Postnatal Depression (PND)

About 1 in 10 women suffer from postnatal depression (PND), and it often develops within the first four weeks after childbirth, and can continue for several months if left untreated. It differs from the 'baby blues' which are very common, but which generally only last for a few days after giving birth, and which rarely need treatment. Postpartum psychosis is a separate mental illness which is a much less common but severe form of depression, affecting about 1 in 1,000 mothers. Postnatal depression shares similar symptoms to clinical depression and can range from mild to severe. Symptoms may include low mood, lack of interest in yourself and your baby, feeling tearful and irritable, and feelings of guilt and inadequacy together with a perceived inability to cope. Poor appetite and loss of libido are common. The symptoms will be covered more thoroughly in the following section.

Any mother can develop PND, and the exact causes are not well understood. It is thought unlikely that it is purely due to hormonal changes after giving birth, but the following are generally agreed upon risk factors. Having a baby brings about massive life changes and can lead to feelings of isolation, worry and being overwhelmed by the responsibility of looking after the newborn. The new mother typically experiences a loss of freedom, income and independence, and may even lose a sense of who she is as a person in her own right. Relationships with the partner can become strained as roles change. If there is no partner or close family, the mother may feel she lacks the skills and support to cope with her new baby on her own, and this can lead to feelings of guilt and failure. Other common risk factors are lack of financial resources, living in poor housing, a prior history of depression, lack of support from family and friends, and loss of outside employment. Having other dependents may compound matters. However, in many cases of PND there is no apparent cause, and just because the mother experiences PND following one pregnancy, does not mean the condition will recur after subsequent pregnancies.

It is important to seek help if you think you are suffering from PND, and just because you feel you are not coping, does not mean that you are a bad mother. Talk to your health visitor who will probably recommend that you see your GP if symptoms are severe. PND almost always gets better in time, and extra support – both emotional and practical – can be vital to your recovery. You may be referred for counselling, and possibly treatment with an anti-depressant by your GP. It can be enormously beneficial to link up with other new parents, perhaps in a support group, to reduce your sense of isolation. Most new parents share similar anxieties and difficulties, and as well as gaining support and understanding, you can share experiences and skills. As PND can be such a disabilitating experience, the earlier it is detected the better. Receiving a diagnosis in itself can be reassuring, and help to alleviate any guilt or sense of inadequacy you may be experiencing. There is much that can be done to alleviate PND, and this is discussed in more detail later. Most women who seek help experience a significant degree of recovery within a few weeks, although it may take a little longer to get over it completely. Be reassured that there are many treatments available, as well as self-help measures you can take, and the sooner you receive help, the more quickly you can return to normal life and enjoy the experience of motherhood.

Symptoms

  • low mood, despondency and tearfulness
  • feelings of hopelessness
  • irritability
  • anxiety and worry
  • exhaustion and lack of energy
  • sleeplessness even when your baby is asleep
  • poor appetite
  • loss of libido
  • loss of interest in things previously enjoyed
  • guilt and feelings of inadequacy
  • feeling you are a bad mother
  • struggling with simple tasks
  • lack of motivation
  • obsessive fears over your baby's health
  • loss of confidence
  • poor concentration and difficulty making decisions
  • feeling overwhelmed
  • strained relationship with your husband or partner
  • psychotic symptoms (rare)

Diagnosis

If you have suffered from several of the symptoms listed in the previous section for more than two weeks, it is important to talk about it with a health care professional, however difficult this may feel, as the earlier you receive a diagnosis, the more quickly you can get the appropriate help. If postnatal depression is not addressed it can last longer and be more severe than it need be. Your health visitor may be your first port of call, and if your symptoms are sufficiently severe you will probably be advised to visit your GP. It is important to be honest, and do not feel that having depressive symptoms means that you are a bad mother, or that your baby will be taken away from you. Every aim of the health professionals will be to keep you and your baby together to enable a bond to develop. The GP will ask you questions to determine whether in fact you do have PND, and a questionnaire called the Edinburgh Postnatal Depression Scale is often used. He or she will then suggest an appropriate course of treatment, and the various options will be discussed in the next section. Remember, PND is a common condition among new mothers, and there is no shame in seeking help, support and reassurance during this difficult time.

Intervention

Receiving treatment can reduce the severity of PND as well as shortening the duration. The appropriate intervention for you will depend on such factors as the severity of your depression, whether you have had mental health problems in the past, and the impact of your symptoms on your ability to look after yourself and your baby. Your GP and/or Health Visitor will help you decide what is the best course of treatment for you based on the above.

Medication

Sometimes the GP will prescribe you with an anti-depressant as this can significantly ease symptoms and enable you to cope better with looking after your baby. Usually a course of anti-depressants will be prescribed for about 6 months, and it is important not to stop taking these even if you feel better as depressive symptoms can return on cessation. Your GP will ensure that the anti-depressant he prescribes will not adversely affect your baby in any way while you are breastfeeding. In some cases the GP may also refer you for psychological counselling, and there is evidence to suggest that this combination of approaches works most effectively.

Psychological Therapies

Cognitive Behavioural Therapy (CBT) is the most commonly used form of psychological therapy, and you may be referred for weekly sessions for a number of weeks with a Psychologist or Counsellor. CBT aims to challenge any negative and unhelpful thoughts you may be experiencing and which are contributing to your PND, and to replace them with more positive and realistic ways of appraising your situation. You will also be encouraged to change any behaviours that are hindering your recovery and your ability to function, and the overall aims are to change the ways you think, feel and behave. The therapist can listen to your problems, and help you to gain insight into your situation and make sense of your difficulties. They may suggest how you can make more effective decisions to help alleviate your suffering and lead a better quality of life as a new mother. Practical support and advice should also be offered.

Help and Support from Partners, Family and Friends

The people who are closest to you may notice your symptoms of PND before you do yourself, and there is much evidence to suggest that emotional and practical support can help with the difficulties the new mother is experiencing. Increased partner support, and additional help with childcare can be enormously helpful, as a sense of isolation can be the most stressful aspect of mothering. This will also give the new mother an amount of freedom, and time to take care of her own needs, including getting some much needed rest. It will help if the partner, friend or relative has an understanding of PND, and the Health Visitor or GP can provide helpful information. Spending time with the mother listening, reassuring and encouraging her can all help on the emotional side, and taking care of some of the practicalities of daily life can ease the burden considerably.

Support Groups

As mentioned in the introduction support groups where you meet other new mothers can be enormously beneficial, particularly if you are a single mother. Being a member of such a group can reduce your sense of isolation, and it enables you to share your experiences and difficulties with other new mothers who may be going through a similar situation to you. As well as gaining support, encouragement and understanding, you can share advice and skills to better manage the task of motherhood. You will feel less alone, and making bonds with others can really help to alleviate the symptoms of depression. Ask your Health Visitor or GP what support or self-help groups are available in your area.

Self-Help

Don't be afraid of being diagnosed with PND, and be reassured that you will get better in time with a combination of help from others and with self-help measures. Close others can be more understanding if they know that you are suffering from this condition. Take care not to bottle up your feelings as talking to someone who understands can provide a great sense of relief. There is no shame in admitting that you are struggling. And remember, you are not alone in suffering this condition.

It is important to rest as much as possible, and this is where supportive others can play a vital role as they take some of the responsibility of the newborn out of your hands for a little while. Try to get as much sleep as you can, or sleep when your baby sleeps. Do try to eat regularly even if you don't feel hungry, and aim for a healthy balanced diet. Also try to exercise regularly as this can really boost your mood; there may be mother and baby exercise classes in your area or you can walk your baby in the pram. Let others help you with things like housework and shopping, and try to find time to relax occasionally and find pleasant activities that are not overly demanding. Try to have quality time with your partner or husband if you have one. Remember most of all that PND is a temporary condition, and that you will recover from it with the appropriate help.