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Postnatal depression


Expert reviewer, Dr Gabrielle Pendlebury, Consultant Psychiatrist
Next review due October 2019

Postnatal depression is a type of depression that some women develop after having a baby. At a time when everyone expects you to be feeling happy, you may be feeling very low. The good news is that, with help and support, postnatal depression can be treated successfully.

Anxious woman

About postnatal depression

More than one in 10 women gets postnatal depression, which 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.

It’s very common to feel overwhelmed, tearful and low for a few days after your baby is born – this is sometimes called the ‘baby blues’. Baby blues usually start two or three days after your baby is born and are over within two weeks. But postnatal depression is more than the ‘baby blues’.

Postnatal depression can be treated successfully, but if left untreated it can cause serious problems with the relationships you have with your baby and partner. So it’s really important that you seek help from your GP if you think you may be depressed.

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 them. 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’s 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. Your mood may be high or low and there may be rapid swings in mood. You may have hallucinations where you see or hear things that aren’t there. You may believe things that aren’t true (delusions). You may feel out of contact with reality, and show out of character behaviour. The symptoms usually start within a month of having a baby.

Postpartum psychosis is a serious condition. If you’re having any of these symptoms you need to alert your GP immediately. This is so you can be assessed and any necessary treatment started as soon as possible. And similarly, if you suspect that someone close to you is having these symptoms, alert their GP. Effective treatments for postpartum psychosis are available.

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, and it’s the best thing you can do for your baby. If left untreated, postnatal depression can damage your relationships with your baby and partner. It can also affect your baby’s development. The important thing to remember is that postnatal depression can be treated. 

Your midwife, health visitor or GP will often 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.

Rarely, some mothers develop postpartum psychosis (see our section on symptoms above). This requires immediate treatment in hospital under the care of a psychiatrist (a doctor who specialises in mental health). Sometimes treatment can be provided in a specialised mother and baby unit, so that your baby can stay with you. However, this isn’t always possible – the important thing is to get effective treatment early.

Treatment of postnatal depression

Remember that many people get postnatal depression and you will get better in time. 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, and whether you’ve had depression before. 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 health visitor 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 many things you can do to help yourself cope with postnatal depression. Here are some suggestions. 

  • Don’t bottle up your feelings. Talk to your partner, friends or family. Or tell your health visitor or GP how you’re feeling.
  • Sleep or rest whenever you can – get some rest while your baby sleeps.
  • Eat a healthy balanced diet, even if you don’t really feel like eating.
  • Get some regular exercise. Perhaps a mother and baby exercise class, or just a walk in the fresh air.
  • Find local groups for new mothers. Ask someone to go with you if you find it difficult at first.
  • Accept offers of help with housework, shopping and childcare.
  • Get in touch with organisations that support women with postnatal depression. See our resources section below for contact details.
  • You may find a self-help manual useful. Ask your health visitor about these. 

Be kind to yourself – you’re going through a tough time. And try not to blame others or take it out on your partner and family who are supporting you.

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 doctor may prescribe antidepressant medicines. They may also offer 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 antidepressant available. There are side-effects to consider, and some may work better for you than others. You and your doctor will decide which medicine is right for you.

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 doctor may advise you to keep taking them for some time once you start to feel better. 

If you’re breastfeeding, make sure your doctor knows that. 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. Your doctor will advise which medicines are safe to take while you’re breastfeeding.

Always read the patient information leaflet that comes with your medicine carefully. If you have any queries about your medicines or how to take them you can ask your pharmacist.

Causes of postnatal depression

There’s 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.

There are many factors which affect your chance of getting postnatal depression. You’re more likely to get it if:

  • you’ve had mental health problems, including depression before
  • you’ve had depression or anxiety during pregnancy
  • you’ve had the ‘baby blues’
  • you aren’t getting the support that you need
  • you’ve had a recent stressful life event, for example bereavement, or losing your job

You may also be more likely to develop postnatal depression if: 

  • 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

But remember, you can become depressed without having any of these causes. And just because you have some of these factors doesn’t mean that you’ll get postnatal depression.

Frequently asked questions

  • Yes, it seems that dads can also feel depressed after the birth of a baby. Studies suggest that around one in five men may be affected. Postnatal depression in dads is more likely if the mum has postnatal depression.

    More information

    If you’re a new dad you might develop postnatal depression for similar reasons that a new mother may. These include having poor support from family and friends, and coping with recent major life events like a job loss or bereavement. You may also be struggling with the extra responsibility, money worries or the changing relationship with your partner. See our section on causes of postnatal depression above. 

    If you’re depressed, it can affect your relationship with your partner and your baby in the same way that postnatal depression in a mother can.

    If you think you have the symptoms of depression, speak to your GP. Symptoms include a lack of energy, feelings of guilt and worthlessness or problems concentrating or sleeping. Our section above on treatment (including self-help) will be relevant to you. And see our resources section below for information about organisations which could help.

  • Most women with postnatal depression will get better without any treatment within three to six months. However, around one in four women may still feel depressed after a year.

    If left untreated, postnatal depression can have a long term and harmful effect on your relationship with your baby and partner. It can also affect how your baby develops. So don’t suffer in silence. If you think you have postnatal depression, talk to your GP or health visitor about getting support and treatment as soon as possible.

  • If you have postnatal depression you may not be able to look after your baby as well as you would if you were well. You may find it hard to interact with, or respond to your baby in a positive way. 

    We know that this can affect your child’s development in both the short and the long term. Having a parent with postnatal depression can affect a child’s social relationships and behaviours, how they develop at school and their emotional development.

    So ask for help and support from your GP or health visitor if you think you might have postnatal depression. By getting help for yourself quickly you’ll be doing the best for your baby.

  • You may be concerned that your partner or someone you care about has postnatal depression. Have a look at our section on symptoms of postnatal depression above for things to look out for.

    If someone you care about has postnatal depression there’s a lot you can do to support her. Here are some suggestions.

    • Encourage her to talk to her health visitor or GP, and to follow their advice. Postnatal depression is treatable.
    • Spend time with her, listen to her and don’t be dismissive about her worries. Reassure her that she’ll get better.
    • Offer practical help with the baby, and with jobs such as cooking, housework and shopping.
    • Try and arrange some time for her without the baby, doing something enjoyable just for her.
    • Encourage her to get out and meet with family and friends. Help her find local groups for new mums.
    • If you’re her partner, try not to feel resentful if you’re getting less attention from her. She needs your help and support.

    Remember, women with postnatal depression often find it hard to talk about it, or even let others know what they are feeling. You can help by reassuring her that it’s not her fault. Help her realise that seeking help is the best thing she can do for herself and the baby.


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Related information

    • Postnatal depression. BMJ Best practice. bestpractice.bmj.com, last updated 5 February 2016
    • Postnatal depression. PatientPlus. patient.info/patientplus, last checked 23 February 2015
    • Depression – antenatal and postnatal. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2015
    • Depression. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2015
    • Antenatal and postnatal mental health: clinical management and service guidance. National Institute for Health and Care Excellence (NICE), 2014. www.nice.org.uk
    • Management of perinatal mood disorders. Scottish Intercollegiate Guidelines Network (SIGN), 2012. www.sign.ac.uk
    • Mood disorders during pregnancy and after the birth of your baby. Scottish Intercollegiate Guidelines Network, 2012. www.sign.ac.uk
    • Reproductive psychiatry, sexual dysfunction, and sexuality. Oxford handbook of psychiatry (online). Oxford Medicine Online. www.oxfordmedicine.com, published March 2013
    • Map of Medicine. Perinatal mental health. International View. London: Map of Medicine; 2016 (Issue 1)
    • Postnatal depression. Royal College of Psychiatrists. www.rcpsych.ac.uk, updated April 2014
    • Postnatal depression and perinatal mental health. MIND. www.mind.org.uk, published July 2016
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, October 2016
    Expert reviewer, Dr Gabrielle Pendlebury, Consultant Psychiatrist
    Next review due October 2019



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