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 (the first year following birth). Having a baby is undeniably life-changing, but postnatal depression can make some mothers feel overwhelmingly anxious and low. If you think you might be a sufferer, it's important to get the advice and treatment you need to begin to recover.
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What is postnatal depression? | Postnatal depression symptoms | Postnatal depression test | Possible risk factors | Postnatal depression treatment | Postnatal depression help | Postnatal depression in men
What is postnatal depression?
PND (sometimes called PPD – postpartum depression) is an illness that affects many women after having a baby, usually within the first year of birth. It is a form of depression that varies in severity and can come on gradually, or appear all of a sudden. While there is no real consensus on what actually causes it, there are several factors that are thought to increase the risk of PND in new mothers. The main ones are stress; the strain of the huge life change new parents experience; having had antenatal depression, and a traumatic birth experience. Some research suggests that the rapid change in reproductive hormones in the perinatal period is the culprit, but these studies are far from conclusive.
What are the symptoms?
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?
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.”
If you’re noticing a few of the symptoms listed below, or any one of them is making you feel overwhelmed, it could be that you have PND, so speak to your midwife, health visitor or GP:
- Loss of interest in your baby
- Inability to enjoy or look forward to anything
- Sleep disturbance
- Appetite disturbance
- Feelings of isolation and detachment
- Panic attacks
- Racing mind
- Feelings of worthlessness, failure or guilt
- Utter despair
- Inability to make decisions
- Foggy brain
- Irrational fears
- Obsessive thoughts
- Loss of self-confidence
- Loss of libido
- Mood swings
- Feelings of changed personality
- Suicidal thoughts
How common is it?
Affecting more than one in every 10 women in the year after giving birth (the perinatal period), it is, unfortunately, relatively common.
Can I take a PND test?
You can use the NHS Choices depression screening tool for a loose idea of whether you might be suffering, but do note that it's in no way a substitute for actually going to see your doctor. 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.
What treatment will I be offered?
Our survey 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.
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 it can be a difficult time for all of you. Telling people how you feel will help them to help you and is the first step to overcoming your illness. The most important thing is not to suffer in silence – once you reach out, help will be available and treatment will make a difference.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.
Talk to your partner or other family members and supportive friends, especially those who might understand what you're going through. Make an appointment to see your doctor and tell them how you're feeling.
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:
- 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.
- 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, healthy meals
Linseed, pumpkin and sunflower seeds – try sprinkling on salads
Porridge with oat milk
Root vegetables (not white potatoes)
Organic eggs and cheese
Local or manuka honey
You could start the day with overnight oats, combining porridge oats, seeds, manuka honey and 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 get 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 moment but long 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.
Where can I go for help?
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: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.
- 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.
PND at work
Returning to work after maternity leave is a readjustment in a number of ways. In our Q&A with therapist Elizabeth Hill, she said that, in her experience with clients who struggle going back to work, the biggest issue is feeling that they should be able to cope. They can be overwhelmed by the pressure to be good at everything which, she reminds us, is impossible.
Elizabeth had this to say: “Many of the women I have 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. She said: “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?
If you’re experiencing the baby blues the important thing to remember is that you're not doing anything wrong and your feelings will usually lift after no more than a fortnight, according to the NHS. It’s also hardly surprising that your moods are up and down, and that you feel irritable or even get tearful for no particular reason. Apart from anything else, you’re probably not getting as much sleep as you need. This is all really common and how you're feeling should pass.
Postnatal depression is another matter. It's an amplified and prolonged version of the feelings described above. You will not feel up and down so much as on a spiral that keeps you from making the most of what you're likely being told repeatedly is the special newborn period.
The symptoms and feelings associated with PND vary from one person to the next, so it can be difficult to diagnose. There can also be some surprising symptoms that could be mistaken for something else, according to Liz Wise: “PND has many different symptoms, including OCD and anxiety. Sometimes it may be difficult to separate OCD from PND, however it would be treated in the same way as a person who had OCD but no depression.”
When OCD is part of PND it tends to get better as the depression lifts. OCD in PND has a lot to do with gaining some control, as when one has PND there seems to be very little control felt.
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.
If you think you might have PND, you don't need to suffer in silence. Speak to your doctor and tell them how you’re feeling. If you're not feeling up to talking to your doctor, try and talk to a close friend or relative first. It's vital that PND is diagnosed as soon as possible so that you can get the treatment you need as quickly as possible.
Elizabeth Hill said that if you're not sure whether you're experiencing PND or are just an exhausted new parent, it is worth seeking out support and ensuring you are attending to your own self-care as much as possible. She recommends that, “a counsellor may be able to help you unpack some of the feelings you are experiencing and provide you with some coping mechanisms. It's also important to visit your GP and look at other possible causes, you may have a vitamin or iron deficiency (very common after birth) which could be addressed easily.”
How long does postnatal depression last?
PND can develop from anywhere between a few weeks and a year after giving birth. It can last for anywhere between a few weeks to multiple months. Whereas the baby blues normally lift within two weeks from birth, PND symptoms are longer-lasting. Many women don't realise that they have it, because symptoms can appear gradually.
Although the symptoms will normally appear within the first year after birth, there are no set timings, as everyone's experience is different.
It's important to know that whenever symptoms show themselves, there is help available. You are not alone and having PND is in absolutely no way a sign of failure – many, many women experience it. Just like for any other form of depression, there is treatment available, people who care about you and ways to get better.
Can PND be prevented?
We don’t know whether it’s possible to prevent it, 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.
According to Liz Wise, measures a woman can take during pregnancy that may lessen the chances of PND occurring include: “Maintaining awareness of how you're feeling, as well as putting support systems in place. Having someone with whom you can really talk about your feelings, trying to rest as much as possible, eating a good diet little and often, exercising within reason, and not having too high expectations of labour, birth and motherhood.”
I had postnatal depression after my first baby. Will it happen again?
Elizabeth Hill said: “In my experience, no two pregnancies are the same. This said, if you have experienced PND before then you will already know that one of the toughest parts is the bit before you are aware of what is going on and are given the help you need. So, if you become pregnant again after experiencing PND, I would advise you to raise your concerns with your midwife and ask to be referred to the perinatal mental health team. If possible, you could also seek some therapy privately to support you with any concerns you might have during pregnancy. 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. Think of it as taking an umbrella out with you on a day when rain is possible: it’s a precaution and nothing more – but why would you risk getting soaked through?”
Am I at risk?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 and it's usually a combination of these that contribute to a new mother experiencing the illness.
However, there will be women who have many possible risk factors and don't become depressed. Conversely, there will be those who have very few risk factors but do suffer.
It’s worth being aware of them just so that if you are in the higher-risk bracket you’re conscious of the possibility that you might be affected and can, therefore, seek treatment more quickly.
Key risk factors
- Previous depression. If you've suffered from depression in the past then being pregnant, and anticipating the changes in your life that parenting will involve, could trigger another bout of depression. If you are already a parent and experienced a perinatal mental health problem after the birth of a child then you are at increased risk of suffering again.
- Lack of support from others. Having a baby is always exhausting and can be lonely at times, so you benefit from having a support network. This might be a partner who does their fair share of looking after the baby, extended family who help when the going gets tough and friends you can talk to. Without these it’s easy for feelings of isolation to develop, which can contribute towards PND.
- Unresolved childhood trauma. Evidence shows that women who suffered unhappy childhoods – including parental neglect, and physical and/or sexual abuse – can be vulnerable to PND. The prospect of bringing a child into the world, and feeling anxious about your ability to care for them, can stir up distressing emotions.
- Stressful home life. Sometimes it feels like the world conspires to make having a baby more difficult than it is already. If you're dealing with issues like money worries and poor housing, at the same time as getting used to life with a newborn, then you might be vulnerable to be PND.
- Other major life events coinciding with your baby's birth. It's best to avoid upheaval in the months leading up to or just after birth. But there are plenty of events beyond your control that could increase the likelihood of you suffering from PND. The death of a loved one is the obvious example but a break-up, illness or redundancy could all be triggers.
Other risk factors
- Losing the relationship with your mother before the age of 11, not necessarily through death, but a loss of the emotional relationship
- Your mother or sister (or close female relative) having experienced PND
- Having had fertility treatment
- Having high expectations of parenthood
- Being a victim of domestic violence
- Relationship problems
- Hormonal changes
- Experiencing a role change in relationship/career
- Having a traumatic birth
- Being a mother of multiples
- Previously having experienced a miscarriage, stillbirth or termination
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.
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. 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 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. Therapist Elizabeth Hill had this to say: “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. 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 to help someone with PND
If your partner, friend or family member is suffering, there are some things you can do to support them.
- Encourage her to see her GP or Health Visitor if she has not done so already. The task of arranging an appointment may feel quite overwhelming for her, so ask if she needs help with booking an appointment. If she is the baby's main caregiver, offer to look after the baby while she visits the doctor.
- Unless she is happy being alone, make sure that she does not have to cope by herself. Rally around other friends and family to make sure she isn't on her own.
- Let her talk about her feelings and worries, no matter how irrational they may seem to you. Her feelings are very real to her, so don't dismiss them.
- Allow her plenty of time to rest. Depression can be incredibly tiring, so when you add a new baby and other responsibilities into the mix, she will no doubt be exhausted.
- Gently and constantly remind her that she is extremely loved, the depression is in no way her fault and better days will come – no matter how hard she may find it to believe you at the moment.
- Provide practical help by preparing meals, doing the cleaning and taking the baby out for a while (if she is happy for you to do so).
PND in men
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.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.
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, so it's worth bearing in mind in the first year of your baby's life, especially as the illness often puts undue stress on a relationship at a time when you need each other most.
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.
What Mumsnetters say
“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.”
“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.”
“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.”
“Identifying what was wrong with me felt almost like a benediction.”
“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 anti-depressants, I felt better in time.”
“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 mummy.”