POSTNATAL DEPRESSION

Postnatal depression (PND) is the name given to a depression which sometimes occurs after a woman has a baby. About one woman in ten experiences postnatal depression. It usually starts within a month of the baby being born but can appear even six months later. Sometimes postnatal depression is quite shortlived but in other cases it may last for months or even years, unless treated.

If you have postnatal depression you will find it harder to cope with day to day life and your new baby, and as a result you may feel guilty or ashamed. It is important to realise that postnatal depression is an illness and not your fault. But the sooner you can get appropriate treatment and support the sooner you will start to feel better and be able to enjoy life and your baby. Tell your GP or health visitor if you think you may have postnatal depression or contact one of the helplines listed in help and info below.

Postnatal depression should not be confused with the milder 'baby blues' which many women experience after their baby's birth, or the more serious, but much less common 'puerperal psychosis', which occasionally occurs in the early weeks after a baby is born. For more information on these conditions see the box entitled other postnatal conditions.

For more information on depression you might like to look at the feature on depression.

Recognising postnatal depression

It is important to recognise that you are feeling depressed so that you can ask for help. Some mothers believe their distress is due to their own inadequacy as a mother or a person and are reluctant to tell anyone how they feel. They do not realise that they have postnatal depression and need treatment and support. Symptoms of postnatal depression vary from person to person and even at different times but you may experience some of the following. For example you may feel:

• unhappy, low or sad for much of the time, or guilty or hopeless
• irritable or angry for no reason, or tense and unable to relax
• highly anxious, perhaps about your own health or that of the baby or about some small matter you normally would have dealt with
• fearful or panicky, for example about leaving the house or being left alone with the baby. Some mothers experience panic attacks with symptoms such as dizziness, chest pains or breathing difficulties
• exhausted and unable to cope with simple chores, although so tired you may also have difficulties in sleeping
• unable to concentrate or make decisions or take an interest in what is going on or your own appearance
• aches or pains for which there appears to be no cause.

If you experience any of these symptoms for more than a week, or any other feelings which you find distressing do tell your health visitor or GP. If, for any reason you find that difficult to do at the moment, contact one of the helplines listed in help and info to talk things through.

Luckily postnatal depression is more widely recognised among health professionals than it was a number of years ago. Many health visitors and GPs will use a questionnaire with mothers about eight weeks after the birth to help them identify postnatal depression. It is called the Edinburgh Postnatal Depression Scale.

Other postnatal conditions

The 'baby blues' affects about half of all mothers. They usually happen a few days after the birth and may last from a number of hours to several days. If you have the 'baby blues' you may feel:

• sad or tearful for no apparent reason
• anxious, confused or inadequate
• tired, tense or irritable.

An opportunity to discuss any worries and plenty of rest and reassurance is usually all that is needed. However, if such feelings persist for more than a week and seem to be getting worse tell your GP or health visitor. It could be the start of a postnatal depression.

A more serious, but much rarer form of illness than postnatal depression affects about one in 500 mothers after childbirth. It is known as 'puerperal psychosis'. 'Puerperal' refers to the period of about six weeks after having a baby, which is when this illness occurs, and 'psychosis' means a mental illness in which the person is out of touch with reality. The onset of puerperal psychosis is often very sudden and the symptoms may be very odd or extreme. They may include very bizarre behaviour or hearing voices. Urgent treatment is essential. Treatment will include medication and support and may include a stay in hospital, preferably in a mother and baby unit.

What causes postnatal depression?

It is not known for certain what causes postnatal depression. It is likely that there may be a combination of contributing factors that vary from person to person.
It has been suggested that in some cases postnatal depression may be related to the hormone changes that take place following childbirth although there is so far no real evidence for this. Levels of oestrogen, progesterone and other hormones drop steeply once the baby has been born but there appears to be no substantial difference in the hormone changes between women who experience postnatal depression and those who do not. It is however possible that some women are more susceptible to these hormonal changes than others.

Other factors which might contribute to postnatal depression include:

• previous experience of depression, particularly postnatal depression
• lack of support from a partner or someone close
• distress or disappointment over a traumatic, difficult or premature birth or a previous termination
• recent stressful events such as moving home or a bereavement
• current problems such as poor housing or financial worries
• unrealistic expectations of herself and the baby.

Some women are unable to find any obvious reasons why they should feel so depressed. This doesn't mean that their depression is any less real.

Treatment and support

Treatment for postnatal depression varies but may involve:

• medication. Your GP may prescribe antidepressant medication. If you are breastfeeding the doctor may be able to prescribe an antidepressant that will enable you to continue to breastfeed.
  
• psychological therapies. Your GP may refer you for counselling, psychotherapy or cognitive behaviour therapy to help you understand and find ways of dealing with any problems that may be contributing to your depression.
  
• your health visitor or another health professional such as a community psychiatric nurse (CPN) may offer you ongoing support by visiting or being available at the end of a phone.

It is important that your partner or those close to you should be involved in your treatment. They need to understand postnatal depression and what they can do to help.

For more information on treatments for depression see the feature on depression.

Hormone supplements of progesterone or oestrogen are sometimes prescribed for women with postnatal depression. Progesterone is often taken in the form of a suppository while oestrogen is sometimes applied in skin patches. Some women report that they have found these helpful but there is as yet no clear scientific evidence that they are effective.

About one in four women with postnatal depression are referred by their GP to a psychiatrist for further help.

How you can help yourself

There are a number of steps you can take to help yourself.

• Make sure you get plenty of rest. Nap, if you can, when the baby is asleep rather than doing chores.
• Eat healthy balanced meals. Do not go long periods without food.
• Exercise regularly. Short walks in the fresh air will help you to feel better.
• Avoid stressful situations, such as too many visitors or long journeys, until you can cope.
• Find ways to relax. Your GP or health visitor can recommend a relaxation exercise.
• Ask your partner or others for help. You don't have to do everything yourself.
• Try to make sure there is someone in whom you can regularly confide, such as a good friend or a health professional.
• Join a local support group and meet other mothers with young babies, once you start to feel better.

If you would like more detailed self-help tips you can read the feature on self-help strategies.

Help and info

To read about one mother's experience of postnatal depression and how she came through, you might like to look at the feature recovering from postnatal depression.

Helpful organisations

for parents:

Association for Post Natal Illness
145 Dawes Road
London
SW6 7EB

Helpline: 020 7386 0868 (Mondays, Wednesdays and Fridays 10am-2pm; Tuesdays and Thursdays 10am-5pm)

E-mail: info@apni.org
Website: www.apni.org

Service for women with postnatal illness, their families, friends and professionals. Offers advice and information. Women experiencing PND can find support through a countrywide network of volunteers who all have experience of the illness. Mothers can also call the helpline or receive postal or e-mail support.

CRY-SIS
27 Old Gloucester Street
London WC1 3XX
Tel: 020 7404 5011 (Every day 8am-7pm)
E-mail: cry-sis@our-space.co.uk
Website: www.our-space.co.uk/serene.htm
Support for families with excessively crying, sleepless and demanding babies and young children. Helpline provides information on local volunteer contacts who once had similar problems.

Meet-A-Mum Association (MAMA)
77 Westbury View
Peasedown St John
Bath BA2 8TZ
For information: 01761 433598 (Mondays to Fridays 9am-5pm)
Helpline 020 8761 0123 (Mondays to Fridays 7-10pm)
E-mail: meet-a-mum.assoc@blueyonder.co.uk
Website: www.mama.org.uk
Network of MAMA groups and individuals providing friendship and support for mothers and pregnant women who are isolated and lonely. Women are put in touch with other women or groups of women for support. There is also a telephone helpline, and leaflets and booklets are available for a small charge.

National Childbirth Trust
Alexandra House
Oldham Terrace
London W3 6NH
Tel: 0870 444 8707 (enquiries)
Breastfeeding line: 0870 444 8708 (Every day 8am-10pm)
Information and support in pregnancy, childbirth and early parenthood. Callers are put in touch with counsellors and/or local and regional contacts for support groups, including groups for caesareans and miscarriage. Provides post-natal exercise groups and antenatal teaching. Also produces leaflets and books.

General:

Depression Alliance
35 Westminster Bridge Road
London SE1 7JB
E-mail: information@depressionalliance.org
Website: www.depressionalliance.org.uk
National network of self-help groups for people experiencing depression. Offers a quarterly newsletter, national pen friend scheme and correspondence service with advice, guidance, support and fellowship to people experiencing depression, and their carers. Produces booklets and leaflets on various aspects of depression.

Mind
15-19 Broadway
London E15 4BQ
MindInfoline: 08457 660 163 (Mondays to Fridays 9.15am-5.15pm)
E-mail: contact@mind.org.uk
Website: www.mind.org.uk
National office and network of over 220 local Mind associations. Campaigns for better mental health services and responds to legislative and policy changes in mental health. Supports MINDLink user network. Provides legal advice and assistance by referral. Supports a network of solicitors who do mental health case work. Offers an information service, factsheets and publications, and a conference and training programme.

The Samaritans
Tel: 08457 90 90 90 (calls are charged at local rates) (Every day 24 hours)
E-mail: jo@samaritans.org
Website: www.samaritans.org.uk
Confidential and emotional support to any person who is suicidal or despairing, 24 hours a day. Increases public awareness of issues around suicide and depression. Can be contacted by e-mail, telephone, writing, or by visiting one of 203 local branches (details are on the website).

Reading

Postnatal Depression: The Element guide by Erika Harvey (Element, 1999) £5.99
Clear, practical advice for women with post-natal depression and their friends and families.

Surviving Postnatal Depression by Cara Aiken (Jessica Kingsley, 2000) £14.95
By relating the stories of 10 different women with experience of post-natal depression, this book aims to promote an understanding of the illness to all, as well as offering help to women who have themselves suffered from PND. Lots of practical advice and positive suggestions.

Surviving the Baby Blues: Recognising, understanding and overcoming postnatal depression by Jane Feinmann (Ward Lock, 1997) £8.99
Explains postnatal depression, its treatment and the ways in which you can help yourself.