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Postnatal depression

Written by Dr Hamish McAllister-Williams, MRC clinical scientist, senior lecturer and honorary consultant psychiatrist

What is postnatal depression?

Women often experience a period of 'low' mood following childbirth

Postnatal depression (PND) is a depressive illness that occurs after having a baby. It is common for women following childbirth to experience a period of 'low' mood. This can range in severity from a mild and normal period of mood disturbance ('baby blues'), through to PND and the most severe and rarest problem (postnatal psychosis). This factsheet deals with PND, though 'baby blues' and postnatal psychosis are Postnatal briefly described. Although there are differences between PND and 'ordinary' depression, there are many similarities.

How common is postnatal depression.

PND is common.

• It occurs in 10 to 15 per cent or one in seven to ten mothers.

When does PND occur?

• PND usually develops within the first month following childbirth.
• It may develop out of severe 'baby blues'.
• Episodes of depression may be more common in mothers for many months after having a baby. Where PND stops and ordinary depression begins is unclear.
  

What are the symptoms of PND?

The symptoms are very similar to those seen in 'ordinary' depression.

• Feeling 'low', 'miserable' and tearful for no apparent reason. These feelings persist for most of the time, though they may be worse at certain times of day, particularly the morning.
• Being unable to enjoy yourself. This may be particularly prominent in new mothers who feel that they are not enjoying having a new baby in the way they expected to.
• Irritability is common. This may be with other children, the new baby and particularly with the partner.
• Sleep disturbance is part of looking after a new baby. However in PND there may be additional problems of finding it hard to go to sleep even though you are tired, or waking early in the morning.
• Given that looking after a young baby means having less sleep than usual, it is no surprise that mothers often feel they have no energy. This can be even worse in mothers with PND.
• Appetite is sometimes affected, with mothers not being interested in food. This can be a particular problem since new mothers need all the energy they can get to look after their babies.
• Anxiety frequently occurs in PND. This may take many forms. It may be feeling tense and 'on edge' all the time. Normal concerns and anxieties that any mother feels for a new baby may become overwhelming. In addition mothers may experience 'panic attacks' which are episodes lasting several minutes when they feel as if something catastrophic is about to happen - such as collapsing, having a heart attack or stroke. These are extremely frightening but they get better on their own.
• Depression is often accompanied by feelings of being 'worthless' and 'hopeless'. These feelings are common in PND. All mothers are faced with new and sometimes difficult problems with a new baby. However, mothers with PND feel all the more 'not able to cope' and unable to see a way through their difficulties.
• When people are depressed, they sometimes feel that there is no way out of their problems and that they, and their family, would be better off dead. Thoughts of suicide are therefore not uncommon. If you feel this way, it is important that you talk to somebody about how you feel, since there are ways out of your difficulties other than suicide. You should also be aware that your child would be at increased risk of developing mental health problems of their own if you do commit suicide. If you fear that somebody you know feels suicidal, take this seriously and try to talk to them about it. Talking about suicide does NOT increase the risk of the person committing suicide. Strongly advise the person to visit their doctor.

What causes PND?

The simple answer is we don't know. It is likely that a number of factors are involved. The illness may arise partly because of the hormonal changes following childbirth. The stress of looking after a young baby and having your sleep disrupted may also help to bring on the illness in susceptible people.

Are some mothers more likely to get PND?

• PND is more common in mothers who have previously had episodes of depression.
• A history of depression in family members also increases the risk, probably via genetic (inherited) factors.
• PND is also more common in mothers who have experienced stressful life events during the pregnancy, those who do not have support at home, in those in whom the baby was unplanned or unwanted, and when the baby has been born with some problem.

How is PND treated?

• PND is treatable.
• It is treated in much the same way as ordinary depression.

Talking about the problem with somebody, such as a health visitor, can be helpful. Getting extra support and help with looking after the baby is also important. Sometimes antidepressants are necessary. Although this can cause problems with breastfeeding, since some drugs get into breast milk, there are drugs that are safe. You should remember that the most important thing both from the baby's and your point of view is to get better as quickly as possible. In this regard there are a few things that you are able to do to help.

What to do if you have PND

• Don't 'bottle things up'. Talk to somebody about how you feel.
• Remember that depression is an illness and you are not suffering from it because you are weak or hopeless. Also remember that it is very common and that it will get better.
• Speak to your health visitor or GP. They will be able to sort out what should be the best way of helping you with your illness.
• Do not worry that you will lose your baby. When mothers have PND they often think that they are poor mothers and that if they speak to somebody like their GP, they will have their baby taken from them. This will NOT happen. What will happen is that you will get the help that you need to get rid of the PND. This will help you deal better with the stresses of motherhood.
• Having a baby is tiring and stressful for any mother. You will not be able to manage all the things that you did before the birth. Reduce your commitments and accept help when it is offered.
• Take any opportunity you can to get some sleep.
• Make sure that you try to keep up your normal diet - you will need all the energy you can get.
• Involve your partner. Having a young baby will be difficult for him too and he will be concerned about your illness. Encourage him to speak to your health visitor or GP so they can understand the illness you have.
• Try to get some time to yourself and with your partner if you can.
• Talk to other mums with new babies. You will find that they also feel many of the same things you do.
• Once again, remember that it is NOT your fault that you have PND. Support and therapy will help the episode of illness to end as quickly as possible.

Do mothers with PND harm their babies?

No. Mothers with PND often worry about harming their babies, or not looking after them properly. However, generally they look after their children at least as well as other mothers. Unfortunately mothers and other family members do sometimes harm babies (battered babies). These people tend to have a history of having been harmed or mistreated when they themselves were young and this does not relate directly to PND. Very rarely a mother with postnatal psychosis may harm her child. This may be because she is suffering from false beliefs (delusions) such as that the child is terminally ill. Alternatively mothers may kill their babies before committing suicide themselves thinking that it is better for both of them to be dead. Fortunately this is unusual. PND and postnatal psychosis are treatable illnesses and the sooner they are treated the better. If you have any worries that you may harm your baby, or you have worries that a mum you know may harm their child, speak to a health visitor or doctor as soon as possible.

'Baby blues' and postnatal psychosis

'Baby blues'

• The commonest and mildest form of mood disturbance following childbirth.
• Experienced by half to two-thirds of all mothers - in other words it is normal for this to occur.
• Involves a period of a few days when mothers experience spells of irritability, feeling gloomy and episodes of crying.
• It is more common in mothers who have given birth for the first time and in those who have experienced problems with pre-menstrual syndrome (PMS or PMT).
• It is probably caused by the large and rapid changes in female hormone levels following childbirth.
• 'Baby blues' tends to sort itself out and usually does not require any specific treatment other than reassurance that what the mother is experiencing is normal.

Postnatal psychosis

• This is a rare complication of childbirth, occurring in 1 in every 500 women or so.
• It is most likely to occur in mothers who have previously had an episode of serious mental illness or in those who had a strong family history of serious mental illness.
• Symptoms of the disorder can be very varied but usually include a disturbance of mood, though this can be either an elevation of mood (mania) or depression. Other symptoms include having muddled thoughts, false ideas (delusions) and hearing voices or seeing things that are not there.
• Symptoms appear from a couple of days to a couple of weeks after the birth.
• Postnatal psychosis requires treatment that will depend on the exact symptoms that the mother is suffering. This will usually involve a psychiatrist. It is important for mothers with postnatal psychosis to receive treatment as soon as possible.