Post Natal Depression

Having a baby is a life changing experience. Pregnancy and the first year after the birth are periods that many parents find quite stressful.

The birth of a baby is an emotional experience and, for many new mothers, feeling tearful and depressed is also common. However, sometimes longer periods of depression, known as postnatal depression (PND), can occur during the first few weeks and months of the babys life.

PND can have a variety of physical and emotional symptoms, and many mothers are unaware that they have the condition. It is therefore important for partners, family, friends and healthcare professionals to recognise the signs of PND as early as possible so that the appropriate treatment can be given. Following childbirth, there are three different types of depression:

  • 'Baby blues' is a common type of depression, and it is the least severe. It does not usually last very long, starting from around the third day after birth and lasting until around the tenth day. During this time, you may feel tearful and irritable, but no medical treatment is needed.
  • Postnatal depression affects about 1 in 10 mothers in the UK, and usually develops in the first 4-6 weeks after childbirth. However, in some cases it may take several months to develop. If you feel depressed for most of the time, and the feelings do not go away, you may have PND. Your GP will be able to determine whether you have the condition and, if you do, suggest an appropriate course of treatment.
  • Postnatal psychosis is a rare, but severe, form of depression. It develops in about 1 in 1,000 mothers. Symptoms can include irrational behaviour, confusion, and suicidal thoughts. Women with postnatal psychosis often need specialist psychiatric treatment.

Although postnatal depression is more common in women, men can be affected too. As the birth of a new baby can be a stressful time for both parents, some fathers feel unable to cope, or feel that they are not giving their partner all the support she needs. They can also find it upsetting if the new baby is getting all of their partners attention.

Postnatal depression can put a strain on a relationship. This can cause the break up of some relationships, which is why it is important to recognise the symptoms of PND at an stage early and take steps to get treatment.

Symptoms

Postnatal depression can affect different women in different ways. The symptoms can begin soon after the birth and last for months (or in severe cases, for over a year).

The symptoms of PND usually include one or more of the following:

  • low mood for prolonged periods of time (a week or more),
  • feeling irritable for a lot of the time,
  • tearfulness,
  • panic attacks,
  • difficulty concentrating,
  • lack of motivation,
  • lack of interest in yourself and your new baby,
  • feeling lonely,
  • feeling guilty, rejected, or inadequate,
  • feeling overwhelmed,
  • feeling unable to cope,
  • difficulty sleeping, and
  • physical signs of tension, such as headaches, stomach pains, or blurred vision.

You may also feel constantly tired, have a lack of appetite, and a reduced sex drive. However, these symptoms normally affect most people for a while after childbirth and, on their own, may not mean that you are depressed.

PND can interfere with your day-to-day life. Some women feel unable to look after their baby, and others feel too anxious to leave the house or keep in touch with friends. Many mothers do not recognise that they have PND, and do not talk to family and friends about how they are feeling. So it is important for partners, family members, and friends to recognise the signs of PND at an early stage, and to seek professional health advice as soon as possible.

Some women who have PND get thoughts about harming their baby. This is quite common, affecting about half of all women with the condition. You may also have thoughts about harming, or killing, yourself. Thoughts like these do not mean that you are a bad or unfit mother, and it is very rare for either mother or baby to be harmed. However, it is vital that you see your GP if you have these or any other symptoms of PND. Treatment will benefit both your health, the healthy development of your baby, as well as your relationship with your partner, family and friends.

Causes

The cause of postnatal depression is not completely clear. The condition can affect any mother (or father). PND does not usually have a single cause, but is the result of a combination of factors. Depression is often caused by emotional and stressful events, such as moving house, the break up of a relationship, the death of a relative, or having a baby.

In terms of PND, stressful events around the birth can increase your risk of getting the condition. This may include factors such as:

  • depression during the pregnancy,
  • worry and anxiety about the responsibility of having a new baby,
  • a difficult delivery,
  • lack of support at home,
  • relationship worries,
  • money problems,
  • having no close family or friends around you,
  • mental health problems in the past, such as depression, or previous postnatal depression, and
  • physical health problems following the birth, such as anaemia, or urinary incontinence.

As depression tends to run in families, genetics are thought to play a part in the PND, but the exact nature of the link between the condition, and genetics, is not fully understood. The changes in hormone levels that occur during and after pregnancy were once thought to cause PND. However, there is no evidence to suggest that this is the case. It is much more likely that the condition is related to the combination of life changes that occur after childbirth.

Diagnosis

If you think you have postnatal depression, you should see your GP as soon as possible. If you do not feel able to leave your home, you can ask to be seen at home by your GP, or health visitor.

PND is diagnosed on the basis of what you tell your GP about your symptoms. You may find it helpful to go with your partner, or a close friend, or relative. They may have noticed a difference in your behaviour even before you realised it yourself, and may be able to give the GP more information.

Sometimes, your GP may do a blood test to make sure that there is not a physical reason for your symptoms, such as an under active thyroid gland, or anaemia.

A study undertaken to find out more about PND, showed that only 1 in 4 women with the condition sought help. As a result of this, many GPs now use a short questionnaire to help diagnose PND. It is called the Edinburgh Postnatal Depression Scale and has 10 simple questions. Recently, some doctors have been using this scale during pregnancy to try and find women who are more likely to become depressed after the birth.

Treatment

If you think that you have postnatal depression, you should see your GP, midwife or health visitor as soon as possible so that a diagnosis can be made, and an appropriate course of treatment undertaken. If you do have PND, it is important for you and your family to remember that it can take a long time to fully recover from the condition.
Common treatment methods for PND include:

Support and advice

The most important step in treating PND is recognising the problem and then taking steps to deal with it. The support and understanding of your partner, family, and friends, can play a big part in your recovery. However, to benefit from this, it is important for you to talk to those who are close to you and explain how you feel, rather than keeping everything pent-up inside. This can cause tension, particularly with your partner, who may feel that he or she is being shut out.
The support and advice from social workers, or counsellors, can also be very helpful if you have PND. Ask your health visitor about what services are available in your area. Self-help groups can also provide you with a good advice about how to cope with the effects of PND, and you may find it reassuring to meet other women who feel the same as you.

Medication

Medication is sometimes used to treat PND.  Antidepressants are often prescribed to treat moderate or severe cases. They work by balancing the mood-altering chemicals in your brain. Antidepressants can help ease symptoms such as low mood, irritability, lack of concentration, and sleeplessness, allowing you function normally, and giving you the ability to cope better with your new baby.

A course of antidepressant medicines usually lasts for between 4-6 months. However, if your symptoms improve, the dose may be reduced. Antidepressants take 2-4 weeks to start working, so it is important to keep taking them even if you do not notice an improvement straight away. It is also important to continue taking your medicine for the full length of time recommended by your doctor because if you stop taking it too early, your depression may return.

The type of medication that you are prescribed will depend on how severe your PND is and also whether you are breastfeeding your baby. For example, some types of medicines, such as lithium, clozapine, and lamotrigine, are not recommended while breastfeeding. Your GP should recommend a medicine that has the least risk to both you and your baby, and it should be started on the lowest possible dose.

You should talk to your GP about the type of medicine that is most suitable for you, and any possible side effects that may be caused. If you do experience any side effects from the medicine that you are prescribed, you should tell your GP so that s/he can alter your dose or change your medicine.

In severe cases PND, such as postnatal psychosis, where symptoms can include irrational behaviour, hallucinations and suicidal thoughts, tranquillisers may be prescribed as a possible treatment option. However, they are usually only recommended for short-term use.

Between 50-70% of those who have moderate to severe PND improve within a few weeks of starting treatment with antidepressants. However, they are not an effective method for everyone.

Counselling

Counselling, or talking treatments, can be useful in treating PND. If your GP feels it may help you, you will be referred to a psychologist, or other mental health specialist. There are various different types of counselling, but their availability on the NHS may vary depending on where you live in the country. Talking treatments can include:

  • Cognitive therapy (CT) is based on the idea that certain thoughts can trigger mental health problems, such as depression. The therapist will help you to understand how your thoughts can be unhelpful, or harmful, and make you depressed. Sessions are usually conducted on a weekly basis, over several months, and the aim is to help you to change your thought patterns in a way that is more helpful and positive.
  • Cognitive behavioural therapy (CBT) combines cognitive therapy and behaviour therapy. Behaviour therapy is about changing any behaviour that is harmful or unhelpful. The aim of CBT is to help you change the way that you think, feel, and behave for the better.
  • Other talking therapies include interpersonal therapy and problem solving therapy. Also, trained health visitors sometimes give short counselling sessions over several weeks, and these have been shown to help ease PND.

For those who have moderate PND, talking treatments, such as CT and CBT, have about the same success rate as antidepressants (50-70%). However, talking treatments may not be as effective for people with severe depression because they require a certain level of motivation, and those with severe depression often find it difficult to motivate themselves.

Some research has suggested that a combination of antidepressants and counselling is better than either treatment alone.

Other Treatments

There are various other treatments that are sometimes recommended to treat PND. They include:

  • Regular exercise such as walking, jogging, cycling, or swimming can help to ease the symptoms of depression.
  • St Johns Wort is a herbal antidepressant that is available to buy over-the-counter (OTC) from pharmacies without prescription. However, some doctors do not recommend it because its effectiveness has not been proven, and it can cause side effects. You should not take St Johns Wort if you are taking certain medications, such as warfarin, oral contraceptives anticonvulsants, or antidepressants. Check with your GP if you are unsure.
  • Specialist treatments such as electro convulsive therapy (ECT), which involves giving electric shocks to the brain, may be recommended if you have severe depression that has not improved after trying other treatments.

Complications

In rare cases, a severe form of depression, called postnatal psychosis, can develop after childbirth. As well as the symptoms of severe depression, mothers with postnatal psychosis may also have delusions (believing things that are untrue), hallucinations (seeing things that are not there, or hearing voices), as well as irrational, or suicidal thoughts.

As with postnatal depression, women who have postnatal psychosis often do not realise that they are ill. However, it is a serious mental illness, and it is vital that someone with the condition sees their GP as soon as possible because their health, and the health of their baby, may be at risk.

Prevention

You should inform your GP about any previous periods of depression that you have had, so that they are aware of the risks of postnatal depression after childbirth. The following self-help measures can also be useful:

  • get as much rest and relaxation as possible,
  • take some gentle exercise and follow a healthy diet,
  • do not go for long periods without food because low blood sugar levels can make you feel much worse,
  • do not drink too much alcohol because heavy drinking can make the situation worse,
  • take a daily multi-vitamin supplement,
  • do not try to do everything at once, instead 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 help lines for advice and support (see selected links section), and
  • do not despair, and remember that most people who have depression make a full recovery.

The information shown here is Crown copyright and has been reproduced with the permission of NHS Direct. Last updated June 2007.