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Postnatal depression

This factsheet is for women who have postnatal depression (postpartum depression), or anyone who would like information about it.

Postnatal depression (PND) is depression that develops within a year of having a baby. If left untreated, it can cause serious problems with the mother's relationship with her baby and partner. It can also affect the baby's development - socially, psychologically and emotionally.

Click on the tabs below for more information about postnatal depression.

Published by Bupa's health information team, November 2009.

About

About

About postnatal depression


It's very common to feel a bit tearful and low a few days after the birth of your baby - this is known as the 'baby blues'. At least half of all mothers are affected, especially if it's your first baby. Usually your mood will improve after 10 to 14 days.

Postnatal depression is much more than the 'baby blues'.

Typical symptoms are similar to those of depression at other times. You may feel low all the time and have reduced energy levels, and possibly also have distressing thoughts about harming your baby. If you're severely affected, you may even feel that life isn't worth living. PND is quite common, affecting between one and two out of every 10 mothers. It usually affects women in the first year after their baby's birth but you may also have been depressed before having your baby.

Puerperal psychosis


Some women get a mood disorder called puerperal psychosis. This is characterised by severe depression, mania, hallucinations, loss of contact with reality, severe thought disturbance and out-of-character behaviour. It affects around one in 500 new mothers. If you develop this, you will need treatment in hospital from a psychiatrist (a doctor who specialises in mental health). Ideally this will be in a specialised mother and baby unit where you can have your baby with you.

Symptoms and diagnosis

Symptoms and diagnosis

Symptoms of postnatal depression


Many symptoms of PND are similar to depression at other times of life, but they start within the first year after your baby is born. Symptoms usually begin within three months of the birth, although there are almost always signs of depression after one month.

It's common for women to dismiss their feelings, or hide them through fear of being labelled a bad mother.

You may feel unable to cope with your baby or get into a routine. You may also feel detached from your baby and not close to him or her. If you have PND, you may worry constantly, thinking that something bad will happen to you or your baby.

It's very rare for women with PND to harm their babies, but out of desperation or tiredness you may worry that you're going to. Mothers who don't have PND can also feel like this sometimes.

Other symptoms may include:

  • low mood
  • low self-esteem
  • not enjoying your baby or other things you used to enjoy
  • loss of appetite or comfort eating
  • tearfulness
  • difficulty sleeping, despite extreme tiredness
  • irritability
  • loss of interest in sex

Diagnosis of postnatal depression


Many women feel bewildered or ashamed of their symptoms and delay seeking help. However, it's important to get help - if left untreated, PND can last for many months or, more rarely, for years. It can damage your relationships with your baby and partner and have a negative effect on your baby's development.

Doctors, midwives and health visitors are trained to be aware of the symptoms of postnatal depression and offer sympathetic, prompt treatment. Your doctor may use a questionnaire such as the Edinburgh Postnatal Depression Scale to see whether you’re at risk. This has 10 simple questions and a scoring system.

Please note that availability and use of specific tests may vary from country to country.

Causes

Causes

There is rarely a single cause for a bout of depression and several factors usually work together. The drop in hormones that happens after childbirth has been blamed for PND. However, researchers haven't found any difference between the hormones of women who get PND and those who don't, and treatment with hormones isn't effective. It's more likely to be because of the combination of life changes associated with childbirth.

The adjustment to the extra responsibility of looking after a totally dependent infant can be demanding. All babies are different, for example some cry more than others, which can make them more difficult to look after.

You may find your relationship with your partner has changed as you focus your energy on childcare, or find that your partner is unsupportive. You may be less interested in sex for a time after childbirth, which may put an additional strain on your relationship. Giving birth can be disappointing or even traumatising, and you may feel out of control and frightened.

You may have stopped work and find that you have less social life, lower status and reduced income.

Depression tends to run in families and so it's likely that some genetic factors are important, although these aren't clearly understood.

Other factors include:

  • depression or postnatal depression in the past
  • depression in previous pregnancies
  • having had the 'baby blues'
  • your baby being premature or sick
  • not getting much help from family or friends
  • having had stressful life events recently, for example, bereavement
Some studies have also shown that you may be more likely to be affected by PND if:

  • it took a long time to conceive
  • the father is depressed
  • your pregnancy wasn't planned
  • you're not breastfeeding
  • you have two or more children
  • you're unemployed
  • you or your partner were stressed when you were pregnant
  • you had a problem with thyroid levels when you were pregnant
It's possible that your risk of PND is greater if you had to have an emergency operation to deliver your baby, such as a caesarean. However, the evidence for this varies and more research is needed.

Awareness of PND is increasing so midwives, doctors and health visitors are often alert to the symptoms. They should ask you specific questions during routine health checks before, during and after the birth of your baby to detect signs of depression and follow them up as appropriate.

See a doctor if you think you may have PND. You will be asked about your mood, health and your baby. If this and any treatments your doctor prescribes don't help, you may be referred to a specialist health professional.

Treatment

Treatment

These include antidepressant medicines and talking therapies, such as counselling and psychotherapy.

If you have very severe postnatal depression, you may be admitted to hospital. Ideally this will be to a mother and baby unit so your baby can stay with you.

Self-help


There are some things you can do that may help to reduce PND. These include:

  • parenting classes with your partner
  • baby massage classes
  • getting support with childcare or help around the house
  • taking time out for yourself - even if it's just visiting friends for half an hour
  • doing 30 minutes of exercise a day to boost levels of endorphins, your body's 'happy hormones'
  • getting as much sleep as you can - try to sleep when your baby does
  • eating healthily to keep your immune system strong
  • complementary therapies such as massage and reflexology for relaxation
  • sharing experiences with other mothers affected by PND

Medicines


Your doctor may prescribe you selective serotonin re-uptake inhibitors (SSRIs) or tricyclic-related medicines - these are antidepressants. The course usually lasts several months. To help prevent PND returning, you will probably be advised to keep taking them for some time after your symptoms clear up.

It's possible to continue breastfeeding if you're taking certain antidepressants. Your doctor will probably advise you to breastfeed before you take your antidepressants, and then not breastfeed for one or two hours afterwards, or to try and take the tablets as a single dose before your baby's longest sleep period.

Talking treatments


Your doctor may be able to arrange counselling. Other forms of psychological treatments that may help PND include:

  • cognitive behavioural therapy (CBT) - this helps to challenge negative thoughts, feelings and behaviour
  • interpersonal counselling - this focuses on your past and present relationships
Two recent studies have shown the importance of having well-informed support in the first few weeks of childbirth to prevent PND. The studies showed that new mothers who receive support from well-trained health visitors and from other women who have had PND were less likely to develop PND.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Sources

Sources

  • Dennis C-L, Hodnett ED. Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database of Systematic Reviews 2007, Issue 4. doi:10.1002/14651858.CD006116.pub2
  • Postnatal depression and puerperal psychosis. Scottish Intercollegiate Guidelines Network (SIGN), June 2002. www.sign.ac.uk
  • Routine postnatal care of women and their babies. National Institute for Health and Clinical Excellence (NICE), July 2006. www.nice.org.uk
  • Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2006: 808
  • Postpartum depression. Emedicine. www.emedicine.medscape.com, published April 2010
  • Postnatal depression. The Royal College of Psychiatrists. www.rcpsych.ac.uk, accessed 22 May 2009
  • Joint Formulary Committee, British National Formulary. 57th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009
  • Postpartum depressive illness. GP Notebook. www.gpnotebook.co.uk, accessed 22 May 2009
  • Morrell CJ, Slade P, Warner R, et al. Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women: pragmatic cluster randomised trial in primary care. BMJ 2009; 338:a3045. www.bmj.com
  • Dennis C-L, Hodnett E, Kenton L, et al. Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. BMJ 2009;338:a3064. www.bmj.com
  • Boyce PM, Todd AL. Increased risk of postnatal depression after emergency caesarean section. Med J Aust 1992; 157(3):172-74
  • Patel R, Murphy DJ, Peters TJ. Operative delivery and postnatal depression: a cohort study. BMJ 2005; 330(7496):879

This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. This content was compiled by Bupa based on clinical information and practice current as at the stated date of publication. Content is likely to reflect clinical practice in a particular geographical region (as indicated by the sources cited) – accordingly, it may not reflect clinical practice in the reader’s country of habitation. This content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Photos and videos are only for illustrative purposes and do not reflect every presentation of a condition.

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