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Postnatal depression

Postnatal depression is a type of depression that some women develop within a year of having a baby. If left untreated, it can cause serious problems with the relationships you have with your baby and partner.

It’s common to feel tearful and low for a few days after your baby is born – this is sometimes called the ‘baby blues’. Around half of all mums are affected. Baby blues usually start two or three days after your baby is born and lasts for around five days. Postnatal depression is more than the ‘baby blues’.

Postnatal depression is common and affects about one to two out of every 10 women. It often starts within one or two months of giving birth, however, it can start several months after having a baby. For some women, their depression starts while they are pregnant.

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  • Symptoms Symptoms of postnatal depression

    Postnatal depression has many symptoms similar to depression at other times of life. However, these symptoms start within the first year after your baby is born.

    It’s common for women to dismiss their feelings, or hide them through fear of being labelled a bad mum.

    You may feel unable to get into a routine or cope with your baby. You may also feel detached from your baby and not able to bond with him or her. If you have postnatal depression, you may worry constantly, thinking that something bad will happen to you or your baby.

    It’s very rare for women with postnatal depression to harm their babies, but out of desperation or tiredness you may worry that you’re going to. Mums, and dads, who don’t have postnatal depression can feel like this sometimes too.

    Other symptoms may include:

    • feeling low in mood and tearful
    • not enjoying your usual activities
    • losing your appetite or comfort eating
    • tiredness and a lack of energy
    • feelings of guilt and worthlessness
    • problems concentrating
    • problems sleeping
    • not wanting to see friends and family
    • loss of interest in sex

    These symptoms aren’t always caused by postnatal depression, but if you have them, see your GP.

    There is a very serious form of depression that may occur after having a baby, called postpartum psychosis. It’s rare, affecting about one in 1,000 women. You may have depression with symptoms such as hallucinations, loss of contact with reality, thought disturbances and out of character behaviour. The symptoms usually start within a month of having a baby.

  • Diagnosis Diagnosis of postnatal depression

    Some women feel bewildered or ashamed of their symptoms and put off getting help. However, it’s important you get help. If left untreated, postnatal depression can damage your relationships with your baby and partner and have a negative effect on your baby’s development. The important thing to remember is that postnatal depression can be treated.

    Your midwife, health visitor or GP should ask you about your mental health and how you’re feeling. They may ask you the following 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 having little interest or pleasure in doing things?

    Depending on your answers they may also ask:

    • is this something you feel you need or want help with?

    Your GP may use another questionnaire called the Edinburgh Postnatal Depression Scale. This has 10 simple questions for you to answer and a scoring system.

    If you get postpartum psychosis, it can be very serious and it needs treating straightaway. You will need to go to hospital and see a psychiatrist (a doctor who specialises in mental health). Ideally this will be in a specialised mother and baby unit where you can have your baby with you.

  • Treatment Treatment of postnatal depression

    For most women postnatal depression usually lasts about three to six months, but a few women still have it after a year.

    The type of help and treatment you need will depend on how severe your postnatal depression is. If your depression is mild, then it may get better without treatment but with support from your family, friends and health professionals. Your GP or midwife can tell you what help and support is available.

    If you have postpartum psychosis, you may be admitted to hospital for treatment. Ideally this will be to a mother and baby unit so your baby can stay with you.

    Self-help

    There are some things you can do yourself or with your partner. Counselling, going to a support group or having visits from your health professional where you can talk about how you feel may all help. Some couples have also found massage helpful.

    Being regularly active and doing a structured exercise programme can also treat mild postnatal depression. Ask your GP, midwife or health visitor for more information.

    Talking treatments

    There are two main talking therapies that can be used to treat mild or moderate postnatal depression.

    • Cognitive behavioural therapy (CBT). CBT looks at how you think about a situation and how you act and how both of these things can affect each other. You will work with a therapist to change the way you think about things and how you behave.
    • Interpersonal counselling. This focuses on how your relationships work and helps you to understand how this may be connected to your depression.

    Medicines

    If you have severe postnatal depression, your GP may prescribe antidepressant medicines. You may also be offered antidepressants if you have mild or moderate depression and other treatments haven’t worked or you prefer not to have talking therapies. You can have talking therapies at the same time as taking antidepressants.

    There are several types of antidepressants available. There are side-effects to consider, and some may work better for you than others. You may have to try several before you find the most suitable one for you. Your GP may prescribe selective serotonin re-uptake inhibitors (SSRIs) or tricyclic-related medicines.

    Some antidepressants take at least two weeks to start working and you may need to take them for several months. To help prevent your postnatal depression returning, your GP may advise you to keep taking them for some time once you start to feel better.

    You can breastfeed your baby and take certain antidepressants. Small amounts of the medicine can be passed on to your baby through your breast milk. Some antidepressants are thought to be safer for your baby than others. Talk to your GP about what type of antidepressant may be suitable for you if you’re breastfeeding.

    Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

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  • Causes Causes of postnatal depression

    There is rarely a single cause for depression and several factors usually work together. Postnatal depression can happen to anyone and it’s important to know that it’s not your fault.

    Having a baby is a huge life change. Adjusting to the extra responsibility of looking after a totally dependent infant can be demanding.

    You may find that your relationship with your partner has changed as you focus your energy on childcare. It’s common to be less interested in sex for a time after childbirth, which may put additional strain on your relationship. Giving birth can be traumatising, and you may feel out of control and frightened. You may have stopped work and find yourself home alone with no adult company.

    You’re more likely to develop postnatal depression if:

    • you have had depression or postnatal depression before
    • you have had the ‘baby blues’
    • you aren’t getting support from family and friends
    • you have had a recent stressful life event, for example bereavement
    • it took a long time for you to conceive
    • the father of your baby is depressed
    • your pregnancy wasn’t planned
    • you’re not breastfeeding
    • you have two or more children
    • you’re unemployed
    • you’re under the age of 16 when you have your baby
    • you had health problems during your pregnancy or the birth
  • FAQs FAQs

    Do dads get postnatal depression?

    Answer

    Yes, in recent years, postnatal depression in dads has become more widely recognised, with as many as four in 100 men affected.

    Explanation

    Dads can also feel depressed after the birth of a baby. Depression is most likely to develop three to six months after the baby is born and may also be more likely if the mum has postnatal depression.

    If a dad is depressed, it can affect his relationship with his baby in the same way that postnatal depression in a mother can.

    If you think you have the symptoms of depression, such as a lack of energy, feelings of guilt and worthlessness or problems concentrating or sleeping, speak to your GP.

    How long does postnatal depression last?

    Answer

    For most women postnatal depression gets better within six months, though for some women it can last longer. If left untreated, it can have a long term and harmful effect on your relationship with your baby and partner, and on how your baby develops.

    Explanation

    How long postnatal depression lasts varies among women. Most women get better without any treatment within three to six months. However, some women may still feel depressed after a year. If you think you have postnatal depression, talk to your GP or health visitor about getting support and treatment as soon as possible.

    Will postnatal depression affect my child?

    Answer

    Postnatal depression can affect your child if it isn’t treated but, by making sure you get treatment as soon as possible, you can help to prevent this.

    Explanation

    Some research shows that postnatal depression, in either parent, can affect how a child develops. It can affect a child’s social relationships and behaviours, how he or she develops at school and their emotional development.

    However, it’s important to remember that postnatal depression isn’t your fault and there are things you can do to help you feel better. Getting the right treatment quickly will help to reduce the effect on your child and on your relationship with your partner.

    Ask for help and support from your GP or health visitor.

  • Resources Resources

    Further information

    Sources

    • Management of perinatal mood disorders. Scottish Intercollegiate Guidelines Network (SIGN), 2012 www.sign.ac.uk
    • Routine postnatal care of women and their babies. National Institue for Health and Care Excellence (NICE), 2006. www.nice.org.uk
    • Postnatal depression. Royal College of Psychiatry. www.rcpsych.ac.uk, published July 2012
    • Postnatal depression. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published January 2009
    • Depression; antenatal and postnatal. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published January 2013
    • Brief psychiatric disorder. BMJ Best practice. www.bestpractice.bmj.com, published April 2013
    • Antenatal and postnatal mental health. National Institute of Health and Clinical Excellence (NICE), 2007. www.nice.org.uk
    • Collins S, Arulkumaran S, Hayes K, et al. Oxford Handbook of Obstetrics and Gynaecology. 2nd ed. Oxford: Oxford University Press, 2008: 439
    • Depression. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2013
    • Postnatal depression. National Childbirth Trust. www.nct.org.uk, accessed 28 November 2013
    • Postnatal depression. BMJ Best Practice. www.bestpractice.bmj.com, published January 2013
    • Cox J L, Holden J M, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. BJP 1987, 150:782–786.
    • CBT. British Association for Behavioural and Cognitive Psychotherapies. www.babcp.com, published October 2012
    • Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 28 November 2013 (online version)
    • Paulson JF, Sharnail D, Bazemore MS. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA 2010; 303(19):1961–1969. doi: 10.1001/jama.2010.605
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    Reviewed by Natalie Heaton, Bupa Health Information Team, February 2014.

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