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Treatment for postnatal depression

Tired and stressed mum with baby

If you think you have postnatal depression (PND) then do seek help, both for yourself and your baby – because if you’re feeling dreadful you won’t have much left to give anyone else

Can PND be treated?

If you were suffering from a physical illness, you wouldn’t feel reluctant or guilty about accepting help and depression should be no different. PND is much more common than you might think and there are plenty of treatments that will make a difference to how you feel.

Try to be open with your family. It can be difficult, opening up about your unhappiness, but try telling your partner or a friend how you feel. They will probably have picked up on your mood, will be upset at seeing you suffer and want to help you. How you feel is the priority but postnatal depression can be difficult for all of you. Telling people how you feel will help them to help you and is the first step to overcoming your illness.

Where can I go for help with PND?

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. The professionals will help you to make informed choices about support and treatment. Any of these people will be able to offer help and advice:

  • GP – can give you medication, and/or a referral to a health visitor, community mental health team, counsellor or support group.
  • Health visitor – can offer to visit you on a regular basis, and make a referral to a support group if there's one available.
  • Midwife – it's very useful if your midwife is aware if you have had PND (or any other form of depression) previously as she’ll be able to spot the signs quickly and make sure you’re offered help early on.
  • 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.
  • Other mothers or Mumsnetters – they might know what you’re going through and have come out the other side. If you don’t want to talk about PND then a circle of support – even if it's just someone to have a cuppa with – always helps.

What treatment will I be given for PND?

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 on which might be best for you:

  • 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 are some drugs you need to avoid when breastfeeding.
  • Counselling – it can be very helpful to talk to a counsellor because someone who doesn't know you can be impartial and objective about how you're feeling. It may be useful to talk to someone who has experience of PND, too and counselling may be one-to-one or in a group. Your GP or health visitor should be able to refer you, see www.postnataldepression.com for further information.
  • 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 and it's well worth finding out more.
  • 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.
  • 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 well feel like taking more exercise and it’s an invaluable way to treat any mental illness.
I took up running and found that having something else to focus on and getting exercise really made a difference for me.
  • Find supportive relationships – it can be really helpful for you to be able to talk through your feelings with someone you trust and who you know will not judge you. This may be your partner, a friend, family member or a counsellor.
  • 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 Antenatal and Postnatal depression Talk forum is available 24/7. Get support, empathy and help from other people who know what you're going through.
  • Being kind to yourself – don’t give yourself inessential tasks to do or take on extra responsibilities. If people ask favours of you then don’t feel guilty about saying “no.” In fact, don’t feel guilty about anything, especially taking it easy.
  • 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. Experts agree that omega-3 fatty acids – found in fish, nuts and seeds – make for a healthy diet, helping your body to function and reducing the risk of heart disease. Some argue that eating these foods can help with depression, too and there's definitely no harm in trying. The following foods may help your mood and can all be used to make simple meals that won’t have you spending hours in the kitchen:
  • Avocados
  • Linseeds, pumpkin and sunflower seeds – try sprinkling on salads
  • Apples
  • Rye bread
  • Rice cakes
  • Porridge
  • Oat milk
  • Tahini
  • Root vegetables (not white potatoes)
  • Organic eggs and cheese
  • Hummus
  • Nuts
  • Local or manuka honey

You could start the day with overnight oats, combining porridge oats, seeds, manuka honey, oat milk. The honey will also spread nicely on rice crackers, as will tahini, while a thumb-size piece of cheese with apple is light yet satisfying. If you fancy something more substantial then try a baked sweet potato with hummus or tell your partner to make you a hearty soup of root vegetables and add garlic, ginger and little pieces of wheat free pasta. 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.

Avoid alcohol – it might help you relax in the short term but, longer term, alcohol is a depressant and therefore is best avoided if you’re taking anti-depressants.

Complementary therapies – some mothers find cranial osteopathy, reflexology, massage and homeopathy helpful as an alternative, but more often as a complementary therapy alongside medical treatment.

Practical help – never feel a failure for accepting practical help. Your health visitor may be able to put you in touch with a Home Start scheme in your area. This charity provides volunteers who visit regularly to give you support and practical help. See home-start.org.uk for further details.

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.

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

Some women worry about having thoughts about harming their baby. This is much more common than you think and the health professionals will have seen it all before, so don’t think you are a terrible person for having these thoughts.

If you're worried about harming your baby then remember that thinking about it doesn’t mean you will do it. Women with PND almost never harm their children. Seek help and hold fast to the fact that postnatal depression does end, although when you're in the depths of it things can be very frightening and it can be difficult to believe that you will recover.

How long does it take to get over PND?

Recovery is gradual and takes time, but many women who have come out the other side of PND feel stronger, say they have more compassion for others and the confidence that, having survived PND, they can survive lots of things.

The second time I had PND I was prepared. My husband took more time off after the birth, I was referred to the perinatal psychiatric service in advance and it was arranged that I would continue to see the midwife for four weeks after the birth. It all helped a lot.

Can I prevent PND?

We don’t know whether it’s possible to prevent PND but steering clear of stress during pregnancy will help reduce the risk. If you suffered from PND after giving birth in the past then you will probably feel anxious about getting pregnant again.
As with all aspects of PND, each individual case is different and your doctor can assess the risk for you. If they decide that you’re likely to suffer from PND they might prescribe antidepressants immediately after you give birth.

Rare conditions

Could I have postpartum psychosis?

This is very serious but extremely rare. It can develop within hours of birth and the main symptom is that the mother behaves strangely or appears distressed. It requires immediate attention and specialist mother and baby units can provide care without separating mum and baby.

Only one or two mothers 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.

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.

What is post-natal post-traumatic stress disorder?

This frightening condition 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. It’s essential you share your concerns with your GP, midwife or health visitor. They are experienced in these matters, have seen and heard everything, and will be able to start helping you straight away.

What Mumsnetters say

“Take baby steps. Be kind to yourself, lower your standards a little. Don't worry about tomorrow, just getting through the next hour and the hour after that. You will get better.”

“The healing process was this: I began to get a few good days in between the bad days. Then I had more good days than bad days. Then I would maybe get a bad day a week. Eventually, but I didn't realise until I was off antidepressants completely, that I hadn't had a bad day for a month or so… and then by the time my son was two I had not had a bad day for three months.”

“A mixture of antidepressants if you need them, therapy and just knowing you won't be dropped like a hot potato whenever you are discharged from hospital really can help.”

“I've begun to learn my own coping mechanisms. The biggie is 'this too shall pass'. When you really feel sh*t try and repeat this and think of a time in the day when things aren't quite as diabolical.”