Postnatal Depression: Causes, Symptoms and Getting Help

You’ve just had a beautiful baby and you’d expected to be filled with joy. Instead, you’re overwhelmed by feelings of anxiety, self-doubt, sadness and confusion. These feelings could be a sign that you are experiencing postnatal depression. If you suspect you might have postnatal depression, know that help and support are available – you don’t have to go it alone. Read on to find out what some of the symptoms and causes of postnatal depression are, how it differs from the ‘baby blues’ and what help is available to you.

What Is Postnatal Depression?

Postnatal depression (PND) is a medical condition that causes severe and long-lasting negative emotions or thoughts in the months after giving birth. The feelings associated with this condition can be so strong that you may even find yourself unable to do normal day-to-day tasks like caring for yourself and your little one. Postnatal depression often appears between one and three weeks after your baby is born. For some mums, however, it may begin later. In reality, the symptoms of postnatal depression can appear any time in the first year after giving birth. Postnatal depression can occur after any delivery, it doesn’t have to be your first one. Keep in mind that feeling overwhelmed, particularly in those first few months, can be totally normal and understandable: You have a new family member, you’re not sleeping much and you have a lot on your plate.

However, if your feelings seem to be more severe and long-lasting, it may be that you have postnatal depression. With postnatal depression, the feelings of sadness and emptiness linger, typically lasting longer than two weeks. Postnatal depression is not a character flaw or a sign of weakness; instead, it can be considered a complication of childbirth. Remember the symptoms of postnatal depression are very real; it is not a figment of your imagination. It can interfere with your day-to-day life and prevent you from enjoying motherhood and bonding with your baby. This could also negatively affect your newborn baby’s development, especially if the PND goes untreated for a long time. This is why it’s best to seek treatment as soon as possible.

How Common Is Depression After Birth?

It’s more common than you might think. About 1 in 10 mums experience postnatal depression within a year of having a baby.

So, if you think you have the symptoms of PND (described in the next section) or if you’ve recently been diagnosed, know that you are not alone and help is available.

Signs and Symptoms of Postnatal Depression

• Feelings of hopelessness and despair

• Anxiety

• Mood swings

• Intense irritability and anger

• Crying a lot and/or uncontrollably

• Difficulty bonding with your baby or not having an interest in your little one

• Fear that you’re unable to look after your baby

• Loss of appetite or eating much more than usual (comfort eating)

• Inability to sleep (insomnia) or sleeping too much

• Overwhelming fatigue or loss of energy

• Having trouble focusing or making decisions

• Withdrawing from loved ones

• Losing interest in the world around you and things you used to enjoy

• Feelings of worthlessness, shame, guilt or inadequacy

• Having panic attacks

• Aches and pains, or generally feeling unwell

• Thoughts of harming yourself or your baby.

Only your doctor can diagnose postnatal depression and help you get the best possible treatment. This is why it’s important to let your health visitor or doctor know if you think you might be experiencing any of these symptoms. Contact your doctor or health visitor right away if

• your symptoms last longer than two weeks

• your symptoms are getting more severe over time

• you’re struggling to get through the day, including caring for yourself and your baby

• you have thoughts of hurting yourself or your baby.

Causes of Depression After Having a Baby

It’s not known exactly what causes postnatal depression. A commonly held myth is that it’s purely linked to changes in the levels of pregnancy hormones. In reality, though, it is a complex condition and experts believe there are many other physical and emotional factors involved.

Keep in mind that postnatal depression can seem to start for no reason at all, and it’s also possible to have some or all of the problems or risk factors listed in the section below without developing postnatal depression.

Risk Factors of Postnatal Depression

Some of the possible risk factors for postnatal depression include the following:

• A history of mental health problems. Depression or other mental health issues earlier in your life – or during or after previous pregnancies.

• Lack of a support network. Having no close friends or family to support you or having problems with a relationship or marriage.

• Recent stressful events. These might include a bereavement, a traumatic breakup or job loss.

• Physical causes. Depression can also be triggered by physical conditions like an underactive thyroid gland or a vitamin B12 deficiency, which can easily be treated.

• Having twins. Parents of twins or other multiples may be at a higher risk of developing postnatal depression.

Baby Blues Vs Postnatal Depression

Baby blues refers to the low mood or feelings of mild depression that many mums experience in the first week or so after giving birth – a time when most people understandably expect to feel happy.

The baby blues are thought to be caused by the hormonal and chemical changes that take place in your body straight after childbirth, and the symptoms usually only last for a few days.

Symptoms of baby blues can include:

• Feeling emotional

• Crying for no apparent reason

• Irritability

• Feeling down

• Anxiety

• Restlessness.

Although having the baby blues can be difficult, these feelings aren’t so severe or long-lasting that they interfere with being able to care for yourself or your baby the way postnatal depression can.

You should know that you’re not alone if you feel down after giving birth. In fact, up to 8 out of 10 mums go through something similar. The baby blues are so common they’re often considered a normal part of giving birth.

You’ve been through a lot and your body is adjusting, and some feelings of sadness and even anger are normal.

During this time, what can help is for you to feel reassured and supported by those around you.

Some good strategies for coping with the baby blues can include:

• Getting as much rest as you can. Try and catch up on some sleep yourself whenever your baby sleeps. If that’s not enough, ask your partner, a family member or someone else you trust to watch your baby while you get some shuteye.

• Talk to someone. Talking to your loved ones about how you’re feeling can help put things into perspective. Your midwife, health visitor and doctor are also there if you need advice or just someone to talk to. Joining a mother and baby group is another good way of meeting people going through a similar experience, who can offer support and advice.

• Don’t be too hard on yourself. Having a new family member to care for can seem overwhelming, and the bonding process may also take longer than you’d expected. Try not to compare yourself with other parents, and keep in mind that sometimes it takes time for a bond to form between you and your little one. None of this means you aren’t a ‘good parent’.

• Give yourself a treat sometimes. Although it’s hard when you need to devote so much attention to your baby, try not to lose sight of your own needs. A little ‘me time’ – spent doing something you enjoy – or perhaps a spot of meditation can work wonders. To make time for this, ask someone you trust to look after your little one for a short time so that you can truly take the time to focus on yourself.

Postpartum Psychosis

Postnatal depression should not be confused with a much more serious disorder called postpartum psychosis, which involves more severe symptoms, such as hallucinations.

Postpartum psychosis is very rare (only 1 or 2 mums experience it for every 1,000 births), and it requires urgent treatment in hospital.

Diagnosing Postnatal Depression

Talk to your doctor or health visitor as soon as you suspect you may have postnatal depression. It’s best not to wait until your next postnatal checkup or your baby’s next health and development review.

Your health visitor or doctor will be able to diagnose postnatal depression based on how you are feeling and the symptoms you have. Special diagnostic tools such as the Edinburgh Postnatal Depression Scale may be used to gain a more accurate assessment.

You might also be offered a physical check-up, to make sure you don’t have any underlying health conditions – such as anaemia after birth – that could be contributing to your depression.

Treatment for Postnatal Depression

The three main treatment types are:

• Self-help strategies

• Therapy

• Medication.

In some cases, more than one of the treatments may be recommended to help treat moderate or severe long-term depression.

Self-Help Strategies

Caring for a newborn baby can be challenging at the best of times, but with postnatal depression it can be even harder to cope. Your doctor may recommend using self-help strategies like these to help ease the symptoms:

• Talk. Let your partner, friends and family know how you’re feeling.

• Have realistic expectations. You’re adjusting to having a baby, so don’t put pressure on yourself for everything to be perfect. Accept offers of help and ask the people around you to help with chores like cooking, shopping and housework.

• Make time for yourself. Let someone care for your baby while you have some ‘me time’. Listen to music, go for stroll, read a book or settle into a warm bath. Leave the house and do something relaxing that you enjoy with people you feel comfortable with.

• Maintain a healthy lifestyle. Be physically active every day, whether it's taking a walk with your baby or doing some other form of gentle exercise. Try to get as much sleep as you can and eat regular, healthy meals. Steer clear of alcohol and drugs.

• Find a postnatal depression support group. Talking to other mums in a similar situation can be reassuring. Ask your health visitor what’s available near you.

Therapy

The first treatment usually offered to mums with postnatal depression (often alongside the self-help strategies described above) is psychological therapy, sometimes referred to as ‘talking therapy’. Different kinds of talking therapies might be recommended, depending on your needs, including:

• Guided self-help. This involves working through a book or following an online course by yourself, with guidance from a therapist. The courses usually last 9 to 12 weeks and are specially designed to help you to deal with the issues you could be facing.

• Cognitive behavioural therapy (CBT). This kind of therapy aims to break a cycle of negative thinking and behaviour. It might take place one-on-one with a therapist, or in a group. The treatment often lasts three to four months.

• Interpersonal therapy. This treatment typically lasts three to four months and involves talking through your problems with a therapist. The aim is to identify issues relating to your family, friends or partner, and how they might affect your depression.

Medication

Antidepressants might be recommended for moderate or severe postnatal depression, or if psychological therapy isn’t working or you don’t want to try it. You might also be offered antidepressants to treat milder postnatal depression symptoms if you’ve had depression in the past.

These medicines help to regulate your mood by altering the balance of certain chemicals in the brain. There are many types of antidepressants, and the doctor treating your depression will be able to prescribe one that's appropriate for you.

Keep in mind that it usually takes at least a week for antidepressants to start working, so you need to keep on taking them even if they don’t seem to help immediately.

You typically need to keep taking the antidepressants for around six months after your symptoms start to improve, otherwise the depression could return. Always check with your doctor before stopping antidepressants or changing the dose.

Breastfeeding and Antidepressants

Not all antidepressants are safe to take while breastfeeding, so it’s important to discuss with your doctor what medicines are suitable for you based on your personal situation.

If you are prescribed antidepressants for postnatal depression, your doctor should explain the risks, benefits and possible side-effects and offer the type that is safest for you and your baby.

How Long Does Postnatal Depression Last?

The duration of postnatal depression can vary significantly from person to person. While some parents may experience postnatal depression symptoms for just a few weeks, others may struggle for many months. On average, postnatal depression usually lasts around 3 to 6 months, but with appropriate treatment and support parents can make a full recovery. However, it’s crucial to remember that every person’s journey is unique, and there’s no ‘normal’ timeframe for recovery. Reaching out and seeking help is a big step towards recovery, and remember you’re not alone; help is available, and recovery is entirely possible.

What If Postnatal Depression Isn’t Treated?

Without treatment, postnatal depression can persist and become a long-term issue, affecting you, your baby and your family. That’s why it’s important to seek help early if you think you might be depressed. Remember, every step towards seeking help is a step towards recovery, and with the right support, you can overcome this challenging time.

Can Postnatal Depression Affect Your Baby?

Postnatal depression may indirectly have an impact on your baby. It’s important to understand that the emotional wellbeing of a new parent is crucial not only for their own health but also for the baby’s development. However, these outcomes are not inevitable and can be mitigated with early intervention, professional help, and a supportive environment. Seeking help as early as possible if you’re facing postnatal depression is highly encouraged. Taking care of yourself is a significant part of taking care of your baby.

How to Prevent Postnatal Depression

Common questions from parents include, ‘Can you prevent postnatal depression?’ and ‘How to avoid postnatal depression?’ There are certain steps you can take to help prevent postnatal depression or manage the signs and symptoms:

• Prioritise physical health. Maintain a balanced diet, engage in regular exercise, and ensure adequate rest.

• Foster open communication. Share feelings with partners, family or friends for emotional support.

• Join a support group. connect with other new mothers and exchange experiences and coping strategies. You can do this during your pregnancy and after the birth.

• Discuss your mental health history. If you’re pregnant or considering having a baby, talk to your GP about any history of mental health issues or depression, either with you or your family. Your GP or midwife can offer you a support plan during and after pregnancy. Remember, seeking help is important for both you and your baby’s well-being.

Postnatal Depression in Partners

How to Support a Loved One Who Has Postnatal Depression

You might be reading this because you’re worried that your partner or someone close to you could have postnatal depression. Depression can set in gradually and people with PND may not always recognise the symptoms in themselves.

They may also have difficulty admitting to themselves or others that they’re depressed.

Signs that someone close to you has postnatal depression could include if they

• cry a lot for no apparent reason

• don’t seem to be bonding with their baby

• withdraw from the people around them

• always talk negatively

• neglect their appearance or personal hygiene

• lose their sense of time

• constantly imagine there’s a problem with their baby

• lose their sense of humour.

Keep in mind that as a partner, friend or family member, you can’t ‘fix’ postnatal depression, but you can be there for the new parent and try and let them know that it isn’t anything to be ashamed of.

Encourage them to talk about how they’re feeling, either to you or to another friend, and especially to their doctor or health visitor.

Here are some practical things you can try:

• Encourage seeing a doctor or talking to their health visitor

• Listen to and accept their feelings; understand that someone with postnatal depression cannot control negative feelings. Simply suggesting they ‘think positively’ won’t help.

• Offer to take care of the baby so they can do relaxing things like go for a walk, get a massage or meet friends guilt-free

• Let them get good sleep by arranging for a family member, friend or babysitter to care for the baby for a few hours

• Do all you can to help out by doing basic errands, chores or day-to-day tasks

• If you are the partner of a mother with postnatal depression, make sure you have some support yourself.

The Bottom Line

Postnatal depression is not your fault. Unfortunately, many women feel guilty or ashamed because they can’t find any reason to explain why they feel so unhappy. Some may even experience having their feelings dismissed or criticised by others.

Remember that postnatal depression is a medical condition that requires treatment, and that you don’t need to suffer alone. There is help and support out there. And once the fog clears, you’ll be able to enjoy this time with your baby to the full.