Written by Dr. Mark Winwood
Dr Mark Winwood is a leading figure in the mental health field and AXA Health’s Consultant Psychologist.
What is postnatal depression?
Postnatal depression is a condition that can affect new mums and dads as they adjust to what is a huge life-changing event, regardless as to how much they welcome or prepare for it. And it’s something that our experts get asked about a lot, in live chats and through our Ask the Expert service. Here leading psychological health expert, Dr Mark Winwood answers a round-up of some of those most frequently asked questions on postnatal depression – its symptoms, what causes it and how to make sure you get the right kind of help.
What are the signs of postnatal depression?
Just like any kind of depression, the signs and symptoms of postnatal depression will be different for everyone; the common factor being the timing, with symptoms developing in the weeks or months following childbirth.
Broadly speaking, depression is a constant feeling of sadness. This low mood is often accompanied by other signs and symptoms that fall into three categories:
Thoughts and feelings e.g. negative thinking, low self esteem, guilt and feeling helpless
Changes in behaviour e.g. distancing themselves from others, frequent crying and sleeping or eating a lot more or less than usual
Physical changes e.g. sudden increase or loss of appetite, listlessness or lack of energy/enthusiasm and constipation.
These are just a few postnatal depression symptoms to look out for. Check out our article Postnatal depression for a more comprehensive look at the signs, symptoms and causes of postnatal depression, how it can be diagnosed and what treatments are available.
What are the main reasons for women developing postnatal depression?
This isn’t an easy one to answer – there is no single known cause for postnatal depression, and sometimes it can start for no obvious reason. However, researchers have suggested a number of possibilities.
Some think it’s likely to be biological – caused by changes in the body, including hormonal changes. However, although some studies show that changes in the level of hormones during pregnancy and after birth can trigger changes in mood, only some women go on to develop postnatal depression – so hormones are unlikely to be the single cause.
Others think past experiences or social circumstances may be contributing factors. Many suggest that a combination of different issues can cause postnatal depression.
The following situations are considered to put someone at particular risk of developing postnatal depression symptoms:
- previous mental health problems including postnatal depression
- lack of support
- experience of abuse
- low self-esteem
- poverty and poor living conditions
- major life events
- substance use and addiction
- traumatic pregnancy.
How long can postnatal depression last for? Is it as severe as normal depression - I know someone who suffers from depression and has done for about 20 years.
Postnatal depression usually starts four to six weeks after the birth of the child, although it can be a matter of months before symptoms develop. Depending on the severity of the symptoms and the sort of treatment applied, the time to resolution will be different for everybody. It may last several months and sometimes up to a year, depending on individual factors. For some who don’t receive support and treatment it can last much longer, so it’s important to get the correct help.
It isn’t usual for someone to have postnatal depression symptoms for a matter of years. According to the NCT, less than a third of people who experience postnatal depression have symptoms lasting a year or more. In most cases, the condition dissipates after a matter of months.
As with any form of depression it can return, especially if left untreated. It’s also worth bearing in mind that there are lots of factors that can contribute to depression.
With postnatal depression, hormonal changes certainly play an important role. However, worries or anxieties over any major lifestyle changes, such as moving house or changing jobs can also influence mood.
And 'yes' postnatal depression is unquestionably as severe as any other depressive disorder and should be treated as such.
How common is postnatal depression?
If you looked at five different resources you’d get five different answers to this question. It’s all down to reporting and diagnosis. It is felt that postnatal depression is often misdiagnosed or under-diagnosed. I would say that the 'baby-blues' is very common and exists for about 85% of new mothers in the UK. The more severe depressive disorder that is formally assessed and diagnosed occurs in around 10-15% of new mothers in the UK.
What advice would you give to a mother who is struggling but feels guilty about it? It's not an easy subject to bring up at a time when you’re expected to be feeling very joyful.
I think every mum in the world would empathise with your statement. The first thing I can suggest is to talk to a friend or close family member who has also had a child (recently if possible) – someone you feel comfortable confiding in. It's an old saying but 'a problem shared...(you know the rest!).’ It’s important to know you’re not alone in your feelings. And if you look at the website mumsnet they describe some research that suggests that the more peer support you can get the better.
A few more tips:
- Find people who can help you with childcare, housework, and errands so you can get some much needed rest.
- Make time for yourself every day, even if it’s only for 15 minutes and do something relaxing or that makes you feel good about yourself. Try checking out our self care tips.
- Keep a daily diary of your emotions and thoughts. This is a good way to let everything out and to keep track of your progress as you begin to feel better.
- Give yourself credit for the things you’re able to accomplish, even if you only get one thing done in a day.
- If you aren’t able to get anything done, don’t be hard on yourself.
- Give yourself permission to feel overwhelmed.
- Remember that no one expects you to be supermum.
- Be honest about how much you can do and ask others for help.
Mumsnet is a great source of information and support, and there are plenty of other websites you can go to for help. We’ve included some of these at the end of this article.
How can I help someone with postnatal depression?
These are some basic ideas. Please remember there’s no 'one size fits all' solution but some of the following suggestions might help.
- It’s really important that any mum who is experiencing difficulties sees a sympathetic doctor about her postnatal depression, to get the help she needs. If necessary go with her and ensure she tells the doctor the full extent of the problem.
- Please remember this is an illness, as much as any other illness. She cannot help it, or ‘pull herself together’ however much she tries or may want to.
- Listen to her as much as you can. Ask her about her thoughts and feelings. Give her time.
- You can't offer a solution or a ‘fix’ for her depression but just listening and maybe hugging and reassuring her is hugely important.
- Try to be empathic, even if it’s boring to listen to the same thoughts and emotions over and over again.
- There will be good days and bad days. Help as much as you can with practical stuff but also let her do as much as she wants to. Leave her role in the home as open for her as possible so she doesn't feel she’s a failure or that you’re taking over. Talk things over together so you both have a clear idea of what is helpful and what’s not!
- Don't push her to do things or go places she feels uncomfortable with: let her lead the way and set the pace.
- She may hate being left alone, especially in the early days. If so, try to rally family and friends so there’s always someone with her that she’s comfortable with.
- Help with childcare and suggest she spends the time doing something just for her.
- Reassure and remind her – and yourself – that the support she gets will help her recover.
Can men get postnatal depression and is there any help out there for new dads who do suffer?
Interesting question – there is a growing body of evidence suggesting that paternal postnatal depression is a very real problem. Research cited on the NHS website found that up to 1 in 10 new dads experience depressive symptoms after the birth of their child, yet it’s only very recently that postnatal depression in men has been more widely acknowledged. It’s likely this is because of the widely held belief that postnatal depression is caused by hormonal changes women experience post-birth. We now know that postnatal depression is actually triggered by a number of factors, of which hormonal changes are just one possible contender. And many of these factors apply to both parents: adjusting to a major life-change, lack of sleep and fear of failure, to name but a few.
When there is a lot of pressure financially, emotionally and physically on a new father, it can cause excessive stress, which can then lead to depression. Dads (like mums) are also at a higher risk if they have previously suffered from depression or if they’re a single parent, having the full responsibility of caring for a new born baby with no support from a partner.
A considerable factor can be that the balance and focus has shifted in the relationship. With either or both parents’ attention now mostly taken up on the baby, leaving little time or energy left for each other as a couple.
Evidence suggests that fathers can be impacted by postnatal depression in their partners. Same sex partners will be impacted in a similar way although there’s less research in this area. The other individuals who may experience the effects of a new mum or dad’s depressive symptoms are the other children in the family. There is evidence to suggest that a child's psychological state and general wellbeing may be affected by their parent’s depression. Clearly, if someone is depressed the symptoms they have can affect everyone in the system (family, work, friendship networks) so any support and treatment offered should take this into consideration.
The good news is that help is available. The NCT has some useful information for dads and partners, which includes postnatal depression in dads.
Do you think pressure to breastfeed is a significant catalyst for postnatal depression? Are we setting some mums up for depression and guilt by stigmatising the alternative so heavily?
I think giving a woman any pressure can be interpreted as them not being a good mother or not doing the best for their child could be a catalyst for that mother to feel depressed, or more depressed if they are already suffering from postnatal depression. Some people certainly believe that the way breastfeeding promotion strategies are communicated may contribute to feelings of guilt and fears of inadequacy by mothers suffering from depression. On top of this is this way social media might influence the way a mother feels about her inability to nurture if she cannot breastfeed. So yes, I believe this could be a factor in the development of someone's negative self-belief and lead to symptoms of low mood and depression.
A few more facts about breastfeeding and postnatal depression
Breast feeding is not a physiological factor in the development of postnatal depression. Studies have found that breastfeeding can ease postnatal depression as it reassures mothers of their ability to nurture and bond with their babies. There’s also the presence of oxytocin – a naturally occurring 'feel good' substance, referred to as the ‘love hormone’ by some, that’s released into the body in large quantities when you breastfeed.
If you have postnatal depression after one birth will it happen again after the next birth?
This is a question that asks us to think about risk factors in the development of postnatal depression. If you’ve experienced a mental health problem in the past – including during pregnancy – this may recur after you’ve given birth. It’s also important to be aware of what might have triggered your mental health problem in the past as this can help plan future treatment and support.
If you experienced postnatal depression after the birth of one child, you are at increased risk of developing postnatal depression after the birth of your next child. However, you may have coped well with you first child, and felt depressed after the second, or the other way around. In short, there’s no way of knowing. Instead of trying to predict what might happen remember that being mindful of your mood in the days and weeks after a future birth could help you spot the signs and get appropriate help and support early if you do start to experience symptoms.
If I suffer depression normally will I have more chance of postnatal depression?
One of the risk factors of developing postnatal depression is a previous history of depression. This doesn’t mean you’ll automatically suffer from postnatal depression but it’s important to discuss the matter with your GP, health visitor or midwife so the correct assessments and supports can be put in place for you.
Does postnatal depression run in families?
This topic hit the headlines in 2013 when researchers in the Midlands identified a variant of a gene that can contribute to the incidence of postnatal depression.1 This gene is found in the brain, which would indicate there may well be a genetic link. We’ve been aware for years that mental health problems can run in families and there has been evidence to suggest that there is a familial link to depressive illness. As we’ve already seen there are a number of biological and social factors that may contribute to developing postnatal depression but none that mean you’ll definitely experience symptoms yourself.
That said, if you have a history of postnatal depression in your family, or indeed any of the risk factors outlined above, it’s important to tell your healthcare team so they can support you correctly.
Will my baby be affected if I get depression during pregnancy or after the birth?
If you experience depression while pregnant, the main effects on the baby will be due to any medication you are taking to ease your symptoms or any behaviours you’re engaging in/or not engaging due to your psychological problem. What I mean by this is if you’re not taking care of yourself or using drugs or alcohol.
Again, immediately after birth, medication may have an impact on your baby and there is some evidence to suggest that early bonding and some cognitive developmental problems may occur.
For these reasons it’s really important to get professional advice and support if you experience mood problems, and also to check any medication you’re taking with your GP.
Can anti-depressants be dangerous for breastfed babies?
Your GP can prescribe medication to help with postnatal depression that’s safe for breastfed babies. It's important to discuss potential benefits and side effects of medicines fully before taking any, and to keep monitoring progress with them. Medication may enter breast milk, and if you/the mother is breastfeeding you will need to bear this in mind when deciding whether or not to take it. Some drugs have known effects on infants, while others appear to be quite safe, so it’s important to discuss this with your doctor or another qualified medical professional. If you do decide to try medication, it may be necessary to try different drugs to achieve the best results. Again, your doctor will be able to advise you on drugs that are safe for you and your baby.
Bear in mind that all antidepressants take time to work. If you do take them, they can be very effective, but you should be prepared to take them for at least six months. They also all have possible side effects, and when you stop taking them you should withdraw slowly, to avoid possible withdrawal effects which can be unpleasant.
Is there any way to prevent postnatal depression or treat it before it becomes a real problem?
This is a really important question. The NHS is guided by the principals recommended by NICE (National Institute for Clinical Excellence in Health). This body recommends that all pregnant woman are screened for their 'risk' of developing postnatal depression (and other psychological problems) and if they fall into a high-risk category preventative treatment should be offered to try and reduce the risk of symptoms developing post-partum. As part of this guidance all women should also be assessed following birth and at health visitor sessions for any changes to mood, so symptoms that occur can be managed more quickly.
If the necessary screening and assessments are carried out it is possible to influence the possibility of symptoms occurring, but not to wipe it out completely. Things can happen during the birthing process or after the birth, which may affect an individual's mood and ability to cope, but that couldn’t have been predicted.
What is puerperal psychosis?
Puerperal psychosis - also known as post-partum psychosis (PPP) is a much less common condition than postnatal depression. Where we estimate that around 15 in 100 women may suffer from postnatal depression, only around 1 in 1000 women experience PPP.
PPP is a severe episode of mental illness, which begins suddenly in the days or weeks after having a baby. Symptoms vary and can change rapidly. They can include high mood (mania), depression, confusion, hallucinations and delusions. Puerperal psychosis is a psychiatric emergency. Professional help needs to be accessed immediately.
This can happen to any woman. It often occurs ‘out of the blue’ to women who have not been ill before. It can be a frightening experience for women, their partners, friends and family. Women usually recover fully after an episode.
Next steps
If you suspect that you or someone you know might be suffering from postnatal depression, it’s important to reach out for help. GPs, midwives and health visitors are all well equipped to identify and manage this common condition and enable you to enjoy your new baby to the full. You can also get information and support at any time of the day or night through our Early Years Support Service.
Early Years Support from AXA Health
At AXA Health, we understand that becoming a parent – and a family – is a life-changing event, which at times we may not feel fully prepared for.
That's why we've developed our Early Years Support Service for anyone embarking on becoming a parent, by birth or through a fostering or adoption process, however many times you may have ‘been there’ before!
Available through our Health at Hand team, the Early Years Support Service has registered midwives and nurses at the end of the phone for you or your family to talk to day or night, 365 days a year*.
We're here to provide medical information and support, whenever you need us. So if you’re looking for some reassurance or just a friendly chat, or if you have questions about anything from pregnancy, delivery, the postnatal period and adapting to parenthood, to negotiating the early developmental stages, planning for the future, returning to work or even extending your family further, call us on 0800 003 004. Or if you prefer you can contact us by email via our Ask the Expert service and one of the team will get back to you.
*Availability of specialist support:
Nurses and counsellors are available 24 hours a day, every day.
Midwife and pharmacists services available 8am to 8pm Monday to Friday, 8am to 4pm Saturdays and 8am to 12pm Sundays. Call backs can be arranged.
We will transfer members to our Counselling service as appropriate.
Further reading
Postnatal depression in dads: 10 things you should know – NCT
Self-care tips – AXA Health
How to find a counsellor or therapist – AXA Health
Useful resources
Pregnancy and Children's health hubs – AXA Health
The National Childcare Trust
Mumsnet
Association for post natal illness
Post natal Illness.co.uk
Mothers for mothers
References
1 Engineer N, Darwin L, Nishigandh D, et al. Association of glucocorticoid and type 1 corticotropin-releasing hormone receptors gene variants and risk for depression during pregnancy and post-partum, Journal of Psychiatric Research. Published online June 3 2013.