Postnatal depression - key facts

This information is for anyone who wants to know more about postnatal depression (PND for short).

This page is a shortened versions of our postnatal depression information

Disclaimer

This webpage provides information, not advice. You should read our full disclaimer before reading further.

©  November 2018 Royal College of Psychiatrists 

You feel low and have other symptoms for at least 2 weeks - and these may last for weeks or months. Symptoms may include:

  • feeling anxious or irritable
  • not sleeping even when your baby sleeps
  • poor appetite (or comfort eating)
  • guilty and negative thoughts
  • being unable to enjoy things
  • feeling that life just isn't worth living
  • finding it hard to look after yourself and the baby.

PND often starts within 1-2 months of giving birth, but can start several months after having a baby. In many ways it feels similar to depression at other times of life (and depression in pregnancy can continue after birth). The difference in PND is that, understandably, you often focus on the baby and the problems of being a mother. For example, you may worry excessively about your baby’s wellbeing or health. You may judge yourself negatively as a mother. It can be hard to bond with your baby. 

It is important for you and those around you to be aware of these feelings persisting, because PND is a very treatable condition, and the risks of missing it can be very distressing.

10-15 in every 100 women become depressed after having a baby.1

Many causes have been suggested. It is more likely if you have (2):

  • previous depression or other mental health problems 
  • depression or anxiety in pregnancy
  • no support
  • a recent stressful event, such as a relationship ending
  • experienced domestic violence or abuse
  • arrived in a developed country as a refugee or to seek asylum

Most women will get better without treatment in 3 to 6 months. 1 in 4 mothers with PND are still depressed when their child is one-year-old.3 Depression can affect your relationship with your baby and partner. It can also affect your child's development.4 So the shorter it last, the better.

Talk to your GP or Health Visitor. For urgent help, go to the Accident and Emergency Department or contact your GP or your mental health service.

The help you need depends on how severe your depression is. Everyone can try the self-help suggestions below. If this is not enough, you might benefit from a talking therapy. For more moderate to severe depression, you may need medication, with or without talking therapy.5 If you have severe PND, your GP can refer you to a specialist perinatal mental health service, if there is one in your area.

Talking helps. Your GP can refer you to your local Improving Access to Psychological Therapies (IAPT) service or you can self-refer. IAPT offers counselling or Cognitive Behavioural Therapy (CBT). CBT helps you to see how some of your ways of thinking and behaving may be making you depressed. IAPT services give priority to women who are pregnant or who have a baby. You can bring your baby to appointments.

Other therapies can help you understand the depression in terms of what has happened to you in the past.

These may help if your depression is severe or not improving.5 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 need to take them for around 6 months after you start to feel better.

Hormones probably don't work well and they may have their own dangers 2, particularly if you have had thrombosis (blood clots in the veins).

St John's Wort is a herbal remedy. There is evidence that it is effective in mild to moderate depression.  There is not enough information to say that it is safe in breastfeeding.6

St John's Wort can interact with other medicines. Check with your doctor before you take it. 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 pregnancy.

Even if you have been depressed for a while, support, counselling and medication can all help. It's never too late.

  • Do tell someone how you feel - your partner, a relative, a friend, your health visitor or your GP.
  • Do sleep or rest during the day or night when you can.
  • Do try and eat regularly.
  • Do find time to do things you enjoy or help you relax.
  • Do go to local groups for new mothers or postnatal support groups.
  • Do let others help with housework, shopping and looking after other children.
  • Do exercise.
  • 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.
  • Don't use alcohol or drugs.

Telephone support from women who have had PND, home visits by professionals, Interpersonal Psychotherapy 7 and Cognitive Behaviour 8 can all prevent Postnatal Depression.

These things make sense:

  • Don't try to be 'superwoman' - do less and try not to get over-tired.
  • Make friends with other pregnant women or new mums.
  • Find someone you can talk to. If you don't have a close friend, try support through the Association for Postnatal Illness, National Childbirth Trust or Netmums.
  • Go to antenatal classes.
  • Don't stop antidepressant medication in pregnancy without advice. You are more likely to relapse if you have had severe depression9, several episodes or a recent episode.10 Discuss this with your GP or psychiatrist. 
  • Keep in touch with your GP or health visitor if you have had depression before. They can recognise any signs of depression early.
  • Make sure you have treatment for depression in pregnancy.
  • Accept offers of help from friends and family.
  • Take time to listen.
  • Try not to be shocked or disappointed by the diagnosis - it can be treated.
  • Encourage your partner, relative or friend to get the help and treatment she needs.
  • Give practical help like shopping, feeding, changing the baby, or housework.
  • Be mindful of language you use – this is an illness, not something someone can ‘snap out of’, ‘get on with’ or cure by ‘thinking positively’.

 For more in-depth information see our main page: Postnatal Depression.

This page reflects the most up-to-date evidence at the time of writing.

1. Woody CA, Ferrari A, Siskind D, Whiteford H, Harris M.  A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2017; 219: 86-92. 

2. Howard LM, Moylneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. The Lancet. 2014; 384;1775-1788.

3. Goodman JH. Postpartum depression beyond the early postpartum period. J Obstet Gynecol Neonatal Nurs. 2004;33:410-20.

4. Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M et al. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;15;384:1800-19.

5. National Institute for Health and Clinical Excellence Antenatal and postnatal mental health: clinical management and service guidance. NICE Clinical Guideline 192 (2014): London. www.nice.org.uk/ guidance/CG192.

6. Budzynska K, Gardner ZE, Dugoua JJ, Low Dog T, Gardiner P. Systematic review of breastfeeding and herbs. Breastfeed Med. 2012; 7: 489-503. 

7. Dennis  CL, Dowswell  T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database Syst Rev. 2013; 2: CD001134

8. Sockol LE.A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. J Affect Disord. 2015; 15:177:7-21. 

9. Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC et al Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006; 295: 499-507.

10. Yonkers KA, Gotman N, Smith MV, Forray A, Belanger K, Brunetto WL  etal. Does antidepressant use attenuate the risk of a major depressive episode in pregnancy? Epidemiology. 2011; 22: 848–854.
 

Produced by the RCPsych Public Education Editorial Board.

  • Series Editor: Dr Philip Timms
  • Main author: Dr Lucinda Green