Postnatal depression (PND)
What is the difference between postnatal depression and the baby blues?
Having the ‘baby blues’ after giving birth is very common. It usually starts in the week after you’ve given birth and stops by the time your baby is around ten days old.
Symptoms of PND can include:
- feeling emotional and irrational
- bursting into tears for no apparent reason
- feeling irritable or touchy
- feeling depressed or anxious.
These are all normal feelings caused by hormone changes as your body gets used to not being pregnant anymore. You don’t need any treatment for the baby blues, but it can be helpful to talk to someone about how you’re feeling.
Postnatal depression is when you have feelings of sadness, hopelessness, guilt or self-blame all the time for weeks or months after you’ve had a baby. Some women have depression when they are pregnant. This is called antenatal depression.
The symptoms can vary from mild to severe and it can affect women in different ways. Some women may find it difficult to look after themselves and their baby if they have severe depression.
Depression is a mental health condition. It is not a sign of weakness, something that will go away on its own or that you should just ‘snap out of.’ The good news is that postnatal depression can be treated with the right care and support and most women will make a full recovery.
It’s important to ask for help if you think you are depressed.
"It was a difficult birth and although I loved her because she was my child, I felt there was something missing. There’s so much pressure and expectation on new mothers - and I wondered what was wrong with me.”
Caroline, mum of one
What are the symptoms of postnatal depression?
You may have postnatal depression if you have:
- feeling of sadness and low mood that won’t go away
- lost interest in life and you’re not enjoying the things you used to
- problems sleeping, such as having trouble getting back to sleep after caring for your baby at night, even when the baby is asleep and you’re feeling exhausted
- difficulty concentrating and making decisions
- low self-confidence
- poor appetite (not eating enough)
- feeling very agitated or, alternatively, you can’t be bothered with anything (apathy)
- feelings of guilt and self-blame
- thinking about, and even planning, suicide.
You may not have all these symptoms and they may come on gradually or you may suddenly start to feel very low.
If you’re feeling like you want to die, it’s important to tell someone. This could be a family member, friend, your GP or midwife. You can also call the Samaritans on 116 123.
"I came home on day three or four and the moment I walked into the house I burst into tears. I got the same anxiety feeling, the feeling I wasn't going to be able to cope with this."
Trust yourself.You are the best judge of whether your feelings are normal for you. Talk to your midwife or GP if you think you have any symptoms of depression and they last for more than two weeks.
How common is it?
Very common. More than 1 in every 10 new mothers experience postnatal depression within a year of giving birth. New fathers can get postnatal depression, too.
What causes depression?
You may be more likely to get postnatal depression if you have:
- had mental health problems before, particularly depression
- had mental health problems during your pregnancy
- no close friends or family to support you
- a poor relationship with your partner
- had a lot of stress in your life recently, such as a bereavement
- had the baby blues.
You may not relate to anything on this list. But having a baby is a life changing event, which can be stressful and exhausting. This alone is enough to cause depression.
What should I do?
Tell your midwife, health visitor or doctor how you feel. Some women feel very distressed or guilty at feeling low at a time when everyone expects them to be happy. Remember that healthcare professionals won’t judge you. They understand that depression is a mental health condition. It is not your fault, or something that you just need to ‘get over’ or move on from. They will focus on helping you find the right treatment and support so you can take care of yourself and your baby.
If you find it difficult to talk about your thoughts and feelings, you could write down what you want to say first, or you may want to have someone with you. The important thing is to let someone know so that you can get the right help as soon as possible.
“I knew something wasn’t right but I didn’t want to admit it. I thought I would be a failure if I admitted that I was struggling with being a mum. One day I went out for a walk and nearly didn’t go home. I thought my husband and son would be better off without me. I knew then it was time to ask for help”
What is the treatment for depression?
The good news is that postnatal depression can be treated - it is a temporary illness that you can recover from. The treatment is likely to depend on how severe your depression is.
“It’s difficult trying to find out what’s wrong with you. Is it just being a new mum? Is it you’re anxious because you can’t settle the baby? Is it postnatal depression? There are so many things that overlap.”
Emily, mum of one
If you have mild depression, the doctor may recommend an exercise programme and/or guided self-help. If you live in England you can self refer for talking therapy or self help .You may be offered medication, especially if you have had depression before or the depression is severe.
If you have mild to moderate depression and have had no previous depression, you may be offered guided self-help or a ‘talking treatment’ (psychological therapy), such as counselling. Your doctor will discuss the options with you, depending on what is appropriate for you and your symptoms.
If you have severe depression or moderate depression and had previous depression your doctor might recommend counselling and antidepressants.
If you are planning to breastfeed your baby, talk to the doctor about this so that they can factor this into the treatment discussions. Some antidepressants are not recommended for breastfeeding and the doctor who is treating you will prescribe one that is suitable instead.
Find out more about medication and breastfeeding.
"I was on medication...and I was under close review because things were bad... But by about four months things started to lift. I've always described it like layers of cling-film coming off."
Stephanie, mum of two
How can I help myself?
There’s no evidence that there’s anything you can do to prevent getting depression. But there are a few things you can do to make things easier for yourself.
It’s important to tell the midwife or doctor if you have had depression in the past because you may be more likely to get depression in this pregnancy or after you give birth. They can then give you the best support to reduce the chances of you getting depression again.
It also helps to know what the symptoms of postnatal depression are so you can ask for help if you get them.
Depression can make you want to hide away from the world and you may feel like you want to do anything at all. But it is important to take care of yourself. Start with little activities, take things at your own pace and most importantly, ask for help if you need it. Here are a few ideas.
- Talk to someone you trust about your feelings, such as your partner, family or a friend.
- Try not to feel guilty, ashamed or embarrassed. These feelings are not your fault.
- Try some of our top tips for looking after your emotional wellbeing.
- Get some exercise every day – keeping active will release some feel-good endorphins.
- Eat well even if you don’t have much appetite.
- Avoid alcohol and smoking – they can harm your baby and make you feel worse.
- Read about planning ahead for emotional wellbeing for after birth
Use the Tommy's Wellbeing Plan to think about how much support you will need.
"It was really only a week after she was born and things started to go right downhill again. I just couldn't get up. I couldn't get out of bed. It wasn't even about bonding with her. I just didn't want to exist anymore." Abby, mum of one
More information and support
PANDAS provides telephone support, online information and local support groups for pregnancy depression and postnatal depression.
APNI (Association for Postnatal Illness) provides telephone support and online information on postnatal depression.
MIND is a mental health charity providing information, support, local groups and an online chatroom
Local support groups may also be available. Check out what’s on offer at Netmums or ask your GP. You can also chat to other new mums suffering from the baby blues, PND, PTSD and more in BabyCentre’s friendly support group.
Clinical Knowledge Summaries (2015) Depression – antenatal and postnatal https://cks.nice.org.uk/depression-antenatal-and-postnatal#!topicsummary
NHS Choices. Feeling depressed after childbirth https://www.nhs.uk/conditions/pregnancy-and-baby/feeling-depressed-after-birth/ (Page last reviewed: 12/10/2015. Next review due: 12/10/2018)
NHS Choices. Postnatal depression https://www.nhs.uk/conditions/post-natal-depression/ (Page last reviewed: 11/02/2016. Next review due: 01/02/2019)