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Written by Dr Hamish McAllister-Williams, MRC clinical scientist, senior lecturer and honorary
consultant psychiatrist
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What is postnatal depression?
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| Women often experience a period of 'low' mood following
childbirth |
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Postnatal depression (PND) is a depressive illness that occurs
after having a baby. It is common for women following childbirth to experience
a period of 'low' mood. This can range in severity from a mild and normal
period of mood disturbance ('baby blues'), through to PND and the most severe
and rarest problem (postnatal psychosis). This factsheet deals with PND, though
'baby blues' and postnatal psychosis are briefly described. Although there are
differences between PND and 'ordinary'
depression, there are
many similarities.
How common is PND?
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PND is common.
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It occurs in 10 to 15 per cent or one in seven to ten
mothers.
When does PND occur?
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PND usually develops within the first month following
childbirth.
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It may develop out of severe 'baby blues'.
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Episodes of depression may be more common in mothers for many
months after having a baby. Where PND stops and ordinary depression begins is
unclear.
What are the symptoms of PND?
The symptoms are very similar to those seen in 'ordinary'
depression.
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Feeling 'low', 'miserable' and tearful for no apparent reason.
These feelings persist for most of the time, though they may be worse at
certain times of day, particularly the morning.
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Being unable to enjoy yourself. This may be particularly
prominent in new mothers who feel that they are not enjoying having a new baby
in the way they expected to.
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Irritability is common. This may be with other children, the
new baby and particularly with the partner.
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Sleep disturbance is part of looking after a new baby. However
in PND there may be additional problems of finding it hard to go to sleep even
though you are tired, or waking early in the morning.
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Given that looking after a young baby means having less sleep
than usual, it is no surprise that mothers often feel they have no energy. This
can be even worse in mothers with PND.
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Appetite is sometimes affected, with mothers not being
interested in food. This can be a particular problem since new mothers need all
the energy they can get to look after their babies.
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Anxiety frequently occurs in PND. This may take many forms. It
may be feeling tense and 'on edge' all the time. Normal concerns and anxieties
that any mother feels for a new baby may become overwhelming. In addition
mothers may experience 'panic attacks' which are episodes lasting several
minutes when they feel as if something catastrophic is about to happen - such
as collapsing, having a heart attack or stroke. These are extremely frightening
but they get better on their own.
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Depression is often accompanied by feelings of being
'worthless' and 'hopeless'. These feelings are common in PND. All mothers are
faced with new and sometimes difficult problems with a new baby. However,
mothers with PND feel all the more 'not able to cope' and unable to see a way
through their difficulties.
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When people are depressed, they sometimes feel that there is no
way out of their problems and that they, and their family, would be better off
dead. Thoughts of
suicide are therefore
not uncommon. If you feel this way, it is important that you talk to somebody
about how you feel, since there are ways out of your difficulties other than
suicide. You should also be aware that your child would be at increased risk of
developing mental health problems of their own if you do commit suicide. If you
fear that somebody you know feels suicidal, take this seriously and try to talk
to them about it. Talking about suicide does NOT increase the risk of the
person committing suicide. Strongly advise the person to visit their
doctor.
What causes PND?
The simple answer is we don't know. It is likely that a number
of factors are involved. The illness may arise partly because of the hormonal
changes following childbirth. The stress of looking after a young baby and
having your sleep disrupted may also help to bring on the illness in
susceptible people.
Are some mothers more likely to get PND?
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PND is more common in mothers who have previously had episodes
of depression.
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A history of depression in family members also increases the
risk, probably via genetic (inherited) factors.
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PND is also more common in mothers who have experienced
stressful life events during the pregnancy, those who do not have support at
home, in those in whom the baby was unplanned or unwanted, and when the baby
has been born with some problem.
How is PND treated?
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PND is treatable.
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It is treated in much the same way as ordinary
depression.
Talking about the problem with somebody, such as a health
visitor, can be helpful. Getting extra support and help with looking after the
baby is also important. Sometimes
antidepressants are necessary.
Although this can cause problems with breastfeeding, since some drugs get into
breast milk, there are drugs that are safe. You should remember that the most
important thing both from the baby's and your point of view is to get better as
quickly as possible. In this regard there are a few things that you are able to
do to help.
What to do if you have PND
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Don't 'bottle things up'. Talk to somebody about how you feel.
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Remember that depression is an illness and you are not
suffering from it because you are weak or hopeless. Also remember that it is
very common and that it will get better.
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Speak to your health visitor or GP. They will be able to sort
out what should be the best way of helping you with your illness.
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Do not worry that you will lose your baby. When mothers have
PND they often think that they are poor mothers and that if they speak to
somebody like their GP, they will have their baby taken from them. This will
NOT happen. What will happen is that you will get the help that you need to get
rid of the PND. This will help you deal better with the stresses of motherhood.
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Having a baby is tiring and stressful for any mother. You will
not be able to manage all the things that you did before the birth. Reduce your
commitments and accept help when it is offered.
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Take any opportunity you can to get some sleep.
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Make sure that you try to keep up your normal diet - you will
need all the energy you can get.
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Involve your partner. Having a young baby will be difficult
for him too and he will be concerned about your illness. Encourage him to speak
to your health visitor or GP so they can understand the illness you have.
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Try to get some time to yourself and with your partner if you
can.
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Talk to other mums with new babies. You will find that they
also feel many of the same things you do.
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Once again, remember that it is NOT your fault that you have
PND. Support and therapy will help the episode of illness to end as quickly as
possible.
Do mothers with PND harm their babies?
No. Mothers with PND often worry about harming their babies, or
not looking after them properly. However, generally they look after their
children at least as well as other mothers. Unfortunately mothers and other
family members do sometimes harm babies (battered babies). These people tend to
have a history of having been harmed or mistreated when they themselves were
young and this does not relate directly to PND. Very rarely a mother with
postnatal psychosis may harm her child. This may be because she is suffering
from false beliefs (delusions) such as that the child is terminally ill.
Alternatively mothers may kill their babies before committing suicide
themselves thinking that it is better for both of them to be dead. Fortunately
this is unusual. PND and postnatal psychosis are treatable illnesses and the
sooner they are treated the better. If you have any worries that you may harm
your baby, or you have worries that a mum you know may harm their child, speak
to a health visitor or doctor as soon as possible.
'Baby blues' and postnatal psychosis
'Baby blues'
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The commonest and mildest form of mood disturbance following
childbirth.
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Experienced by half to two-thirds of all mothers - in other
words it is normal for this to occur.
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Involves a period of a few days when mothers experience
spells of irritability, feeling gloomy and episodes of crying.
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It is more common in mothers who have given birth for the
first time and in those who have experienced problems with
pre-menstrual syndrome (PMS or
PMT).
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It is probably caused by the large and rapid changes in
female hormone levels following childbirth.
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'Baby blues' tends to sort itself out and usually does not
require any specific treatment other than reassurance that what the mother is
experiencing is normal.
Postnatal psychosis
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This is a rare complication of childbirth, occurring in 1 in
every 500 women or so.
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It is most likely to occur in mothers who have previously had
an episode of serious mental illness or in those who had a strong family
history of serious mental illness.
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Symptoms of the disorder can be very varied but usually
include a disturbance of mood, though this can be either an elevation of mood
(mania) or depression.
Other symptoms include having muddled thoughts, false ideas (delusions) and
hearing voices or seeing things that are not there.
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Symptoms appear from a couple of days to a couple of weeks
after the birth.
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Postnatal psychosis requires treatment that will depend on
the exact symptoms that the mother is suffering. This will usually involve a
psychiatrist. It is important for mothers with postnatal psychosis to receive
treatment as soon as possible.
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Last updated 05.01.2005
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