What is postnatal depression?
Postnatal depression is a type of depression some women experience after they have had a baby.
It usually develops in the first four to six weeks after childbirth, although in some cases it may not develop for several months.
There are many symptoms of postnatal depression, such as low mood, feeling unable to cope and difficulty sleeping, but many women are not aware they have the condition.
It's common to experience mood changes, irritability and episodes of tearfulness after birth – the so-called baby blues. These normally clear up within a few weeks. But if a woman experiences persistent symptoms, it could well be the result of postnatal depression.
It is important for partners, family and friends to recognise signs of postnatal depression as early as possible and seek professional advice.
Read more information about the signs and symptoms of postnatal depression.
It's very important to understand that postnatal depression is an illness. Having it does not mean you do not love or care for your baby.
Treating postnatal depression
Postnatal depression can be lonely, distressing and frightening, but there are many treatments available.
As long as postnatal depression is recognised and treated, it is a temporary condition you can recover from.
It is very important to seek treatment if you think you (or your partner) have postnatal depression.
The condition is unlikely to get better by itself quickly and it could impact on the care of the baby.
Treatment for postnatal depression includes:
Read more about the treatment of postnatal depression.
Why do I have post natal depression?
The cause of postnatal depression isn't clear, but it's thought to be the result of several things rather than a single cause. These may include:
- the physical and emotional stress of looking after a newborn baby
- hormonal changes that occur shortly after pregnancy; it is thought some women may be more sensitive to hormones than others
- individual social circumstances such as money worries, poor social support or relationship problems
Women might be more at risk of developing post natal depression if they:
- have a previous history of depression or other mood disorders such as bipolar disorder
- have a previous history of postnatal depression
- experience depression or anxiety during pregnancy
Read more about the causes of postnatal depression.
Who is affected
Postnatal depression is more common than many people realise and cases can often go undiagnosed.
It is estimated around one-in-seven women experience some level of depression in the first three months after giving birth.
Rates of postnatal depression are highest in teenage mothers and is thought to affect all ethnic groups equally.
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.
Postnatal depression symptoms
Postnatal depression can affect women in different ways. They can begin to have symptoms soon after the birth which can last for months, or in severe cases for more than a year.
Key symptoms are:
- 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 pleasure
- lack of energy and feeling tired all the time fatigue
Other symptoms can include:
- disturbed sleep, such as not being able to fall asleep during the night (insomnia) and then being sleepy during the day
- difficulties with concentration and making decisions
- low self-confidence
- poor appetite or an increase in appetite ("comfort eating")
- feeling very agitated or alternatively very apathetic (can’t be bothered)
- feelings of guilt and self-blame
- thinking about suicide and self-harming
Postnatal depression can interfere with your day-to-day life. Some women feel unable to look after their baby, or feel too anxious to leave the house or keep in touch with friends.
Some women who have postnatal depression get thoughts about harming their baby. This is quite common, affecting around half of all women with the condition. You may also have thoughts about harming or killing yourself. These thoughts do not mean you are a bad mother, and it is very rare for either mother or baby to be harmed.
However, it is vital you see your doctor if you have these or other symptoms of postnatal depression. Treatment will benefit both your health and the healthy development of your baby, as well as your relationship with your partner, family and friends.
Seeking help for postnatal depression does not mean you are a bad mother or unable to cope.
Spotting the signs in others
Many mothers do not recognise they have postnatal depression, and do not talk to family and friends about their true feelings.
It's therefore important for partners, family members and friends to recognise signs of postnatal depression at an early stage. Warning signs include:
- They frequently cry for no obvious reason.
- They have difficulties bonding with their baby.
- They seem to be neglecting themselves – for example, not washing or changing clothes.
- They seem to have lost all sense of time – often unaware if 10 minutes or two hours have passed.
- They lose all sense of humour and cannot see the funny side of anything.
- They worry something is wrong with their baby, regardless of reassurance.
If you think someone you know has postnatal depression, encourage them to open up and talk about their feelings to you, a friend, doctor or health visitor.
Postnatal depression needs to be properly treated and isn't something you can just snap out of.
A rarer and more serious mental health condition that can develop after birth is known as postnatal psychosis, thought to affect around 1 in 1,000 women.
Symptoms of postnatal psychosis include:
- bipolar-like symptoms – feeling depressed one moment and very happy the next
- believing things that are obviously untrue and illogical (delusions) – often relating to the baby, such as thinking the baby is dying or that either you or the baby have magical powers
- seeing and hearing things that are not really there (hallucination) – this is often hearing voices telling you to harm the baby
Postnatal psychosis is regarded as an emergency. If you are concerned someone you know may have developed postnatal psychosis, contact your doctor immediately. If this is not possible, call NHS Direct on 0845 46 47 or your local out-of-hours service.
If you think there is a danger of imminent harm to you, your partner or your baby, call your local Emergency Department and ask to speak to the duty psychiatrist.
Some women develop a mental health condition called obsessive compulsive disorder (OCD) after giving birth. People with OCD experience unwanted (and often unpleasant) thoughts, images or urges (obsessions) that cause them to feel a need to carry out repetitive behaviours (compulsions) to avoid the realisation of these obsessions.
OCD can often be treated with behavioural therapy or medication.
Causes of postnatal depression
The cause of postnatal depression is not completely clear. Most experts think postnatal depression is the result of a combination of things.
These may include:
- depression during pregnancy
- a difficult delivery
- lack of support at home
- relationship worries
- money problems
- having no close family or friends around you
- physical health problems following the birth, such as urinary incontinence (loss of bladder control), or persistent pain from an episiotomy scar or a forceps delivery
Even if your life is free of these problems and you had a straightforward pregnancy or labour, simply having a baby can be a stressful and life-changing event that can trigger depression.
People often assume they will naturally adapt to parenthood overnight. But it can take months before people begin to cope with the pressures of being a new parent. This is true even for those who already have children.
In addition, some babies are more difficult and demanding than others, and don't settle so easily. This can lead to exhaustion and stress.
Who's at risk
Factors that can increase your risk of having postnatal depression include:
- a family history of depression or postnatal depression (genetics appears to play a role in both of these conditions but exactly how is still unclear)
- having experienced depression or postnatal depression previously, or other mood disorders such as bipolar disorder
The role of hormones
Huge changes in hormone levels during and after pregnancy were once believed to be the sole cause of postnatal depression. This is no longer thought to be the case, although hormonal changes may still play a part.
One theory is that some women are more sensitive to the effects of falling hormone levels after they have given birth. All mothers will experience hormonal changes but only some mothers will be affected emotionally.
It's possible that this, as well as the stress of looking after a baby or money problems, may trigger the depression.
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.
Incontinence is when you pass urine (urinal incontinence), stools or gas (faecal incontinence), because you cannot control your bladder or bowels.
Diagnosing postnatal depression
Your doctor should be able to diagnose postnatal depression by asking two questions:
- During the past month, have you often been bothered by feeling down, depressed or hopeless?
- During the past month, have you often been bothered by taking little or no pleasure in doing things that normally make you happy?
If the answer to either of these is yes, then it is possible you have postnatal depression. If the answer is yes to both, postnatal depression is probable.
Depending on your answers, you may also be asked whether you feel you need or want help.
Some mothers, especially those without a partner or relative to help care for their baby, can be reluctant to provide honest answers to these questions. This is because some worry that a diagnosis of postnatal depression will mean they are seen as a bad mother and that there is a chance their baby will be taken into care.
It should be stressed that a baby will only be taken into care in the most exceptional of circumstances. One of the prime goals of treatment of postnatal depression is to help you care for and bond with your baby.
Even if symptoms of your postnatal depression are so severe you require treatment at a mental health clinic, specialist mother and baby clinics are available.
Sometimes, your doctor may carry out a blood test to make sure there is not a physical reason for symptoms like tiredness and low mood, such as an underactive thyroid gland or anaemia (lack of red blood cells which can lead to tiredness). These conditions often occur after having a baby.
Sometimes your doctor or health visitor may ask you to complete a questionnaire, such as the Edinburgh Postnatal Depression Scale (EPDS). This can help assess your situation by focusing on certain symptoms and difficulties commonly encountered in postnatal depression. It can also help to track your response to treatment as you get better.
Assessing the severity of postnatal depression
If your doctor suspects postnatal depression, they will want to know your symptoms so they can assess how severe it is.
They will want to know if you have:
- disturbed sleep
- problems concentrating or making decisions
- low self-confidence
- a loss of appetite or increased appetite (comfort eating is often a symptom of depression)
- been feeling anxious
- been feeling tired, listless and reluctant to undertake physical activity
- been feeling guilty or self-critical
- been experiencing suicidal thoughts
Honesty is important when answering these questions as providing your doctor with accurate information will ensure you receive appropriate treatment.
If you have three of the above symptoms, it is likely you have mild depression.
If you have five or six symptoms, it is likely you have moderate depression. People with moderate depression will have great difficulty carrying out normal activities.
The number of symptoms you have in total, and above all their severity and persistence, will help your doctor decide whether your depression is mild, moderate or severe.
If you have all of the above symptoms, it is likely you have severe depression. People with severe depression are unable to function at all, and almost always need help from a dedicated mental health team.
During a blood test, a sample of blood is taken from a vein using a needle, so it can be examined in a laboratory.
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.
The thyroid is a jointed piece or cartilage that encloses the vocal cords and forms the Adam’s apple in men.
Treatment for postnatal depression
If you think you have postnatal depression speak to your doctor, midwife or health visitor as soon as possible.
It is important for you and your family to remember it can take some time to recover fully from the condition.
Common treatments and help for postnatal depression are detailed below.
Support and advice
The most important first step in managing postnatal depression is recognising the problem and taking action to deal with it. The support and understanding of your partner, family and friends plays a big part in your recovery.
However, to benefit from this, it is important for you to talk to those close to you and explain how you feel. Bottling everything up can cause tension, particularly with your partner, who may feel shut out.
Support and advice from social workers or counsellors can be helpful. Self-help groups can also provide good advice about how to cope with the effects of postnatal depression, and you may find it reassuring to meet other women who feel the same as you.
Ask your health visitor about the services in your area.
Exercise has been proven to help depression, and is one of the main treatments if you have mild depression.
Psychological therapies are usually recommended as the first line of treatment for mild-to-moderate postnatal depression for women with no previous history of mental health conditions.
Some common ones are discussed below.
Guided self-help is based on the principle that your doctor can "help you to help yourself".
For example, your doctor can provide self-help manuals detailing types of issues you might be facing and practical advice on how to deal with them. They also contain information on using cognitive behavioral techniques to help combat feelings of helplessness (see below for more information).
Talking therapies are where you are encouraged to talk through problems either one-to-one with a counsellor or with a group.
You can then discuss ways to approach problems in a more positive manner.
Two widely used talking therapies used in the treatment of postnatal depression are:
- cognitive behavioural therapy
- interpersonal therapy
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, thinking there is a perfect ideal of "motherly behaviour" is both unrealistic and unhelpful. All mothers are human and humans make mistakes. It is neither necessary nor helpful to try and be “Supermum”.
CBT is usually provided in four-to-six weekly sessions.
Interpersonal therapy (IPT) aims to identify whether your relationships with others may be contributing toward feelings of depression.
Again, IPT is usually provided in four-to-six weekly sessions.
The use of antidepressants may be recommended if:
- You have moderate postnatal depression and a previous history of depression.
- You have severe postnatal depression.
- You have not responded to counselling or CBT, or would prefer to try tablets first.
A combination of talking therapies and an antidepressant may be recommended.
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.
Contrary to popular myth, antidepressants are not addictive. A course usually lasts six-to-nine months.
Antidepressants take two-to-four weeks to start working, so it is important to keep taking them even if you don't notice an improvement straight away. It is also important to continue taking your medicine for the full length of time recommended by your doctor. If you stop too early, depression may return.
Between 50% and 70% of women who have moderate to severe postnatal depression improve within a few weeks of starting antidepressants. However, antidepressants are not effective for everyone.
Antidepressants and breastfeeding
The selective serotonin reuptake inhibitors (SSRI) types of antidepressants are usually recommended for women who are breastfeeding.
Tests have shown the amount of these types of antidepressants found in breast milk is so small it is unlikely to be harmful.
Side effects of SSRIs include:
- feeling sick
- blurred vision
- diarrhoea or constipation
- feeling agitated or shaky
- insomnia (not sleeping well) or feeling very sleepy
These side effects should pass once your body gets used to the medication.
Discuss feeding options with your doctor when you're making decisions about taking antidepressants.
Many mothers are keen to continue breastfeeding because they feel it helps them to bond with their child and boosts their self-esteem and confidence in maternal abilities. These are important factors in combating symptoms of postnatal depression.
Treating severe postnatal depression
You may be referred to a mental health team if your postnatal depression is severe, or does not respond to treatment. These teams are usually made up of a range of specialists, including psychologists, psychiatrists, specialist nurses and occupational therapists, and can provide intensive talking treatments such as psychotherapy.
If it is felt your postnatal depression is so severe you are at risk of harming yourself or your baby, you may be admitted to hospital or referred to a mental health clinic. If you have support available from your partner or family, it may be recommended they care for your baby until you are well enough to return home.
If you do not have support available to help you care for your baby, or your mental health team feels separation from your baby would adversely affect your recovery, you may be recommended for transfer to a specialised "mother and baby" mental health clinic.
Your baby may have to sleep in a separate nursery until you are well enough to look after them. Once your symptoms begin to respond to treatment, your baby will sleep in your room.
A small number of women develop symptoms of psychosis after birth (being unable to tell the difference between reality and their imagination).
If this happens to you, you may be treated with a combination of:
- mood-stabling medications such as lithium or an anti-epileptic drug
- an antipsychotic (this helps combat the symptoms of psychosis)
- a tranquiliser, such as a benzodiazepine to help relax you
You cannot breastfeed while taking these types of medications, so your baby will have to be bottle-fed.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT) may be recommended if you have severe postnatal depression, but is only used when antidepressants and other treatments have not worked.
If ECT is recommended, you will be given a general anaesthetic and medication to relax your muscles. Electrodes are placed on your head and a pulse of electricity passed through your brain. Most people have either six or twelve sessions of ECT, normally with two sessions a week.
For most people, ECT is effective in relieving severe depression, but it is necessary to take antidepressants afterwards to keep symptoms under control. It's unclear how ECT works, but the generally agreed view is that electricity changes the chemical composition of the brain in such a way as to elevate mood.
Some people experience unpleasant side effects after having ECT, including headaches and both short-term and long-term memory loss. Due to the risk of memory loss, your memory will be assessed at the end of each ECT session.
If it looks like your memory is being affected, or you experience other adverse side effects, then the ECT sessions will be stopped.
However, most people tolerate ECT very well.
Antidepressant medicine is used to treat depression. For example fluoxetine, paroxetine.
Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen.
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Counselling is guided discussion with an independent trained person, to help you find your own answers to a problem or issue.
Dose is a measured quantity of a medicine to be taken at any one time, such as a specified amount of medication.
Preventing postnatal depression
To try to prevent postnatal depression, tell your doctor about any previous depression you have had or if you have felt very low or anxious during your pregnancy.
Also speak to your doctor if you have had postnatal depression in the past and are pregnant or considering having another baby, as there can be a risk you will develop postnatal depression again.
Keeping your doctor informed will ensure they are aware of the possibility of postnatal depression after your baby is born. This helps prevent delay in diagnosis, and allows treatment to begin earlier. In the early stages, postnatal depression can be easy to miss.
It is difficult to estimate the exact risk of a women developing postnatal depression as many factors are involved, including:
- previous medical history
- individual social and psychological circumstances
- current relationships
- complications during labour
Even if you have a high risk of developing postnatal depression, it can be avoided. Getting support from your doctor, midwife and other healthcare professionals will help reduce your risk of developing postnatal depression.
The following self-help measures can also be useful:
- Get as much rest and relaxation as possible.
- Take regular gentle exercise.
- Don't go for long periods without food because low blood sugar levels can make you feel much worse.
- Don't drink too much alcohol because heavy drinking can make you feel worse.
- Eat a healthy, balanced diet.
- Don't try to do everything at once. Make a list of things to do and set realistic goals.
- Talk about your worries with your partner, close family and friends.
- Contact local support groups or national helplines for advice and support.
- Don't try to be "Supermum". Avoid extra challenges either during pregnancy or in the first year after your baby is born. A new baby is enough of a challenge for most people.
- Don't despair. Postnatal depression can affect anyone. You are not to blame.
If your risk of developing postnatal depression is thought to be especially high, your doctor or the doctor in charge of your care may recommend you start taking antidepressants as a precaution shortly or soon after giving birth.
Similarly, if you have a history of bipolar disorder or psychosis, you may be advised to start taking lithium shortly before or after the birth. Lithium has a mood-stabilising effect and can often help prevent psychosis reoccurring.
Blood Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart. Depression Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.
Louise Hudson, 42 when interviewed, has two children, Jamie, then 15 and Alice, then 10. Louise developed postnatal depression just before Alice's birth.
"When I had Jamie, I had a really difficult birth, but despite this setback, I enjoyed the whole experience. I was so glad to be a mum and I loved every minute of it.
"With Alice, it was different. She’s the apple of my eye now and she was a lovely, beautiful baby. Although I recall the whole experience of her birth and her first years of life, I also have the feeling that I don’t want to remember it. When I look back, it’s like I was robbed of those early years.
"My illness started quite late in pregnancy. I was around 34 weeks pregnant and I started suffering from insomnia. I thought it was because the baby was pressing on my bladder and I had to keep going to the lavatory. But I also felt strange in myself; quite detached, like I was there but not involved in what was going on.
"My usual doctor was away, so I saw a locum who didn’t really understand. He gave me some Tamazapan and a page of top tips for getting a good night’s sleep. It didn’t help and even with Tamazapan, I couldn’t get any sleep.
"My husband and my mother both knew there was something wrong. Mum said that I’d gone into myself, that it was like I wasn’t there. But I didn’t care. I just didn’t want to live. It was like I was in a bubble and I could see everyone, but they couldn’t see me. I knew something was desperately wrong with me but I didn’t know what.
"I went back to the doctor when I was around 37 weeks pregnant and saw my usual doctor, who was brilliant. She recognised that I was depressed and prescribed low-dose antidepressants. Although some people worry about taking medication, those antidepressants gave me back my life. It took three weeks for them to kick in, but they took me from the black into the grey. I wasn’t better, but it got me out of the worst depths of depression.
"Throughout this time, I was going through the motions of normal life. The baby was born when Jamie was five, so I was looking after him and the baby. I went on automatic pilot – I did it all, but there was no heart or enjoyment in it. I knew I had a lovely, beautiful baby, but I couldn’t enjoy her.
"My doctor had increased the dosage of antidepressants after the baby was born, but no one knew how bad I was feeling. I can’t talk now about the thoughts I was having, but they were so frightening. I later learned that a lot of women with postnatal illness have very scary thoughts. I thought I was going mad. I was having these thoughts, I couldn’t sleep or eat, I was depressed, tearful and having awful panic attacks.
"Everyone with postnatal illness has different symptoms and my main symptom was anxiety. I worried about everything and I just couldn’t break the cycle. When Alice was around five months old, I started seeing a psychotherapist who helped me understand some of the reasons why I was so anxious. At the same time I began talking to a counsellor. With their help, I began to recover very slowly and gradually.
"It took two-to-three years for me to feel myself again. There were good days and bad days, and sometimes it felt like I was going backwards. It was easy to do too much and it would set me back again. Some women get better a lot quicker than I did, but this illness is different with everyone.
"I was lucky in some ways. I had a fantastic doctor who knew about postnatal depression and picked up on it early on and I was also lucky that I found a brilliant counsellor. And I did get better. I’ve been myself for the last seven years.
"I don’t know if it would happen again if I had another baby – I know my chances of getting it again are higher and that thought is a terrifying one. But it’s important to understand that although this is a serious illness, you do get better. It takes time but, with help, there is light at the end of the tunnel."