While having a baby is often a time of happiness, not all new parents experience this joy right away. Exhaustion, shock, and stress can lead to many feeling emotional and tearful as they come to terms with this life-changing experience.
Here we'll look into this condition in more depth, including signs of postnatal depression, who it affects, and the different treatment options available.
What is postnatal depression?
Postnatal depression (PND) is a condition that usually develops within the first year following the birth of a baby. It can affect any parent at any time and may happen slowly or appear suddenly. According to the NHS, it affects one in 10 people who give birth, while other studies suggest this is closer to a quarter of people (23%). Studies have also revealed that, following the first Covid-19 lockdown, nearly half (47.5%) of women with babies aged six months or younger have met the criteria to be considered to have postnatal depression.
Counsellor Samantha Phillis explains more about PND, including the difference between the baby blues and the baby pinks, and how to find the right therapist for you.
Partners who have not given birth can also experience PND, though there is little research into the exact number of those who experience postnatal or postpartum depression (PPD). It's thought around 1 in 10 new fathers become depressed after having a baby.
Postnatal depression can be triggered by a combination of factors during or following childbirth. Symptoms share similarities with those of general depression and vary in intensity. Becoming emotionally withdrawn, feeling overwhelmed, and experiencing despair, guilt, or worthlessness can all be common. Eating and sleeping patterns may change, and you may feel a lack of interest in everyday life. Ultimately, many people with postnatal depression feel unable to function normally, which can negatively impact many aspects of their life.
Postnatal depression can affect people of any background, ethnicity, and socioeconomic status and its effects can differ from person to person. It can vary from mild (lasting a few months) to severe (a year or more). Many may miss the signs of PND. It’s important to be on the lookout, so you can get the help and support needed to recover quickly and be able to enjoy time with your baby.
What are the baby blues and baby pinks?
According to UK National Screening Committee (UK NSC) statistics, as many as eight in 10 women experience the ‘baby blues’. Typically happening within a few days of giving birth, the baby blues refers to when the parent who has given birth seems more unhappy or upset, and typically lasts around one to two weeks.
The ‘baby pinks’ refers to a feeling of extreme euphoria or mild mania experienced by the parent who has given birth. They may feel overly full of energy or express that they do not need to sleep. Talking too fast, impulsive or unusual behaviour, and a decrease in concentration can all be common indicators. The effects can last for around six to eight weeks, with as many as one in 10 experiencing the baby pinks. Those with a history of mood disorders may be at higher risk of experiencing this.
Symptoms of postnatal depression can be mistaken for baby blues. There are, however, stark differences between feeling emotional following the birth of your baby and feeling extremely low, anxious and lethargic.
When my son was four months old, it was very suddenly apparent that all was not well with me. Postnatal Depression had crept up on me without being noticed by me or by my family. I was frightened to go to sleep because I was sure that I would not wake up again.
- Cindy shares her experience in her story: Postnatal depression crept up on me.
Symptoms of postnatal depression
You may experience a few or many symptoms of PND, which can start in the days and weeks after giving birth, or may come months later. Common symptoms of postnatal depression can include:
How you may feel
- A persistent feeling of sadness and low mood.
- Feeling particularly low at certain times of the day, such as mornings or evenings.
- Loss of interest in everyday life and 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.
- An overwhelming sense of worthlessness, guilt, blame and despair.
- Feeling unable to cope.
- Constantly irritable, angry, or increasingly apathetic.
- Feelings of hostility and indifference to your baby or 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 or self-esteem.
- Changes to appetite (eating more, less or forgetting to eat) or loss of libido.
- Thinking about suicide or self-harming.
- Increasingly isolating yourself from friends and family, avoiding social events.
A small number of people develop psychotic symptoms following the birth of their child. Called postnatal psychosis, this can include hallucinations (seeing or hearing things that aren’t really there) and delusions (unusual beliefs that are illogical or untrue). Mood swings (feeling very down or depressed one moment, then manic or euphoric the next) can be another symptom of postnatal psychosis.
Experiencing frightening or obsessional thoughts about harming yourself or your baby are classic, common signs of how postnatal depression can affect you. These thoughts can trigger further feelings of guilt, worries that you aren’t a good parent, or fear that your baby doesn’t love you, which, in turn, causes 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 both your health and baby are not affected. In the vast majority of cases, these harmful thoughts are not acted upon, but they can greatly impact emotional well-being.
Increased anxiety, particularly over the baby's health, is a common symptom. New parents with PND tend to feel overwhelmed with thoughts and concerns such as:
- my baby is ill
- my baby is not putting on enough weight
- my baby is crying too much and I can't settle them
- my baby is too quiet or might have stopped breathing
Some new parents with postnatal depression might 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 them. Heightened anxiety can bring on physical symptoms such as breathlessness, sweating and racing pulse.
It’s important that post-natal depression is not ignored or dismissed. It is a very real and physical mood disorder, and the sooner it is looked at, the better.
- Counsellor Andria Gordon, PGDip, Reg MBACP in 'The reality and life changes after having a baby'
What causes postnatal depression?
There is no single cause of postnatal depression. For many, it may seem to start for no specific reason. There are, however, some factors which can increase your chances of experiencing PND.
Research indicates that you are more likely to develop postnatal depression if you have:
- a history of mental health issues (eg. depression)
- lack of support from friends and family
- have experienced a major life event (eg. the death of a loved one, losing a job)
- a history of abuse
- a number of personal worries such as financial problems and poor living conditions
- experienced depression or anxiety during pregnancy
Many experts argue that some people have a biological predisposition to developing postnatal depression. Those who give birth, in particular, are considered more at risk than their partners due to hormonal changes that occur during pregnancy and after birth, which can trigger very significant changes in mood.
Stressful events that occur before birth, a traumatic delivery, or 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, 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 partners
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 PND. The exact cause is unknown, but there are two key factors thought to have a significant impact on a new father's emotional well-being, which can make them 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 or during 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 PND.
Like new mums, new fathers are also likely to struggle with the financial pressures and changes in lifestyle that can occur following the birth of a baby. Younger dads on lower incomes also tend to experience higher rates of anxiety and depression following the birth of their children.
All I had in my head was that I needed to “man up”. I didn’t feel like I could talk to anyone about it. I kept it hidden from Michelle because I didn’t want to impact her mental health.
- Mark shares his experience in I’m a Dad who suffered postnatal depression.
How long can PND last?
While the baby blues typically only last for two weeks, postnatal depression can persist for weeks or months if left untreated. In a small number of cases, without help, postnatal depression becomes a long-term problem that lasts for years.
Does PND affect how you feel about your baby?
Postnatal depression can lead to you withdrawing from everyone – including your baby. This doesn’t mean that you are a ‘bad parent’ or that you love them any less. It means that you need help and support.
Preventing postnatal depression
Many people ask if postnatal depression is preventable. There are things that you can do to try and minimise the likelihood of experiencing PND. These can include:
- maintaining a healthy lifestyle
- ensuring you have people you can talk to and turn to for support
- making friends with other new parents (eg. through antenatal classes)
If you have a history of depression or mental health problems, speak with your midwife or GP. They will be able to offer appropriate help, referrals or treatment as needed. They may offer regular visits in the first few weeks following birth if you have experienced ill mental health whilst pregnant.
Diagnosing postnatal depression
The diagnosis of postnatal depression often starts with recognising your feelings aren’t a minor case of the 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 your 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 identify common symptoms of the condition. You may also 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. 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 gets the care and support necessary. Many people with postnatal depression fear their baby will be taken away, but doctors and health professionals only want to help you get better.
Finding support is the first step toward seeking help. Having postnatal depression doesn’t mean you are a bad parent, that you have done anything wrong, or that you are going to lose your baby. Seeking help means you are doing what is best for you and your baby. It’s important to remember that postnatal depression is not your fault. It is never too early or too late to get help.
While there are the more traditional avenues for support - such as counselling and medication - there are also groups hosted both online and in-person which aim to bring like-minded people together to share and support each other. These aren't treatment options but can be incredibly helpful in giving you a safe space to talk and complement any additional treatment or support you are receiving.
For example, you could seek out PND support groups. As well as offering you a space in a community that knows some of what you are experiencing, these groups can offer support and friendships with fellow new parents, and help with feelings of isolation and loneliness.
If you have symptoms of PND, speak with your GP, health visitor or midwife.
Treatment for postnatal depression
There are several approaches to treating postnatal depression. Your GP, midwife or health visitor should be able to provide you with the information you need to make a choice that feels right for you or highlight the right path for further help and support. Medication and counselling (therapy) 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 may be 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 therapies such as cognitive behavioural therapy (CBT) are used to help guide clients through their problems - enabling them to understand the nature of their depression and how they can change their thoughts and behaviours to reach their full potential and 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, counselling for postnatal depression allows sufferers to feel comfortable enough to open up about their illness without feeling ashamed or judged.
For those who need more support, specialist services may be recommended. These can include perinatal mental health services, community mental health teams (if no perinatal mental health team is in your area), or mother and baby units (MBUs). MBUs are special psychiatric wards in hospitals that provide treatment and support for you and your baby. A small number of people who give birth (between two to four in every 1000 who have a baby) will be admitted to a MBU.
Find out more about Mother and Baby Units.
Mental health problems triggered by childbirth and pregnancy
There are a number of other mental health problems that can be experienced during pregnancy or after giving birth. According to the Royal College of Psychiatrists, around 1 in 5 women experience a mental health problem during their pregnancy or the first year after giving birth. Common issues can include:
Birth trauma (PTSD)
If you experience flashbacks, nightmares, or feelings of intense distress, this could be a sign of PTSD (also referred to as birth trauma). You may develop PTSD if something goes wrong during your pregnancy, if you experience a traumatic birth, or have experienced past abuse.
Postpartum panic disorder
If you experience sudden bouts of panic or fear, this could be a sign of a panic disorder. Also known as postpartum panic disorder, this condition is typically experienced during the first few months after giving birth and can result in feelings of excessive worry, fear and anxiety.
Perinatal OCD consists of two parts: obsessive thoughts that make you feel uncomfortable or anxious, and compulsions that give temporary relief. Common perinatal obsessions can focus around hurting your baby, fearing they may be unwell or focusing on making the wrong decisions.
What should I be looking for in a counsellor?
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) has developed a set of guidelines that provide advice about the recommended treatments.
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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