Overview

Postnatal depression is a type of depression that many parents experience after having a baby.

It's a common problem, affecting more than 1 in every 10 women within a year of giving birth. It can also affect fathers and partners.

It's important to seek help as soon as possible if you think you might be depressed, as your symptoms could last months or get worse and have a significant impact on you, your baby and your family.

With the right support, which can include self-help strategies and therapy, most women make a full recovery.

Depression during pregnancy

Depression in pregnancy (antenatal depression) is also common. Around 1 in 8 people will experience depression during their pregnancy.

Other mental health symptoms that can occur during or after your pregnancy include anxiety, panic attacks and psychosis.

Symptoms of postnatal depression

Many women feel a bit down, tearful or anxious in the first week after giving birth.

This is often called the "baby blues" and is so common that it’s considered normal.

The "baby blues" don’t last for more than 2 weeks after giving birth.

If your symptoms last longer or start later, you could have postnatal depression.

Postnatal depression can start any time in the first year after giving birth.

Signs that you or someone you know might be depressed include:

  • a persistent feeling of sadness and low mood
  • lack of enjoyment and loss of interest in the wider world
  • lack of energy and feeling tired all the time
  • trouble sleeping at night and feeling sleepy during the day
  • difficulty bonding with your baby
  • withdrawing from contact with other people
  • problems concentrating and making decisions
  • frightening thoughts – for example, about hurting your baby

Many women don't realise they have postnatal depression, because it can develop gradually.

Speak to a GP, midwife or health visitor if you think you may be depressed.

Many midwives and health visitors have been trained to recognise postnatal depression and have techniques that can help.

If they cannot help, they'll know someone in your area who can.

Remember that:
  • a range of help and support is available, including therapy
  • depression is an illness like any other
  • it's not your fault you're depressed – it can happen to anyone
  • being depressed does not mean you're a bad parent
  • it does not mean you’re going mad
  • your baby will not be taken away from you – babies are only taken into care in very exceptional circumstances

Treatments for postnatal depression

Postnatal depression can be lonely, distressing and frightening, but support and effective treatments are available.

These include:

  • self-help – things you can try yourself include:talking to your family and friends about your feelings and what they can do to help; making time for yourself to do things you enjoy; resting whenever you get the chance and getting as much sleep as you can at night; exercising regularly; and eating a healthy diet
  • psychological therapy – a GP may be able to recommend a self-help course, or may refer you for a course of therapy, such as cognitive behavioural therapy (CBT)
  • antidepressants – these may be recommended if your depression is more severe or other treatments haven't helped; your doctor can prescribe a medicine that's safe to take while breastfeeding

Local and national organisations, such as the Association for Post Natal Illness (APNI) and Pre and Postnatal Depression Advice and Support (PANDAS), can also be useful sources of help and advice.

Causes of postnatal depression

The cause of postnatal depression is not completely clear.

There are a number of things that may make you more likely to have postnatal depression. These include:

  • a history of mental health problems, particularly depression, earlier in life
  • a history of mental health problems during pregnancy
  • having no close family or friends to support you
  • a difficult relationship with your partner
  • recent stressful life events, such as a bereavement
  • physical or psychological trauma, such as domestic violence
  • experiencing the "baby blues"

Even if you do not have any of theses, having a baby is a life-changing event that can sometimes trigger depression.

It often takes time to adapt to becoming a new parent. Looking after a small baby can be stressful and exhausting.

Preventing postnatal depression

There are things you can do to help you keep well such as maintaining a healthy lifestyle and having someone you can talk to and turn to for support.

Going to antenatal classes and making friends with other pregnant women or new parents can also be helpful.

If you are pregnant or thinking about getting pregnant, talk to a GP or your mental health team if:

  • you have a history of depression or mental health problems
  • someone in your family has had mental health problems after childbirth (for example, your mother or sister)

This is so they can offer you appropriate treatment

You can also talk to a midwife, who can support you or refer you to specialist mental health services if needed. If you have had a mental health problem while pregnant, your doctor should arrange for you to be seen regularly in the first few weeks after birth.

The mental health team, maternity team and GP will work closely with you during your pregnancy and after you have given birth.

Myths about postnatal depression

Postnatal depression is often misunderstood and there are many myths surrounding it.

These include:

  • postnatal depression is less severe than other types of depression – in fact, it's as serious as other types of depression
  • postnatal depression is entirely caused by hormonal changes – it's actually caused by many different factors
  • postnatal depression will soon pass – unlike the "baby blues", postnatal depression can persist for months if left untreated and in a minority of cases it can become a long-term problem.
  • postnatal depression only affects women – research has actually found that up to 1 in 10 new fathers become depressed after having a baby

These factors are equally true of antenatal depression.

Further information:

The Royal College of Psychiatrists website has more information about postnatal depression.

Symptoms

Postnatal depression can affect women in different ways. It can start at any point in the first year after giving birth and may develop suddenly or gradually.

Many women feel a bit down, tearful or anxious in the first week after giving birth. This is often called the "baby blues" and is so common that it's considered normal. The "baby blues" don't last for more than 2 weeks after giving birth. 

If your symptoms last longer or start later, you could have postnatal depression.

Common symptoms of postnatal depression

The main symptoms include:

  • feeling sad, low in mood or tearful much of the time
  • feeling irritable towards your partner, baby or other children
  • loss of interest in the world around you and no longer enjoying things that used to give you pleasure (like you “can’t be bothered”)
  • lack of energy and feeling tired all the time
  • trouble sleeping at night, you may be awake even when your baby is sleeping
  • feeling very sleepy during the day
  • problems concentrating and making decisions
  • loss of appetite or overeating (comfort eating)
  • feeling agitated or irritable
  • negative thoughts such as feeling you are not a good enough mother, you are unable to look after your baby or your baby does not love you
  • feelings of guilt, hopelessness and self-blame
  • feeling anxious that something bad may happen to your baby
  • problems bonding with your baby, no sense of enjoyment in being with them

Important

If you think you may be depressed talk to a GP, midwife or health visitor as soon as possible so you can access the support you need.

Contact a GP, or call 111, immediately if:

  • you have frightening thoughts about hurting your baby (these can be scary, but people with these kinds of thoughts rarely harm their baby)
  • you are thinking about suicide and self-harm.
  • you develop unusual beliefs (delusions) or have hallucinations (seeing and hearing things that are not real, like hearing voices)

Call 999 if:

  • you think there's a danger of immediate harm to yourself or others

Do not struggle on alone and hope the problem will go away. It can continue for months or years or get worse if nothing is done. Depression is treatable and you can get better with the right help.

Fathers and partners can also become depressed after the birth of a baby. You should seek help if this is affecting you.

Spotting the signs in others

Postnatal depression can develop gradually and it can be hard to recognise. Some parents may avoid talking to family and friends about how they’re feeling because they worry they’ll be judged for not coping or not appearing happy.

Signs for partners, family and friends to look out for in new parents include:

  • frequently crying for no obvious reason
  • having difficulty bonding with their baby, looking after them only as a duty and not wanting to play with them
  • withdrawing from contact with other people
  • speaking negatively all the time and claiming that they're hopeless
  • neglecting themselves, such as not washing or changing their clothes
  • losing all sense of time, such as being unaware whether 10 minutes or two hours have passed
  • losing their sense of humour
  • constantly worrying that something is wrong with their baby, regardless of reassurance

If you think someone you know is depressed, encourage them to talk about their feelings to you, a friend, their GP or their health visitor.

Related conditions

As well as postnatal depression, a number of other mental health conditions can also develop after giving birth (as well as during pregnancy).

These include:

Speak to a GP or health visitor if you or someone you know may have developed a mental health condition.

Treatment

Speak to a GP, midwife or health visitor as soon as possible if you think you might have postnatal depression or depression during pregnancy (antenatal depression).

With appropriate treatment and support, most women make a full recovery, although it can take time.

The 3 main types of treatment are:

  • self-help – for example, talking to your family and friends about your feelings, making time to do things you enjoy, getting as much sleep as you can at night, exercising regularly, and eating a healthy diet
  • psychological therapy – a GP may be able to recommend a self-help course or refer you for a course of therapy, such as cognitive behavioural therapy (CBT)
  • antidepressants – these may be recommended if your depression is more severe or other treatments have not helped; your doctor can prescribe a medicine that's safe to take while breastfeeding

Talk to a GP about the pros and cons of different treatments so you can decide together what's best for you.

They may check to see if any physical health problems may be causing or contributing to feelings of depression.

For instance, you may be anaemic after giving birth or your thyroid may not be working properly. This can cause or add to any feelings of depression. These types of physical health problems can usually be easily treated

Self-help for postnatal depression

Looking after a baby can be stressful and challenging for anyone, and it can be even tougher if you're dealing with postnatal depression as well.

There are a number of things you can try yourself to improve your symptoms and help you cope.

These include:

  • talking to your partner, friends and family – try to help them understand how you're feeling and what they can do to support you
  • not trying to be a "supermum" – accept help from others when it's offered and ask your loved ones if they can help look after the baby and do tasks such as housework, cooking and shopping
  • making time for yourself – try to do activities that you find relaxing and enjoyable, such as going for a walk, listening to music, reading a book or having a warm bath
  • resting when you can – although it can be difficult when you're looking after a baby, try to sleep whenever you get the chance, follow good sleeping habits and ask your partner to help with the night-time work
  • exercising regularly to boost your mood
  • eating regular, healthy meals and not going for long periods without eating
  • not drinking alcohol or taking drugs, as this can make you feel worse

Ask your health visitor about support services in your area. They may be able to put you in touch with a social worker, counsellor or local support group.

It can be reassuring to meet other women who are going through something similar.

Psychological treatments

Psychological therapies are usually the first treatment recommended for women with postnatal depression.

Guided self-help

Guided self-help involves working through a book or an online course on your own or with some help from a therapist.

The course materials focus on the issues you might be facing, with practical advice on how to deal with them.

The courses typically last 9 to 12 weeks.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a type of therapy based on the idea that unhelpful and unrealistic thinking leads to negative behaviour.

CBT aims to break this cycle and find new ways of thinking that can help you behave in a more positive way.

For example, some women have unrealistic expectations about what being a mum is like and feel they should never make mistakes.

As part of CBT, you'll be encouraged to see that these thoughts are unhelpful and discuss ways to think more positively.

CBT can be carried out either 1 to 1 with a therapist or in a group. Treatment will often last 3 to 4 months.

Interpersonal therapy

Interpersonal therapy (IPT) involves talking to a therapist about the problems you're experiencing.

It aims to identify problems in your relationships with family, friends or partners and how they might relate to your feelings of depression.

Treatment also usually lasts 3 to 4 months.

Antidepressants

Antidepressants may be recommended if you have moderate or severe depression and you don't want to try psychological treatment or psychological treatment does not help.

They may also be used if you have mild postnatal depression and a previous history of depression.

Antidepressants work by balancing mood-altering chemicals in your brain. 

They can help ease symptoms such as low mood, irritability, lack of concentration and sleeplessness, allowing you to function normally and helping you cope better with your new baby.

Antidepressants usually need to be taken for at least 1-2 weeks before the benefit starts to be felt, so it's important to keep taking them even if you don't notice an improvement straight away. It can take up to 6 weeks to see the full effect.

You'll usually need to take them for around 6 months after you start to feel better. If you stop too early, your depression may come back.

If you decide to stop taking your medicine, talk to a GP or your specialist. They can help you stop safely.

Antidepressants and breastfeeding

If you’re breastfeeding, talk to your doctor about suitable medicines, as not all anti-depressants are safe to take while breastfeeding.

Your doctor should explain any risks of taking antidepressants and you should be offered the type with the least risk for you and your baby.

When deciding about antidepressants it is important to consider the risks the untreated mental health problem can pose to yourself and your baby, as well as risks associated with side effects.

Side effects

General side effects of antidepressants include:

These side effects should pass once your body gets used to the medicine.

Severe postnatal depression

If your postnatal depression is very severe and it doesn't respond to the treatments above, you'll probably be referred to a specialist mental health team.

Ask a GP or health visitor about these teams and whether a referral would be helpful for you. The team will be able to offer additional treatments, such as:

  • more intensive CBT
  • other psychological treatments, such as psychotherapy
  • therapies such as baby massage to help you bond better with your baby, if this has become a problem
  • different medicines

If your depression is severe you may be admitted to hospital or a mental health clinic until you are well enough to return home. Ideally this should be with your baby in a specialised mother and baby mental health unit.

Charities and support groups

There are a number of national support groups that you can contact for advice.

You can also use them to attend events with other parents affected by postnatal depression.

These groups include:

You can also search for local support groups and find details of national telephone or email support lines on the Maternal Mental Health Alliance website or in our local services directory.



The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 24/03/2022 13:43:29