Postnatal depression

What is postnatal depression?

If you've had a baby and are feeling persistently low, anxious or overwhelmed, you may be experiencing postnatal depression (PND), sometimes called postpartum depression. It's more than the 'baby blues', but it's also a treatable illness, and the majority of parents who get support go on to recover fully.

What are the symptoms of postnatal depression?

No two people experience postnatal depression in quite the same way. It might come on suddenly or creep up gradually, and you don't need to have every symptom below for it to be PND:

• Low mood, sadness or feeling hopeless
• Losing interest in things you'd normally enjoy
• Feeling guilty, worthless, or like you're not doing well enough as a parent
• Constant worry, anxiety or fearfulness
• Feeling irritable or on edge
• Trouble sleeping, even on the odd occasion when you do get a chance to rest
• Struggling to concentrate or make even simple decisions
• Withdrawing from friends, family or your usual activities
• Finding it hard to bond with your baby
• Frightening or intrusive thoughts, for example about your baby being harmed – these are distressing but very rarely acted on
• Thoughts of harming yourself.

Feeling a bit low, tearful or anxious for the first week or so after birth is extremely common, and most people describe this as the baby blues – it tends to settle by itself within around two weeks. If your symptoms last longer than this or start later, and you're finding it hard to cope, it's worth getting this checked out.

What causes postnatal depression, and who is at risk?

It isn't fully understood why postnatal depression happens. The sheer physical and emotional demands of looking after a newborn, broken sleep, and shifting hormone levels are all thought to play a part, though sometimes there's no obvious trigger at all.

• Any previous mental health problem, including depression
• Difficult experiences in your life recently, such as a bereavement or losing a job
• Having a baby who was born prematurely or who is unwell
• Not having much support from family or friends
• Difficulties in your relationship with your partner
• Experiencing domestic abuse.

Postnatal depression is common – estimates put it at somewhere between 1 and 1.5 in every 10 mothers during their baby's first 12 months. It's less widely known that dads and partners can be affected too, although this happens less often.

Are there different types of postnatal depression?

Postnatal depression sits within a wider range of mood changes that can happen around childbirth, and it helps to know how these differ.

• Baby blues: This is very common, mild, and short lived, usually resolving on its own within about 2 weeks of birth without needing treatment
• Postnatal depression: Low mood and related symptoms that last longer than the baby blues, or start later, and don't resolve on their own
• Antenatal depression: The same kind of depression, but occurring during pregnancy rather than afterwards
• Postpartum psychosis: A rare but severe mental illness with a sudden onset, typically in the first couple of weeks after birth. It can involve extreme mood swings, confusion, hearing voices or unusual beliefs, and needs urgent medical treatment.

How is postnatal depression diagnosed?

There's no blood test or scan for postnatal depression. It starts with an honest conversation, usually with a doctor, midwife or health visitor, about the way you've been coping and feeling, sometimes alongside a short questionnaire to help build a fuller picture of your mood. Once they have a clearer sense of what's going on, they'll talk you through the treatment and support that could help.

How is postnatal depression treated?

These are a few different types of mental health support available:

• Guided self-help: Such as working through a structured book or online programme, often used for milder symptoms
• Talking therapy: Such as CBT (cognitive behavioural therapy)
• Antidepressant medicine: Many antidepressants are considered safe while breastfeeding, so mention this to your doctor so they can pick one that's suitable
• A referral to a dedicated perinatal mental health service: This is for support that's more specialist, if your symptoms are more severe or aren't improving with other treatment
• A short admission to a specialist unit: You can stay together with your baby, allowing more intensive treatment while you continue caring for them.

Most people notice things improving somewhere between 3 and 6 months in, though it can take considerably longer for some. Getting treatment makes a real difference to those chances.

When should I see a doctor?

• You suspect postnatal depression could be what you're experiencing, even if you only recognise some of the signs
• Your low mood, tearfulness or anxiety has lasted longer than about 2 weeks after birth
• You're finding it hard to cope, even if you're not sure why
• You're having thoughts of hurting yourself or your baby.

If you ever feel that there's no way out of this and wonder whether life is worth carrying on with, or you're frightened you might act on thoughts of hurting yourself or your baby, treat this as urgent and don't sit with it alone.

Tell your partner, a friend, your GP or your midwife straight away. Samaritans are free to call, any time, on 116 123, and in an emergency you should call 999. You won't have your baby taken away for asking for help – this is very rare, and your care team's whole role is to help you keep looking after your baby while you recover.