Being a mother to a young baby means an enormous life adjustment, and it can be a time when women develop depression. Depression that develops within a year of having a baby is called postnatal depression.
What is postnatal depression?
It’s very common to feel a bit tearful and low a few days after the birth of a baby, especially if it’s your first - this is known as the “baby blues”. At least half of women who have had a baby are affected. Usually, your mood will improve after 10 to 14 days.
Postnatal depression (PND) 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. You may even have distressing thoughts about harming your baby. In severe cases, you may even feel like life is not worth living. PND is quite common, affecting between one and two out of every 10 mothers.
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, and there are almost always signs of depression after six weeks. You might suffer from any of the following:
You may lose your appetite and lose weight, or you may do the opposite and “comfort eat”.
It’s very rare for women with PND to harm their babies, but out of sheer desperation or tiredness you may worry that you are going to. Mothers who don’t have PND can also feel like this sometimes.
Whatever their symptoms, it’s common for women to dismiss their feelings, or hide them through fear of being labelled a bad mother.
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. Women with puerperal psychosis need treatment from a psychiatrist in a hospital. Ideally this will be in a specialised mother and baby unit where you can have your baby with you.
There is rarely a single cause for a bout of depression - several factors usually work together. The drop in hormones that happens after childbirth has been blamed for PND, but doctors 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 due to the combination of life changes associated with childbirth.
The adjustment to the extra responsibility of looking after a totally dependent infant, is demanding. All babies are different; some cry more than others, which can make them particularly difficult to look after.
You may find your relationship with your partner has changed, as you focus your energy on childcare. You may be less interested in sex for a time after childbirth, which may cause an additional strain on your relationship. The birth experience itself can be disappointing or even traumatising, with some women feeling out of control and frightened.
You may have stopped work and find that you have less social life and suddenly on a lower income. Depression does tend to run in families, so it’s likely that some genetic factors are important, although these aren’t clearly understood.
Awareness of PND is increasing, and midwives, GPs and health visitors are alert to the symptoms.
See your GP if you think you might have PND. He or she will ask you questions about your mood, health and your baby. You may be referred to your health visitor or midwife for more support. Your GP may refer you to a psychiatrist or a community psychiatric nurse.
Any woman can get PND, but you are more likely to have it if:
• you have had depression or postnatal depression in the past
• other members of your family have depression or postnatal depression
• you were depressed when you were last pregnant
• you had the “baby blues”
• you have a poor relationship with your partner, where you don’t feel you can discuss your feelings
• you don’t get much help from family or friends
• you have had other stressful events in your life recently, for example moving house or bereavement
• you or your partner are unemployed
Many women feel bewildered or ashamed of their symptoms, and delay seeking help. But it’s important to get help. If untreated, PND can last for many months and damage your relationship with your baby and partner.
Doctors, midwives and health visitors are trained to be aware of the symptoms of postnatal depression and offer sympathetic, prompt treatment. A questionnaire to help professionals spot women at risk is regularly used with new mothers. The most commonly used is the Edinburgh Postnatal Depression Scale, which has 10 simple questions and a scoring system.
These include talking therapies, such as counselling and psychotherapy, and antidepressant medicines.
Counselling is certainly a great adjunct in dealing with PND, but it is important that you select carefully or get advice. Mainstream styles in of counselling in gereral are best suited. There are many forms of psychological treatments that will help PND such as cognitive behavioural therapy (CBT), which aims to reduce unhelpful thoughts and behaviours, and interpersonal counselling, which focuses on your past and present relationships.
Your doctor may prescribe a type of antidepressant medicine called selective serotonin re-uptake inhibitors (SSRIs), such as fluoxetine (eg Prozac). Alternatively, your doctor may prescribe another type called the tricyclic or tricyclic-related family of medicines, such as amitriptyline or trazodone. Your treatment with these medicines will usually last for several months. To help prevent PND coming back, the course of medication will usually last for some time after your symptoms clear up.
It’s possible to continue breastfeeding if you are taking certain antidepressants. Your GP may 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.
Taking parenting classes with your partner or classes in baby massage with your baby may help to reduce PND. Practical measures, such as help with childcare and getting help so you can have time off can also be helpful. Sharing experiences with other mothers affected by PND can also help
If you feel that you may be suffering Post Natal Depression, counselling can definitely help, but you should also contact your GP immediately.