you to do so.

PND at work

Returning to work after maternity leave is a readjustment in a number of ways.

Elizabeth Hill, an integrative counsellor, says, “In my experience with clients who struggle going back to work, the biggest issue is their feeling that they should be able to cope. They can be overwhelmed by the pressure to be good at everything, which is impossible.”

“Many of the women I've worked with have benefited from an honest conversation with their employer about what their return to work will look like and where to go when they are feeling stressed or unable to cope. Employers have a duty of care to address this properly.”

She also encourages women to find a network of people with whom they can have an honest conversation about their experiences.

“Often it helps to find other women who are struggling with the same issues so that you don’t feel as alone. It is also important that the right support is in place for the mother to go back to work and not feel as if she has to do everything when she returns home. This includes finding the right childcare for her baby, friends and family pitching in and an honest conversation with a partner about household responsibilities.”

How do I know if I have the 'baby blues' or PND?

While you will likely have heard or been warned about the ‘baby blues’, which affect up to 80% of mums and is characterised by mild symptoms that last around two weeks, anything more than this may be a sign of something more serious.

While symptoms and feelings associated with PND vary from one person to the next, which can make it difficult to diagnose, if you're not sure whether you're experiencing PND or are just an exhausted new parent, it's worth seeking out support and ensuring you are attending to your own self-care as much as possible.

"Identifying what was wrong felt almost like a benediction."

postpartum depression

How long does postnatal depression last?

PND can last anywhere from a few weeks to multiple months and, because symptoms can appear gradually, many women don't realise they have it.

It's important to know that, whenever symptoms show themselves, there is help available.

Can PND be prevented?

While there is no evidence to suggest that PND can be prevented, measures a woman can take during pregnancy that may lessen the chances of PND occurring include:

  • Maintaining awareness of how you're feeling

  • Putting support systems in place and having someone with whom you can really talk about your feelings

  • Maintaining as healthy a lifestyle as possible – try to rest as much as possible, eat a good diet little and often, and exercise within reason

  • Not having too high expectations of labour, birth and motherhood

Possible risk factors and causes

"When I had my first son I thought we'd made a mistake. I was ashamed of thinking that. With my second son I was terrified he was going to die. I'm well now and love my boys. My recovery was quicker because I asked for help and did what I was advised."

There are many possible risk factors for PND. It’s worth being aware of these so that, if you are in the higher-risk bracket, you can seek treatment more quickly.

  • A history of mental health problems in general or a history of mental health problems during pregnancy

  • Unresolved childhood trauma

  • Stressful home life

  • Other major life events coinciding with your baby's birth, including bereavement, illness or redundancy

Other risk factors

  • Having had fertility treatment

  • Having a traumatic birth

  • Previously having experienced a miscarriage, stillbirth or termination

  • Being a victim of domestic violence

  • A close female relative having experienced PND

  • Relationship problems

  • Hormonal changes

  • Experiencing a role change in relationship/career

  • Being a mother of multiples

Rare conditions

Could I have postpartum psychosis?

Postpartum psychosis, or puerperal psychosis, is a rare but serious and potentially life-threatening mental health issue. It takes the form of severe depression, mania or both.

Postpartum psychosis can appear out of the blue in women with no previous history of mental illness. If acted upon quickly it can be treated, otherwise symptoms can escalate drastically which can result in serious consequences. Symptoms vary from woman to woman but they will often experience delusions or hallucinations coupled with depression, mania or confusion.

It will more than likely be the case that the mother won’t recognise these symptoms herself – it will be those around her who should seek help and act immediately as this is considered a medical emergency. Specialist mother and baby units can provide care without separating mum and baby.

Only one or two mums in every thousand suffer from it and they’re likely to already be suffering from mental illness or to have done so in the past. Most women make a full recovery but it can take weeks or months.

What is postnatal post-traumatic stress disorder?

"Hallmarks of PTSD are intrusive thoughts, flashbacks, nightmares (not necessarily all three but often two of them), avoiding thinking about what happened and avoiding situations that remind you of what happened, and being on high alert all the time. If that matches how you feel, you need to tell your doctor."

Postnatal PTSD can be the result of a problematic birth. It can also be caused by anxiety that afflicts some women after becoming mothers and can strike immediately or months after giving birth.

It can manifest itself in obsessive thoughts about death – fear of dying or fear of your baby dying – and it’s essential you share your concerns with your GP, midwife or health visitor.

What to do if you’re worried you might hurt your baby

Some women worry about having thoughts about harming their baby. Elizabeth Hill says, “Intrusive thoughts can be overwhelming and very scary. Do not wait for them to go away on their own. They can be distressing but are often a symptom of something else – an anxiety or depression which needs to be treated.”

If you're worried about harming your baby then remember that thinking about it doesn't mean you will do it, but always seek help from a medical professional nonetheless.

PND in men

"My DH was badly affected after the birth of my DS, at the same time that I was suffering from PND. The pregnancy/birth hormones didn't seem to be the only factor and I feel strongly that men who experience this are not told it's only for women. In this country, we are good enough at stigmatising mental health without making it any harder for fathers to seek help or talk about what's happening to them."

While the term 'PND' naturally conjures up the image of a new mum, the risk of depression in men doubles during the first year of being a dad, according to the National Childbirth Trust, and is especially high between months three and six after the birth.

Just as in mothers, the illness can be caused by hormonal changes that come about after the birth of a new baby, but often goes undiagnosed in men. Of mothers experiencing PND, up to 50% of male partners will also experience it at the same time.

PND is treated in much the same way whether the sufferer is male or female, so in either case it's important to contact your GP and talk it through with them so that they can recommend the best course of action.

postnatal depression support goup

What other support is available?

The NHS has put together a leaflet called New Mum Wellbeing which aims to tell you more about the common problems many mums experience and where to find help.

There are many charities and organisations out there whose aims are to support women suffering with postnatal mental health conditions, particularly as the taboo is starting to be lifted and more awareness raised of this important issue.

A couple of examples are:

Pre and Postnatal Depression Advice and Support (PANDAS)

They are available seven days a week, 365 days a year.

PND and Me

#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 is 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.

By getting help early on you will not only be helping yourself but you will be helping your baby by giving them the best version of yourself you can be. The days can seem very long and dark trying to muddle through on your own, but there are people out there who can help and bring back the light to your day.

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