Postnatal depression

Postnatal depression is a type of depression that many parents go through after having a baby. It affects more than 1 in 10 mothers within a year of giving birth. Fathers and partners can be affected too, though this is less common.

With the right support, most people make a full recovery. That support can include self-help strategies and therapy.

Postnatal depression affects everyone differently. It can start at any point in the first year after giving birth, and it may come on suddenly or build up slowly. For some people it carries on from depression during pregnancy.

Many people feel a bit down, tearful or anxious in the first week after giving birth. This is often called the baby blues, and it doesn't last for more than 2 weeks after the birth.

If your symptoms last longer than that, or they start later, you could have postnatal depression.

The main symptoms of postnatal depression include:

• a persistent feeling of sadness and low mood
• loss of interest in the world around you
• no longer enjoying things that used to give you pleasure
• lack of energy and feeling tired all the time
• trouble sleeping at night
• feeling that you're unable to look after your baby
• problems concentrating and making decisions
• loss of appetite or comfort eating
• feeling agitated or irritable
• feelings of guilt, hopelessness and self-blame
• difficulty bonding with your baby or not enjoying their company
• frightening thoughts, for example, about hurting your baby (these can be scary, but they're very rarely acted upon)
• thinking about suicide and self-harm

These symptoms can affect your day-to-day life and your relationships with your baby, family and friends.

• you think you may be depressed

Don't struggle on alone and hope the problem will go away. It can take a lot longer to feel better if it's not addressed.

Postnatal depression can build up slowly, so it's not always easy to recognise. Some parents avoid talking to family and friends about how they feel. They may worry that people will judge them for not coping or for not looking happy.

Signs of postnatal depression in new parents include:

• crying often for no obvious reason
• having difficulty bonding with their baby
• getting no pleasure from playing with their baby
• feeling that they're not a good parent
• withdrawing from contact with other people
• speaking negatively all the time
• feeling hopeless
• neglecting themselves, like not washing or changing their clothes
• losing all sense of time, like being unaware whether 10 minutes or 2 hours have passed
• losing their sense of humour
• constantly worrying that something is wrong with their baby, even when others reassure them

If you think someone you know is depressed, encourage them to talk about their feelings. They could talk to you, a friend, their doctor, their health visitor or their midwife.

The exact cause of postnatal depression isn't completely clear. It has been linked to:

• a history of mental health problems, particularly depression earlier in life or during pregnancy
• having no close family or friends to support you
• a poor relationship with your partner
• recent stressful life events, like a bereavement
• experiencing the 'baby blues'

Even if there's no specific cause for your symptoms, having a baby is a life-changing event, and it can sometimes trigger depression.

It often takes time to adapt to becoming a new parent. Looking after a baby can be stressful and exhausting.

Postnatal depression can feel lonely, distressing and frightening. But support and treatments are available, and with the right treatment and support most people make a full recovery, although it can take time.

Talk to your doctor about the different treatment options, so the two of you can decide together what's best for you.

Your doctor might also check your physical health to see if there are any problems that need attention. For example, you may be anaemic after giving birth, and this could add to any feelings of depression you already have.

Talking therapies are usually the first treatment doctors recommend for postnatal depression. There are a few kinds.

Guided self-help means working through a book or an online course. You can do it on your own or with some help from a therapist. The course looks at the issues you might be facing and gives practical advice on how to deal with them. Most courses last 9 to 12 weeks.

Cognitive behavioural therapy (CBT) is a type of talking therapy. It's based on the idea that unhelpful and unrealistic thinking leads to negative behaviour. CBT tries to break that cycle and find new ways of thinking, so you can behave in a more positive way. You can have it 1-to-1 with a therapist or in a group, and treatment often lasts 3 to 4 months.

Interpersonal therapy (IPT) means talking to a therapist about the problems you're going through. It tries to identify problems in your relationships with family, friends or partners, and then looks at how those problems might relate to your feelings of depression. Treatment usually lasts 3 to 4 months.

Your doctor may recommend antidepressants for postnatal depression if:

• you have moderate or severe depression
• you don't want to try psychological treatment
• psychological treatment doesn't help
• you have mild postnatal depression and a previous history of depression

If you're breastfeeding, talk to your doctor about which medicines are suitable for you. Many types of antidepressants are safe to take while breastfeeding.

Your doctor should explain the risks and benefits of taking antidepressants. You should be offered the type with the least risk for you and your baby.

There are plenty of things you can try yourself to ease the symptoms of postnatal depression and help you cope. You could also try to:

• ask your loved ones if they can help look after the baby and do tasks like housework, cooking and shopping
• make time for yourself, and do activities you find relaxing and enjoyable
• rest when you can (it's hard with a baby to look after, but try to sleep whenever you get the chance)
• follow good sleeping habits
• if you have one, ask your partner to help with the night-time work
• exercise regularly, as this has been shown to help lift mood in people with mild depression
• eat regular, healthy meals

Try to avoid

• going for long periods without eating
• drinking alcohol or taking drugs, as this can make you feel worse

You might be referred to a specialist perinatal mental health team for postnatal depression if:

• your depression is more severe
• treatments like antidepressants, self-help or therapy don't help

The doctors and nurses looking after you will talk with you about whether other treatments suit you. Sometimes, for a small number of people, coming into hospital can help speed up recovery.

If your doctor or nurse suggests this, you can be offered a place in a Mother and Baby Unit. This means you can keep looking after your baby while you get the best treatment for your illness.