Postnatal depression

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, 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. For some though, baby blues develop into a much deeper and longer-term form of depression known as postnatal depression (PND).

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 is a condition that usually develops within the first year following the birth of a baby, either gradually or suddenly. According to the NHS, it affects one in 10 women and one in 10 men.

Postnatal depression 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 In particular, sufferers may become emotionally withdrawn and overwhelmed with feelings of despair, guilt and worthlessness.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 change, and you may feel a lack of interest in everyday life. Ultimately, many people with postnatal depression will feel unable to function normally and this can negatively impact many aspects of their life.

Unfortunately, many people are unaware that they have postnatal depression and may miss out on getting the support they need to recover. Others may find it difficult to take the necessary steps to seek support, but treatment for postnatal depression is crucial for improving quality of life and restoring the enjoyment of being a parent.

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.

- Read Cindy's experience 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). Some people may experience a number of symptoms while others may have only a few.

In most cases, symptoms of postnatal depression will start soon after the birth of a baby, and it's due to this that they can go unrecognised, often mistaken for natural 'baby blues'. There are, however, stark differences between feeling emotional 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 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 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 (eating more, less or forgetting to eat).
  • Thinking about suicide or self-harming.
  • Loss of libido.
  • Increasingly isolating yourself from friends and family, avoiding social events.

This video from charity NCT explains how some women experience PND.

Psychotic symptoms

A small number of women 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). Some sufferers will experience mood swings, feeling very depressed one moment then very manic the next.

Frightening thoughts

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. 

Increased anxiety

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 them
  • their 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 their baby. 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 Adriana Gordon, PGDip, Reg MBACP.

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 (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 

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. The exact cause is unknown, but there are two key factors thought to have a 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.

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 also tend to experience higher rates of anxiety and depression following the birth of their child.

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 of postnatal depression with Happiful.

Dad reading a book to his baby

Diagnosing postnatal depression 

The diagnosis of postnatal depression often starts with the 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 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 get 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.

Treatment for postnatal depression 

There are several approaches to 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. 

Medication

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

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 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.


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) have 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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