What is Post Natal Depression

Having a baby is a time of huge change and it is common to feel many different emotions. If after giving birth the feeling of tearfulness hasn't cleared up within a few weeks, talking to your midwife or GP can help.

As many as eight out of 10 women get what's known as the "baby blues". It normally begins within a few days of the birth, and common symptoms include bursting into tears for no reason, you may feel irritable and low or feel fantastic one minute and miserable the next. Fortunately, the symptoms only last for a short time.

If you become more unhappy or upset, or if your low mood lasts longer than a week, you might have postnatal depression.

Postnatal depression affects one in 10 new mums. You're more likely to develop postnatal depression if:

  • you've been depressed in the past,
  • there's a family history of postnatal depression or depression during pregnancy,
  • you've had a difficult pregnancy, or problems with your baby's health,
  • you feel isolated, with nobody close to talk to,
  • you've had a recent bereavement,
  • you have little money or nowhere settled to live,
  • or you have twins or triplets, mainly because of the additional stress of caring for more than one baby.

But postnatal depression can happen to anybody, no matter what your circumstances, no matter how much you love your baby and there is no reason to feel guilty or ashamed.

The symptoms of PND are similar to those that occur with depression at any other time. They usually include one or more of the following. In PND, symptoms are usually there on most days, for most of the time, for two weeks or more.

  • low mood and this tends to be worse first thing in the morning, but not always,
  • not really enjoying anything, including a lack of interest in yourself and your baby,
  • lack of motivation to do anything,
  • often feeling tearful,
  • you may lose your appetite and forget to eat,
  • feeling irritable a lot of the time,
  • feelings of guilt, rejection, or not being good enough,
  • poor concentration (like forgetting or losing things) or being unable to make a decision about things,
  • feeling unable to cope with anything.

New Mum Checklist

If you are suffering from PND, reading a website full of lots of information may be very overwhelming. We have been recommended this "new mums checklist" by someone as a useful tool to reach out should you need others to gain an understanding of how you are feeling. (Kindly provided by Postpartum Progress):

I'd like to talk to you about the stress I've been having since I had my baby. Because I'm exhausted, overwhelmed & struggling, this is the best way for me to make sure you know what is going on with me, and that I might need your help as something just isn't right.

Here are some of the recognized symptoms that I have been having:

  • I can't sleep, even when my baby is sleeping.
  • I have lost my appetite.
  • I feel sad. I have been crying a lot for no reason.
  • I am feeling worried or anxious most of the time.
  • I am having anger or rage that is not normal for me.
  • I feel numb or disconnected from my life.
  • I can't enjoy the things I used to.
  • I don't feel like I'm bonding with my baby.
  • I am having scary "what if" thoughts over & over about harm coming to me, my baby or others (also called intrusive thoughts, a sign of postpartum OCD).
  • I feel a lot of guilt and shame.
  • I'm worried that I'm not a good mother.
  • I feel overwhelmed with all of the things in my life.
  • I can't concentrate or stay focused on things.
  • I feel like I'm losing it.
  • I want to be alone, some or most of the time.
  • My thoughts are racing, I can't sit still.
  • I feel like the only way to get better is by using alcohol, prescription drugs or other substances.
  • Sometimes I wonder if my baby or my family would be better off without me.
  • I've been having physical symptoms that are not normal for me (for example: migraines, back aches, stomach aches, shortness of breath, panic attacks)
  • I have had serious thoughts of hurting myself.
  • I have had thoughts that I should (not that I might or what if, but that I should or need to) hurt my baby or someone else.
  • I am worried I'm seeing or hearing things that other people don't see or hear.
  • I'm afraid to be alone with my baby.
  • I feel very concerned or paranoid that other people might hurt me.

I have had these symptoms for more than ……………..
weeks and I had my baby ………………………………ago.

Here are some recognized risk factors that may help you understand my situation@

  • I have had depression, anxiety/OCD or PPD before
  • I have a history of bipolar disorder or psychosis
  • My family has a history of mental illness
  • I have a history of or am now going through trauma (for example: domestic violence, verbal abuse, sexual abuse, poverty, loss of a parent)
  • I have had a stressful event in the last year
  • (for example: house move, job loss, divorce or relationship problems, or the death of a loved one)
  • I'm a single mum
  • I don't have much help or support at home from my partner or family members.
  • I have had infertility treatment
  • My baby has colic, reflux or other health problems
  • I have had a previous miscarriage or stillbirth
  • I have a history of diabetes, thyroid problems, or pre-­‐menstrual dysphoric disorder (PMDD)
  • I delivered multiples
  • I'm away from my home country or culture
  • I or my baby had problems

This checklist is not intended to diagnose any mental illness. It is a discussion tool for mums to use with your health visitor, midwife or GP.

It was created by Postpartum Progress, a national nonprofit supporting mums with maternal mental illness.
©2015 Postpartum Progress Inc.

How to get Help

If you or your family think you might be suffering from post natal depression, it's important to get help as soon as possible.

A doctor, midwife or health visitor will usually check for depression in all women who have recently given birth but sometimes fear of asking for help can be part of the problem, and you may need encouragement and support in getting it.

You can talk to your midwife or health visitor and explain how you're feeling. Don't wait for them to visit you. They will be able to assess and advise you. If you can't contact your midwife or health visitor, talk to your GP.

You may not be suffering from depression. Some women have postnatal anxiety, and may be feeling exhausted and worried about their baby's safety. Talk to your midwife, health visitor and doctor about this, too.

What can they do?

They may ask the following two questions when they see you (this may be during one of your postnatal checks or visits):

  1. During the past month, have you often been bothered by feeling down, depressed, or hopeless?
  2. During the past month, have you often been bothered by having little interest or pleasure in doing things?

The answers to these questions may suggest you are feeling down. They may also ask you two questions to get an idea of your anxiety levels:

  1. During the past month have you been feeling nervous, anxious, or on edge?
  2. During the past month have you not been able to stop or control worrying?

It is very important that you are truthful about how you are feeling. You should not think that having PND makes you a bad parent or will mean that your baby is taken away from you.

Your health visitor will reassure you and may be able to make extra visits, so that you can talk. Some of them run groups where mums can get together and make new friends.

You can also see your GP and together you can decide on the right treatment for you.

The type of treatment that is best for you can depend on various things including:

  • how severe your depression is and what symptoms you have,
  • the impact of your symptoms on your ability to function (to look after yourself and your baby),
  • whether you have had depression or other mental health problems in the past. What has worked best for you before if this is the case,
  • the likely waiting time for any of the treatments available should your GP need to refer you,
  • your current situation.
  • your own preferences once the options, and pros and cons have been explained fully to you,
  • in the case of medication the possible effects on the baby if you are breast-feeding.

There are antidepressants that are safe for breastfeeding mums. Antidepressant medication is often prescribed for PND, especially if the depression is moderate or severe. Symptoms such as low mood, poor sleep, poor concentration, irritability, etc are often eased with an antidepressant. This may then allow you to function more normally, and increase your ability to cope better with your new baby.Over time, with the right support and, if necessary, treatment, you'll recover.

HSSD are currently running a group to support mothers who are experiencing post-natal depression or who want to learn more about it. The group is headed by clinical psychologist Dr Sara Johnson who can be contacted on 725241 extn 3368. You do need to be referred by your GP for this course of 8 sessions. This is called the "breaking free course" and is highly recommended by those volunteers who have attended to help them.

If you feel too scared to take medication or are worried about a delay in attending counselling then there are alternative treatments you can try:

  • Vitamins D and B
  • Burning frankincense
  • Yoga/swimming/walking any gentle exercise
  • Mediterranean diet
  • Cutting out alcohol
  • Reflexology/acupuncture
  • Pure magnesium oil 8
  • Evening primrose oil
  • Books to read: mindfulness , surviving post natal depression at home, no one hears you scream.
  • Cognitive Behavioral Therapy
    ***further links and info for the above will follow but if you need immediate assistance please email [email protected]

The effect of PND on children

PND can interfere with your ability to function, including your ability to take care of yourself and your child. If you are suffering from PND, it doesn't mean that you're a bad mother. However, when you're consumed with symptoms of depression such as fatigue, irritability, apathy, and tearfulness, it is difficult—if not impossible - to properly look after your newborn's needs. Your baby may be affected if the depression is left untreated.

The Impact of Postnatal Depression on Children

Behavioural problems: Children of depressed mothers are more likely to develop behavioural problems down the line, including sleep problems, temper tantrums, aggression, and hyperactivity.

Delays in cognitive development: Development is often delayed in babies and children who have depressed mothers. They may learn to walk and talk later than other children. They may also have many other learning difficulties, including problems with school.

Social problems: Children of depressed mothers have difficulty establishing secure relationships. They may find it hard to make friends in school. They may be socially withdrawn, or they may act out in destructive ways.

Emotional problems: Studies have shown that children of depressed mothers have lower self-esteem, are more anxious and fearful, are more passive, and are less independent.

Depression: The risk of developing major depression early in life is particularly high for the children of mothers with PND

If you're suffering from PND, there is no reason to feel guilty or ashamed. The symptoms are outside your control, however, the choice to get treatment is in your control.

PND in Fathers

Whilst only mothers can formally be diagnosed with postnatal depression, studies have found that around 4 per cent of fathers can also experience depression.

Similarly to mums, there is no single answer as to why some men can be affected, the increased pressures of fatherhood, more financial responsibility, changes in relationships and lifestyle, combined with a lack of sleep and an increased workload at home, may all affect a new dad's well-being.

There are some factors that appear to have a significant impact on dads experiencing PND are:

1. New dads are more prone if the relationship they have with their partner has been strained throughout the pregnancy.

2. There is also a moderate but clear link between a dad experiencing depression and his partner also suffering from depression.

3. Young fathers are more at risk because being young might mean that it is less likely that the child was planned. A young dad might therefore not feel ready to take on the new responsibilities that come with fatherhood.

A new dad's own personality, social factors, family history and past mental health history can also affect his chance of developing depression.

The symptoms of PND among dads can be similar to those found amongst new mums experiencing depression. Symptoms can include:

• feeling very low, or despondent, that life is a long, grey tunnel, and that there is no hope. Feeling tired and very lethargic, or even quite numb. Not wanting to do anything or take an interest in the outside world,
• feeling a sense of inadequacy or unable to cope,
• feeling guilty about not coping, or about not loving their baby enough,
• being unusually irritable, which makes the guilt worse,
• wanting to cry/crying a lot or even constantly,
• having obsessive and irrational thoughts which can be very scary,
• loss of appetite, which may go with feeling hungry all the time, but being unable to eat,
• comfort eating,
• having difficulty sleeping: either not getting to sleep, waking early, or having vivid nightmares,
• being hostile or indifferent to their partner and/or baby,

Men can sometimes feel uncomfortable about opening up about their feelings but it's so important that you seek the support you need. Share your feelings with people you trust. This could be your family or friends, a health professional or your own GP.

What is Postnatal Psychosis?

Postnatal (puerperal) psychosis is an uncommon, but severe form of mental illness that can occur after childbirth. There may be symptoms of severe depression; there are also other serious symptoms such as false beliefs (delusions), hallucinations (such as hearing voices), odd behaviours, and irrational thoughts. Affected mothers may not recognise that they are ill. Postnatal psychosis usually occurs within the first month of giving birth. Women generally need to be admitted to hospital with their baby for treatment.

Please note that the vast majority of women with postnatal depression (PND) do not develop this severe disorder.