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.About this leafletThis leaflet is for
anyone wants to know more about postnatal depression (PND for
short). We hope it will be helpful to:
- women who have, or think they might have postnatal
- pregnant women who are worried about getting postnatal
- partners, family and friends.
The leaflet describes
- what it's like to have postnatal
- how to help yourself
- how partners, families and friends can
- when to seek help from your GP or mental
- further sources of help and information.
What is postnatal depression?
Postnatal Depression is a depressive illness
which affects between 10 to 15 in every 100 women having a baby.
The symptoms are similar to those in depression at other times.
These include low mood and other symptoms lasting at least two
weeks. Depending on the severity, you may struggle to look
after yourself and your baby. You may find simple tasks difficult
Sometimes there is an obvious reason for PND, but not
always. You may feel distressed, or guilty for feeling like
this, as you expected to be happy about having a baby. However, PND
can happen to anyone and it is not your fault.
It's never too late to seek help. Even if you have been
depressed for a while, you can get better. The help you need
depends on how severe your illness is. Mild PND can be helped by
increased support from family and friends.
If you are more unwell, you will need help from your GP and
health visitor. If your PND is severe, you may need care and
treatment from a mental health service.
When does PND happen?
The timing varies. PND often starts within one
or two months of giving birth. It can start several months after
having a baby. About a third of women with PND have symptoms which
started in pregnancy and continue after birth.
What does it feel like to have PND?
You may have some or all of the following
You feel low, unhappy and tearful for much or
all of the time. You may feel worse at certain times of the
day, like mornings or evenings.
You may get irritable or angry with your
partner, baby or other children.
All new mothers get pretty tired. Depression
can make you feel utterly exhausted and lacking in energy.
Even though you are tired, you can't fall
asleep. You may lie awake worrying about things. You wake during
the night even when your baby is asleep. You may wake very early,
before your baby wakes up.
You may lose your appetite and forget to
eat. Some women eat for comfort and then feel bad about
You find that you can't enjoy or be interested
in anything. You may not enjoy being with your baby.
There are several reasons why you lose
interest in sex after having a baby. It may be painful or you may
be too tired. PND can take away any desire. Your partner may not
understand this and feel rejected.
- Negative and guilty
Depression changes your thinking:
- you may have very negative thoughts
- you might think that you are not a good
mother or that your baby doesn't love you
- you may feel guilty for feeling like this or
that this is your fault
- you may lose your confidence
- you might think you can't cope with
Most new mothers worry about their babies'
health. If you have PND, the anxiety can be overwhelming.
You may worry that:
- your baby is very ill
- your baby is not putting on enough
- your baby is crying too much and you can't
- your baby is too quiet and might have stopped
- you might harm your baby
- you have a physical illness
- your PND will never get better.
You may be so worried that you are afraid to be left alone with
your baby. You may need re-assurance from your partner, health
visitor or GP.
When you feel anxious, you may have some of the following:
- racing pulse
- thumping heart
- fear that you may have a heart attack or collapse.
You may avoid situations, such as crowded shops because you are
afraid of having panic symptoms.
You may not want to see friends and family. You might find it
hard to go to postnatal support groups.
You may feel that things will never get better. You may think
that life is not worth living. You may even wonder whether your
family would be better off without you.
If you have thoughts about harming yourself, you should ask your
doctor for help. If you have a strong urge to harm yourself, seek
urgent help (see below).
A small number of women with very severe depression develop
psychotic symptoms. They may hear voices and have unusual beliefs.
If this happens, you should seek help urgently (see below).
How does PND affect how I feel about my baby?
- You may feel guilty that you don't feel the way you expected
- You may or may not love your baby.
- You may not feel close to your baby.
- You might find it hard to work out what your baby is feeling,
or what your baby needs.
- You may resent the baby or blame the baby for the way you
Do women with PND harm their babies?
Depressed mothers often worry that they might
do this, but it is very rare. Occasionally, through utter tiredness
and desperation, you might feel like hitting or shaking your baby.
Many mothers (and fathers) occasionally feel like this, not just
those with PND. In spite of having these feelings at times, most
mothers never act on them. If you do feel like this, tell
Women often worry that if they tell someone how they feel, their
baby may be taken away. Actually your GP, health visitor and
midwife will want to help you get better. This will mean that you
can enjoy and care for your baby at home.
Doesn't everyone get depressed after having a baby?
Having a baby is a time of huge change. It is common to
feel many different emotions. Not everyone gets a depressive
Over half of new mothers will experience the 'baby blues'. This
usually starts 3 to 4 days after birth. You may have mood swings.
You may burst into tears easily. You can feel irritable, low and
anxious at times. You may also over-react to things. It
usually stops by the time your baby is about 10 days old. Women
with baby blues do not need treatment. If it continues for more
than 2 weeks, tell your health visitor or GP. They can check
whether you have PND.
Other mental health problems around childbirth
Depression and anxiety are the most
common mental health problems in pregnancy. They affect 10-15 in
every 100 women. Depression in pregnancy can be helped in much the
same way as postnatal depression. Women also experience a range of
other mental health problems during pregnancy, just like at other
See our leaflet on mental
health in pregnancy.
Postpartum (puerperal) psychosis
This is the most severe type of mental illness
that happens after having a baby. It affects around 1 in 1000 women
and starts within days or weeks of childbirth. It can develop
in a few hours and can be life-threatening, so needs urgent
There are many symptoms that may occur. Your mood may be
high or low and there are often rapid mood swings. Women often
experience psychotic symptoms. They may believe things that are not
true (delusions) or see or hear things that are not there
This illness always needs medical help and support. You may have
to go into hospital. Ideally, this should be to a specialist mother
and baby unit where your baby can go with you.
Women who have had previous episodes of severe mental illness,
disorder, are at a high risk of postpartum psychosis.
Women, who have had a severe episode of illness following a
previous delivery, are also at very high risk. Let your doctor or
midwife know about this. You can discuss with them ways to increase
the chances of you staying well.
Although puerperal psychosis is a serious condition, the vast
majority of women make a full recovery.
Other mental health problems after childbirth
You may have had a mental illness before pregnancy. Your
symptoms may get worse or return after your baby is born. Just as
at other times, women can experience many types of mental health
problems. If you are worried about any type of mental illness,
discuss this with your GP. They can make sure you get the help and
support you need.
What causes PND?
Many possible causes for PND have been
suggested. There is probably no single reason, but a number of
different stresses may add up to cause it.
You are more likely to have PND if you:
- have had mental health problems, including
- have had depression or anxiety during
- do not have support from family or
- have had a recent stressful event - e.g.
death of someone close to you, relationship ending, losing a
There may be a physical cause for your
depression, such as an underactive thyroid. This can be easily
PND can start for no obvious reason, without any of these
causes. Also having these problems does not mean that you will
definitely have PND.
Can postnatal depression be prevented?
We don't know enough about PND to prevent it in the first place.
The following suggestions seem sensible and may help to keep you
- Don't try to be 'superwoman'. Try to do less
and make sure that you don't get over-tired.
- Do make friends with other women who are
pregnant or have just had a baby. It may be more difficult to make
new friends if you get PND.
- Do find someone you can talk to. If you don't
have a close friend you can turn to, try the National
Childbirth Trust or The Pandas
Foundation. Their local groups are very supportive
both before and after childbirth.
- Do go to antenatal classes. If you have a
partner, take them with you. If not take a friend or relative.
- Don't stop antidepressant medication during
pregnancy without advice. Around 7 in 10 women who stop
antidepressants in pregnancy relapse if they stop
the medication. You need to discuss the risks and
benefits of continuing treatment in pregnancy and
- Do keep in touch with your GP and your health
visitor if you have had depression before. Any signs of depression
in pregnancy or PND can be recognised early.
- Do make sure that you have treatment for
depression in pregnancy. This may be a talking therapy or
- Do accept offers of help from friends and
Recognising postnatal depression
The first thing is to recognise you have had a depressive
illness. Don't dismiss it as the 'baby blues'. Don't assume it's
normal to feel like this when coping with a baby.
There are lots of reasons why women delay seeking help. You
- not realise what is wrong
- worry about what other people think
- feel ashamed to admit that you are not enjoying being a
Some women worry that their baby will be taken away. In
fact, you are doing what is best for your baby and for yourself by
getting help for your PND. Doctors and health visitors want to get
the care you need so you can look after your baby.
People are now more aware of depression in general. This means
PND shouldn't be missed so often.
Doctors, midwives and health visitors usually ask new mothers
about their mental health. They may ask you to fill in a
questionnaire or ask the following questions:
- During the last month, have you been bothered by feeling down,
depressed or hopeless?
- During the last month, have you been bothered by having little
interest in pleasure or in doing things?
- Is this something you feel you need or want help with?
It is important to answer these questions honestly so that you
can be offered help if you need it. If your answers suggest you
might have PND, you should see your GP. Your GP will need to ask
more questions to confirm the diagnosis.
Where to get help
The help and treatment you need depends on how severe your PND
is. Your GP and health visitor can help you decide what kind of
help you need.
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. Your GP can advise you about these treatments.
A small number of women will need help from mental health
services. In some areas, there are perinatal mental health
services. These are specialist services for pregnant women or
women with a baby under a year old. Your GP can refer
you. This is usually only needed for women with more severe
Only a few women will need to go into hospital for treatment of
PND. In that case, you should usually be admitted with your
baby to a specialist Mother and Baby Unit.
If you cannot look after yourself or your baby, or if you have
plans to harm yourself, you should be seen
- your GP;
- a mental health service - your GP can arrange this. You may
already have a crisis number to call;
- your local Emergency Department - open 24 hours.
- Don't be frightened by the diagnosis. Many
women have postnatal depression and you will get better in time.
Your partner, friends or family can be more helpful and
understanding if they know what the problem is.
- Do tell someone about how you feel. It can be
a huge relief to talk to someone understanding. This may be your
partner, a relative or friend. If you can't talk to your family or
friends, talk to your health visitor or GP. They will know that
these feelings are common and will be able to help.
- Do take every opportunity to get some sleep or
rest during the day or night. If you have a helpful partner,
relative or friend, ask them to feed the baby at night sometimes.
You can use your own expressed breast milk, or formula milk for
this. If you are on your own, try and rest when the baby
- Do try to eat regularly, even if you don't
feel like eating. Eat healthy food.
- Do find time to do things you enjoy or help
you relax - e.g. go for a walk, read a magazine, listen to
- If you have a partner, do try to enjoy some
time together. If you are a single mother, try to do something
enjoyable with a friend or family member.
- Do go to local groups for new mothers or
postnatal support groups. Your health visitor can tell you about
groups in your area. You may not feel like going to these groups if
your are depressed. See if someone can go with you. You may
find the support of other new mothers helpful. You may find some
women who feel the same way as you do.
- Do let others help you with housework,
shopping and looking after other children.
- Do some exercise. Ask your health visitor if
there are any mother and baby exercise classes in your area.
Walking with your baby in the pram is good exercise. Regular
exercise can boost your mood.
- 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. Life is tough at this time, and
tiredness and irritability can lead to quarrels. 'Having a go' at
your partner can weaken your relationship when it needs to be at
its strongest. The same can happen with other close family or
friends who are trying to support you.
- Don't use alcohol or drugs. They may make you
feel better for a short time, but it doesn't last. Alcohol and
drugs can make depression worse. They are also bad for your
How partners, family and friends can help
- Don't be shocked or disappointed if your
partner, friend or relative says she has postnatal depression. It
is common and can be effectively helped.
- Make sure that you understand what postnatal depression is. Ask
the health visitor or GP if you need more information.
- It's helpful just to spend time with someone who is
depressed. It is important to listen and to offer
encouragement and support. Reassure her that she will get
- Take your partner, relative or friend seriously if she talks
about not wanting to live or about harming herself. Make sure she
seeks help urgently (see section above on Urgent Help).
- Encourage your partner, relative and friend to get the help and
treatment she needs. If you have any worries about treatment,
discuss these with the doctor.
- Do all you can to help with the practical things. This includes
feeding and changing the baby, shopping, cooking or housework.
- If you are the mother's partner, make sure that you have some
- If this is a first baby, you may feel pushed to one side, both
by the baby and by your partner's needs. Try not to feel
resentful. Your partner needs your help and support.
- Fathers can also get depressed after the birth of a baby. This
may be more likely if the mother also has postnatal depression. If
you are a father and think you may have depression, talk to your
GP. It is important for you and your family that you get the help
See our Partners in Care leaflet on Postnatal Depression.
Why is treatment important?
Most women will get better without any
treatment within 3 to 6 months. 1 in 4 mothers with PND are still
depressed when their child is one-year-old. However, this can mean
a lot of suffering. PND can spoil the experience of new motherhood.
It can strain your relationship with your baby and partner. You may
not look after your baby, or yourself, as well as you would when
you are well. PND can affect your child's development and behaviour
even after the depression has ended. So the shorter it lasts, the
Which treatments are available?
The treatment you need depends on how unwell you are. You should
be told about all the likely benefits and risks of treatment so you
can make the best choice for you.
- talking treatments
Talking about your feelings can be helpful, however depressed
you are. Sometimes, it's hard to express your feeling to
someone close to you. Talking to a trained counsellor or therapist
can be easier. It can be a relief to tell someone how you feel. It
can also help you to understand and make sense of your
Many general practices now have a counsellor. Trained health
visitors can offer counselling at home in some areas.
There are also more specialised psychological treatments.
Therapy can help you to see how some of your ways
of thinking and behaving may be making you depressed. You can learn
to change these thoughts which has a positive effect on other
symptoms. Other psychotherapies can help you to understand
the depression in terms of your relationships or what
has happened to you in the past.
Some counselling and psychotherapy services will see you more
quickly if you have recently had a baby. Ask your GP or health
visitor about services in your local area.
Are there problem with talking treatments?
Talking treatments are usually very safe, but they can have
unwanted effects. Talking about things may bring up bad
memories from the past. This can make you low or
distressed. Psychotherapy can put a strain on relationships with
people close to you.
Make sure that you can trust your therapist and that they have
the necessary training.
Another problem with talking therapies is that they are still
hard to get in some areas. National guidelines state that women
with PND should be seen within a month. In reality, there are often
long waiting lists. This means you may not get any treatment for
quite a while.
If you have a more severe depression, or it has not improved
with support or a talking therapy, an antidepressant will
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
will need to take them for around 6 months after your start to feel
Are antidepressants safe in breastfeeding?
Make sure that your doctor knows that you are breastfeeding. For
many antidepressants, there is no evidence that they cause problems
for breastfed babies, so breastfeeding is usually possible.
However, the decision is an individual one for each woman.
Some antidepressants have been used in breastfeeding for many
years. There is less information about newer
medications. You doctor can provide up-to-date information
To decide whether to breastfeed when taking an antidepressant,
you need to think about:
- how severe your illness is (or has been in the past)
- treatments which have helped you before
- up-to-date information about the safety of medication in
- the benefits of breastfeeding
- whether your baby is very premature or has any health
- the impact of the untreated illness on your baby.
What about hormonal treatments?
Hormones have been suggested as a treatment for PND. However,
there is little evidence that they work, and they have their own
dangers, particularly if you have had thrombosis (blood clots in
St John's Wort is a herbal remedy available from chemists.
There is evidence that it is effective in mild to moderate
depression. It seems to work in much the same way as some
antidepressants, but some people find that it has fewer
One problem is that St John's Wort can interfere with
the way other medications work. If you are taking other medication,
you should discuss it with your doctor. 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
There is not enough information to say that it is definitely
safe in breastfeeding. Only small amounts get into breast milk, but
do not assume that because it is 'herbal', it will be safe. Discuss
the risks and benefits of treatment in breastfeeding with your
Antenatal and postnatal
mental health: clinical management and service guidance. NICE
Clinical Guideline 45 (2007) National Institute
for Clinical Excellence: London.
Musters C, McDonald E, Jones L (2008) Management of
postnatal depression. British Medical Journal, 337,
Dennis CL, Hodnett ED (2007) Psychosocial
and psychological interventions for treating postpartum depression.
Cochrane Database of Systematic Reviews. Oct.
Organisations that can help
Association for Postnatal
Helpline: 020 7386 0868.
Provides telephone helpline, information leaflets and a
network of volunteers who have themselves experienced PND.
Tel: 0845 123 23 20; email: email@example.com
Information, support and understanding for
people who suffer with depression, and for relatives who want to
help. Self-help groups, information, and raising awareness for
Helpline: 08451 228669. Provides self-help and
support for families with excessively crying and sleepless and
Tel: 020 7254 6251. Support and practical help for families
affected by mental illness, including 'Newpin' services - offering
support to parents of children under-5 whose mental health is
affecting their ability to provide safe parenting.
Tel: 0800 068 6368. Support and practical help for families with
at least one child under-5. Help offered to parents finding it hard
yo cope for many reasons. These include PND or other mental
illness, isolation, bereavement, illness of parent or child.
Helpline: 0300 330 0700; Pregnancy and
Birth Line: 0300 330 0772; Breastfeeding: 0300 330 0771; Postnatal:
0300 330 00773. Support and information on all aspects of
pregnancy, birth and early parenthood. Local groups and telephone
A website offering support and information on pregnancy and
parenting. There is a specific section on offering support. There
is also information on local resources and support groups.
An organisation that helps individuals and their families
with pre- and postnatal depression advice and support. They also
offer support to families in the antenatal period. Helpline (open
9am to 8pm): 0843 2898401.
24-hour helpline 08457 90 90 90 (UK) or
1850 60 90 90 (Ireland); Email: firstname.lastname@example.org.
Confidential emotional support for those in
distress who are experiencing feelings of distress or despair,
including suicidal thoughts.
Tel: 0300 100 1234. Relationship support including couple and
family counselling. Face-to-face, telephone or online
- Overcoming postnatal depression: a five
areas approach by Christopher Williams, Roch Cantwell and
Karen Robertson, Hodder Arnold (2009)
- Coping with postnatal depression by
Dr Sandra Wheatley, Sheldon Press (2005)
- Surviving postnatal depression by Cara Aitken, Jessica
Kingsley Publishers (2000)
- Feelings after childbirth: the NCT book of postnatal
depression by Heather Welford, NCT Publishers (2002)
Produced by the Royal College of Psychiatrists' Public
Education Editorial Board.
Series Editor: Dr Philip Timms
Expert Review: Dr Lucinda Green
User and Carer Input: members of Depression
This leaflet reflects the best available evidence at the time
For a catalogue of public education materials or copies of our
leaflets contact: Leaflets Department
Royal College of Psychiatrists, 21 Prescot
Street, London E1 8BB, Telephone: 020 7235
Charity registration number (England and Wales) 228636 and in
© Updated: April 2014. Due for review: April
2016. Royal College of Psychiatrists. This leaflet may be
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