What is postnatal depression?
Postnatal depression (PND), also called postpartum depression (PPD), is a common mental health condition that can develop after having a baby. It can affect parents during pregnancy or after having a baby, and may develop gradually or appear suddenly. Between 10-15% of people who give birth in England experience postnatal depression. If things don’t feel quite as you expected after having a baby, you’re not alone, and understanding what you’re experiencing can be an important first step towards getting the support you need.
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.
Fathers and partners can also experience depression after having a baby.
Postnatal depression can be triggered by a combination of factors during or following childbirth. Symptoms share similarities with those of 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 Becoming emotionally withdrawn, feeling overwhelmed, and experiencing despair, guilt, or worthlessness can all be common.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 or socioeconomic status, and everyone's experience can be different. Recognising the signs and seeking support can help you access the care that's right for you.
What are the baby blues and baby pinks?
Around 80% of new mothers experience the baby blues. This is a short period of mood swings, tearfulness, irritability, and sleep disturbances. The baby blues usually pass within a short time. If difficult feelings last longer, become more intense, or affect your day-to-day life, it can be helpful to speak to your GP, midwife, or health visitor for support.
The ‘baby pinks’, or postpartum euphoria, refers to a feeling of extreme euphoria 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 decreased concentration can all be common indicators.
Research suggests that hypomanic symptoms after giving birth may be relatively common, although estimates vary considerably between studies. Those with a history of mood disorders may be at higher risk of experiencing this. If these changes are significant, concerning or accompanied by confusion, hallucinations or unusual beliefs, seek urgent medical advice.
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.
Postnatal depression symptoms
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.
When to seek urgent help
If you’re struggling with your mental health, support is available. If you need urgent help, call NHS 111 and select the mental health option, or ask for an urgent GP appointment.
If you feel that you or your baby are in immediate danger, or you don’t feel able to keep yourself or someone else safe, call 999 or go to A&E. You can find more information about getting urgent help for your mental health on the NHS website.
Frightening thoughts
Some people with postnatal depression experience frightening or unwanted thoughts about harming themselves or their baby. These thoughts can feel distressing and may lead to feelings of guilt or worries about what they mean.
It can be difficult to talk about these thoughts, but you don't have to manage them alone. Speak to your GP, midwife or health visitor about what you're experiencing so they can help you access appropriate support.
Increased anxiety
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.
Postpartum psychosis
Postpartum psychosis is a serious mental health condition that can develop soon after having a baby. Symptoms can include hallucinations, delusions, confusion and significant changes in mood. It is different from postnatal depression and requires urgent medical assessment.
If you think you or someone you know may have developed postpartum psychosis, speak with your GP for an urgent same-day assessment, or call 111 if you cannot speak to a GP. Your midwife or health visitor may be able to help you access care.
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 (e.g. depression);
- Lack of support from friends and family;
- Have experienced a major life event (e.g. the death of a loved one, losing a job);
- A history of abuse;
- A number of personal worries such as financial issues and poor living conditions;
- Experienced depression or anxiety during pregnancy.
Stressful events that occur before birth, a traumatic delivery, or low self-esteem can also contribute, as can certain physical illnesses such as an underactive thyroid, which can trigger symptoms of depression.
Postnatal depression can 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 and fathers
Up until recently, postnatal depression has been widely considered a condition that affects mainly people who give birth, but it has become recognised that partners 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 wellbeing, which can make them more vulnerable to developing symptoms of postnatal depression. These include:
- Strained relationship with their partner. New parents 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 partner experiencing symptoms of postnatal depression and their partner also experiencing PND.
Like new mothers, new fathers are also likely to struggle with the financial pressures and changes in lifestyle that can occur following the birth of a baby.
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 experienced postnatal depression.
How long does postnatal depression last?
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.
Can postnatal depression be prevented?
There is no guaranteed way to prevent postnatal depression, and experiencing it does not mean that you have done anything wrong. However, looking after your wellbeing and having support around you may help to reduce some of the factors that can contribute to poor mental health after having a baby. This could include:
- Maintaining a healthy lifestyle;
- Having people you can talk to and turn to for support;
- Connecting with other new parents, for example through antenatal classes.
If you have a history of depression or poor mental health, speak with your midwife or GP. They can discuss the support available to you during pregnancy and after your baby is born.
How is postnatal depression diagnosed?
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 experiences – especially if they are experiencing frightening thoughts.
Others may simply be unaware that they have a mental health condition, 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 questions about how you've been feeling that your GP will ask to identify common symptoms of the condition. You may be asked to complete a questionnaire about your symptoms, such as the Edinburgh Postnatal Depression Scale (EPDS).
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 underactive thyroid gland, for example, can develop after childbirth.
If you're diagnosed with postnatal depression, your healthcare professional will talk to you about the treatment and support available.
Getting support for postnatal depression
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.
Alongside treatment such as counselling or medication, some people find peer support helpful. 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.
Postnatal depression treatment
There are several approaches to treating postnatal depression. Your GP, midwife or health visitor can discuss the treatment and support options available to you. Treatment will depend on your symptoms and individual circumstances. Medication and counselling are common treatment types and tend to be offered to individuals depending on the severity of their postnatal depression.
Medication
Antidepressants may be recommended for some people with postnatal depression. If you're breastfeeding, your doctor can discuss which medicines may be suitable for you.
Counselling
Counselling for postnatal depression can provide an outlet for those experiencing PND 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 people through their experiences, helping them to understand the nature of their depression and how they can change their thoughts and behaviours.
Other counselling approaches can help you explore how your relationships or past experiences may be affecting how you feel. Counselling can also offer a supportive, non-judgemental space to talk openly about what you’re experiencing and work through difficult thoughts and feelings at your own pace.
Specialist services
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 1,000 who have a baby) will be admitted to an MBU.
Other perinatal mental health problems
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 one in five 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
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 on hurting your baby, fearing they may be unwell or focusing on making the wrong decisions.
Finding a counsellor for postnatal depression
There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat postnatal depression.
NICE recommends different treatment options depending on your symptoms, their severity, your circumstances and your preferences. These may include supported self-help, psychological therapies such as cognitive behavioural therapy (CBT), medication, or a combination of psychological therapy and medication.
Your healthcare professional can discuss the benefits and risks of the options available to you and help you decide what may be appropriate for your circumstances.
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 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).
Ready to talk?
If you’re experiencing postnatal depression and feel ready to talk, professional support is available. You can use our advanced search to find a counsellor who works with postnatal depression and explore who might feel right for you.
