Giving birth and bringing a baby into the world is generally considered a time of happiness. As a new parent however, you might not experience this straight away. Often, many parents go through a period of exhaustion, shock and stress following the birth of their baby, and may initially feel emotional and tearful as they come to terms with such a life changing experience.
This period of 'baby blues' is very common among new parents and usually only lasts for a few weeks. However for some, the baby blues develops into a much deeper and longer-term form of depression known as postnatal depression (PND).
On this page
- What is postnatal depression?
- Signs of postnatal depression
- What causes postnatal depression?
- Postnatal depression in men
What is postnatal depression?
Postnatal depression is a very common condition that usually develops within the first six weeks following the birth of a baby, either gradually or suddenly. According to the NHS, it affects one in ten women, but a recent study conducted by the Medical Research Council has found that one in 28 men will also experience symptoms of postnatal depression following the birth of their child.
There is no definite cause of postnatal depression, but it tends to be triggered by a combination of factors that are brought to the fore during or following childbirth. Symptoms share similarities with those of general depression, and will vary in intensity. In particular, sufferers may become emotionally withdrawn and overwhelmed with feelings of despair, guilt and worthlessness. Eating and sleeping patterns may alter markedly, and lack of interest in everyday life and even the baby may develop. Ultimately, many people with postnatal depression will feel unable to function normally and this can negatively impact many aspects of their everyday life.
Unfortunately many people are unaware that they have postnatal depression and so will miss out on getting the support they need to recover. Others may find it difficult to seek help, but treatment for postnatal depression is crucial for improving quality of life and helping to restore the enjoyment of being a parent. This page will explore the treatment for postnatal depression that is available, as well as signs and symptoms of the illness to provide insight into how it can be effectively diagnosed and overcome.
Signs of postnatal depression
Postnatal depression is an individual illness - affecting each person differently to the next. Just like general depression, PND can vary from mild (lasting for a few months) to more severe (persisting for more than a year), and whilst some people may experience a number of symptoms, others may have only a few. In most cases, symptoms of postnatal depression will start soon after the birth of a baby, and it is due to this that they can go unrecognised - often mistaken for natural 'baby blues'. There are however stark differences between feeling emotional and irritable following the birth of your baby, and feeling extremely low, anxious and lethargic.
Take a look at the common symptoms of postnatal depression below:
How you may feel:
- A persistent feeling of sadness and low mood. You may feel particularly low at certain times of the day, such as mornings or evenings.
- Loss of interest in everyday life and no longer enjoying the things that once gave you pleasure.
- Not enjoying spending time with your baby.
- Feeling constantly exhausted and tired.
- Getting tearful for no apparent reason.
- Feeling hopeless about the future.
- Overwhelming sense of worthlessness, guilt, blame and despair.
- Feeling unable to cope.
- Constantly irritable and angry.
- Increasingly apathetic.
- Feelings of hostility and indifference to your baby.
- Feelings of hostility and indifference to your partner.
Changes to your normal ways of functioning:
- Disturbed sleep, such as feeling sleepy all day but struggling to sleep at night.
- Difficulty concentrating and finding it hard to make decisions.
- Low self-confidence and self-esteem.
- Changes to appetite - not wanting to eat or simply forgetting to, or eating more than normal (comfort eating).
- Thinking about suicide or self-harming.
- Loss of libido.
- Increasingly isolating yourself from friends and family - deliberately avoiding any social event.
A small number of women - usually around one in 1000, according to the NHS - develop psychotic symptoms following the birth of their child. Symptoms of postnatal psychosis may include hearing voices and seeing things that aren't really there (hallucinations) and having unusual beliefs about things that are not true and illogical (delusions). Many sufferers may even show signs of bipolar disorder - feeling very depressed one moment then very happy the next.
Symptoms of postnatal depression may also include frightening thoughts, or 'obsessional ruminations' in which new parents may envision harming themselves or their baby. These negative thoughts are quite common, and are classic signs of how depression can change your thinking. Often they trigger more complex emotions such as guilt that you are not a good parent and fear that your baby doesn't love you, which can cause further distress. Although many people may feel ashamed or scared to admit they are having harmful thoughts, seeking help can put your mind at ease and will ensure your health and that of your baby is not affected. In the vast majority of cases these harmful thoughts are not acted upon, but they can greatly impact emotional well-being.
Another side effect of postnatal depression is increased anxiety - particularly over the baby's health. New parents with PND tend to feel overwhelmed with thoughts and concerns such as:
- their baby is ill
- their baby is not putting on enough weight
- their baby is crying too much and they can't settle him/her
- their baby is too quiet or might have stopped breathing.
Some new parents with postnatal depression may be afraid to be left alone with their baby, and may fret excessively over their own health and whether they are fit and able to cope with looking after their baby. Heightened anxiety will usually occur in the form of breathlessness, sweating, racing pulse and thumping heart.
What causes postnatal depression?
There is no one single cause of depression, and in many cases it starts for no particular reason, but various factors are thought to influence its development. These are a range of biological, environmental and socio-cultural factors - a combination of particular circumstances that can increase the chances of someone having PND.
Generally, consensus and research indicates that you are more likely to develop postnatal depression if you have:
- a history of mental health issues - including depression
- lack of support from friends and family
- experienced a major life event - e.g. death of a loved-one, losing a job, relationship ending.
- a history of abuse
- a number of personal worries such as financial problems and poor living conditions.
- experienced depression or anxiety during pregnancy.
In addition, many experts argue that some people have a biological predisposition to developing postnatal depression. Women in particular are considered more at risk than men due to hormonal changes that occur during pregnancy and after birth, which can trigger very significant changes in mood. Stressful events that occur before the birth, a traumatic delivery and low self-esteem can also contribute, as can certain physical illnesses such as an under-active thyroid, which can trigger symptoms of depression. Above all however, postnatal depression can quite easily be linked to the physical and emotional stress of looking after a newborn baby, especially if lack of sleep is involved.
Postnatal depression in men
Up until recently postnatal depression has been widely considered a condition that affects mainly women, but it has become recognised that dads too can be highly susceptible to developing the illness following the birth of their child. Research from the Medical Research Council has shown that 'paternal depression' affects one in 28 dads in the first year after the birth of their child. The exact cause is unknown, but there are two key factors thought to have significant impact on a new dad's emotional well-being, which can make him more vulnerable to developing symptoms of postnatal depression. These are:
- Strained relationship with their partner - new dads are more prone to depression (both antenatal and postnatal) if the relationship they have with their partner has been strained before and during the pregnancy.
- Partner experiencing postnatal depression - a clear link has been shown between a dad experiencing symptoms of postnatal depression and his partner also suffering from the illness.
Additionally, nowadays men are facing increased pressures of fatherhood and associated responsibility, which may too put them at risk of developing postnatal depression. Like new mums, new fathers are also likely to struggle with the financial pressures and change in lifestyle that can occur following the birth of a baby. Younger dads on lower incomes tend to experience higher rates of anxiety and depression following the birth of their child.
Diagnosing postnatal depression
The diagnosis of postnatal depression often starts with recognition that persistent feelings of low mood, irritability and exhaustion are not just a case of minor baby blues. Many people with postnatal depression will try to ignore their symptoms, as they may fear being seen as a bad parent if they admit to their problems - especially if they are experiencing frightening thoughts. Others may simply be unaware that they have a serious illness, and it may be through their partner, friends and family that they decide to seek professional advice. Visiting a GP is an important step in the diagnosis of postnatal depression.
Generally, the diagnosis of depression begins with a couple of questions that your GP will ask to identity common symptoms of the condition. These will be along the lines of:
- "During the past month, have you often been bothered by feeling down, hopeless or depressed?"
- "During the past month, have you taken little or no pleasure in doing things that normally make you happy?"
If you have answered yes to both questions, postnatal depression is very probable, but further tests will be carried out to determine this. You may be asked by your GP to complete a questionnaire called the Edinburgh Postnatal Depression Scale which focuses on specific symptoms and difficulties most commonly associated with postnatal depression. A blood test may also be needed to make sure there is no physical reason for symptoms of postnatal depression such as exhaustion and low mood. Conditions such as anaemia and an under-active thyroid gland, for example, can develop after childbirth.
If you are diagnosed with postnatal depression, you will be immediately referred for treatment to ensure you and your baby get the care and support necessary. Many people with postnatal depression fear their baby will be taken away, but doctors and health professionals will want to help you get better.
Treatment for postnatal depression
There are a range of approaches for treating postnatal depression, and your GP should be able to provide you with the information you need to make a choice that feels right for you. Medication and counselling are common treatment types, and tend to be offered to individuals depending on the severity of their postnatal depression.
For those with severe cases of postnatal depression, antidepressants are typically prescribed to help ease symptoms and eventually enable sufferers to overcome the illness. There are several types of antidepressants, all of which work equally well and take at least two weeks to start working. Side effects will vary, and some are designed specifically for mothers who are breastfeeding.
Counselling for postnatal depression provides an outlet for sufferers to talk about their thoughts and feelings with the help of a professional therapist. Specialised psychological therapies such as Cognitive Behavioural Therapy are used to help guide clients through their problems - enabling them to understand the nature of their postnatal depression and how they can change their thoughts and behaviours to reach their full potential and learn how to enjoy being a parent. Other counselling approaches can help clients to understand their PND in terms of their relationships or what has happened to them in the past. Above all however, counselling for postnatal depression allows sufferers to feel comfortable enough to open up about their illness without feeling ashamed or judged.
What should I be looking for in a counsellor or psychotherapist?
There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat postnatal depression. However, the National Institute for Health and Care Excellence (NICE) have developed a set of guidelines that provide advice about the recommended treatments, including the following:
If you develop depression while pregnant or after giving birth:
- If you have mild or moderate depression you may be offered treatments such as an exercise programme, self-help, short-term psychological treatments or counselling.
- If you have mild depression but you have had severe depression in the past, you may be offered an antidepressant if you prefer not to have psychological treatment or it has not helped you.
- If you have moderate depression and have had depression before, or you have severe depression, you may be offered a psychological treatment, or an antidepressant if you prefer. If these treatments do not help you on their own, you may be offered both together.
These treatments usually help, but if they don't, you may be offered a different drug or electroconvulsive therapy (ECT).
Read the full NICE guidelines:
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- Have I got the baby blues? Or is this something more?
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- Postnatal depression: The importance of early intervention
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- Do I have the ‘baby blues’ or postnatal depression?
Noel Bell BA (Hons), MA, PG Dip Psych, UKCP7th May, 2015
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