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The Royal College of Psychiatrists Improving the lives of people with mental illness
 

Postnatal Depression (PND): key facts

New podcast: Postnatal depression - Louise's story
Louise is a young mother who developed postnatal depression (PND) following the eventful birth of her first child. Here, she discusses with Raj Persaud her experiences, and what it was like to be admitted to a Mother and Baby Unit.

 

How does it feel to have this disorder?

10-15 in every 100 women become depressed after having a baby. This means you have a low mood and other symptoms for at least 2 weeks, and may last for weeks or months. These may include:
  • feeling anxious or irritable
  • not sleeping even when your baby sleeps
  • poor appetite (or comfort eating)
  • guilty and negative thoughts
  • being unable to enjoy things
  • feeling that life just isn't worth living
  • finding it hard to look after yourself and the baby.

PND often starts within 1-2 months of giving birth, but can develop later in some women. In many ways it feels similar to depression at other times of life (and depression in pregnancy can continue after birth). The difference in PND is that, understandably, there is often a great deal of focus on the baby and in being a mother. For example, it can be difficult to bond with your baby which can lead to worries about the baby's welfare or anxiety about your qualities as a mother.

It is important for you and those around you to be aware of these feelings persisting, because PND is a very treatable condition, and the risks of missing it can be very distressing.

What causes Postnatal Depression?

Many causes have been suggested. It is more likely if you have:

  • had depression or other mental health problems before
  • had depression or anxiety in pregnancy
  • no support
  • had a recent stressful event, such as a relationship ending.

Treatments that can help

Why is treatment important?

Most women will get better without treatment in 3 to 6 months. 1 in 4 mothers with PND are still depressed when their child is one-year-old.  Depression can affect your relationship with your baby and partner. It can also affect your child's development. So the shorter it last, the better.

Where to get help for Postnatal Depression

Talk to your GP or Health Visitor. For urgent help, go to the Accident and Emergency Department or contact your GP  or your mental health service.

The help you need depends on how severe your depression is. Everyone can try the self-help suggestions below. If this is not enough, you might benefit from a talking therapy. For more severe depression, you may need medication, with or without talking therapy.

Talking treatments

Talking helps. Your GP can refer you for counselling. Cognitive Behavioural Therapy helps you to see how some of your ways of thinking and behaving may be making you depressed. Other therapies can help you understand the depression in terms of what has happened to you in the past.

What about antidepressants?

These may help if your depression is severe or not improving. There are several types of antidepressants. They all work equally well, but have different side-effects. They are not addictive. They can all be used in PND, but some are safer than others if you are breastfeeding.

Antidepressants take at least 2 weeks to start working. You need to take them for around 6 months after you start to feel better.

Are there alternatives?

Hormones probably don't work well and they may have their own dangers, particularly if you have had thrombosis (blood clots in the veins).

St John's Wort is a herbal remedy. There is evidence that it is effective in mild to moderate depression.  There is not enough information to say that it is definitely safe in breastfeeding.

St John's Wort can interact with other medicines. Check with your doctor before you take it. This is very important if you are taking the oral contraceptive pill. St John's Wort might stop your pill working. This can lead to an unplanned pregnancy.

Even if you have been depressed for a while, support, counselling and medication can all help. It's never too late.

 

How to help yourself

  • Do tell someone how you feel - your partner, a relative, a friend, your health visitor or your GP.
  • Do sleep or rest during the day or night when you can.
  • Do try and eat regularly.
  • Do find time to do things you enjoy or help you relax.
  • Do go to local groups for new mothers or postnatal support groups.
  • Do let others help with housework, shopping and looking after other children.
  • Do exercise.
  • Do use self-help books and websites.
  • Do contact organisations that support women with Postnatal Depression.
  • Don't blame yourself, your partner or close friends or relatives.
  • Don't use alcohol or drugs.

Can Postnatal Depression be prevented?

We don't know enough about PND to prevent it. These things make sense:

  • Don't try to be 'superwoman' - do less and try not to get over-tired.
  • Make friends with other pregnant women or new mums.
  • Find someone you can talk to. If you don't have a close friend, try the National Childbirth Trust or the Pandas Foundation. They have support groups.
  • Go to antenatal classes.
  • Don't stop antidepressant medication in pregnancy without advice. Discuss this with your GP. Around 7 out of 10 women who stop antidepressants in pregnancy relapse.
  • Keep in touch with your GP or health visitor if you have had depression before. They can recognise any signs of depression early.
  • Make sure you have treatment for depression in pregnancy.
  • Accept offers of help from friends and family.

How can partner, family or friends help?

  • Take time to listen.
  • Try not to be shocked or disappointed by the diagnosis - it can be treated.
  • Encourage your partner, relative or friend to get the help and treatment she needs.
  • Give practical help like shopping, feeding, changing the baby, or housework.

 

For more in-depth information see our main leaflet: Postnatal Depression.

This leaflet reflects the most up-to-date evidence at the time of writing.

Produced by the RCPsych Public Education Editorial Board.

Series Editor: Dr Philip Timms

Main author: Dr Lucinda Green

Reviewed by Dr Michael Yousif

© February 2014. Due for review: February 2016. Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.

For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB. Telephone: 020 3701 2552.

Charity registration number (England and Wales) 228636 and in Scotland SC038369.

 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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