What you need to know about postnatal depression

Postnatal depression refers to depression that occurs within one year of giving birth and affects one in 10 mothers in the UK. It can also affect partners and is different to the ‘baby blues’.

Here, we will explore the symptoms of postnatal depression, its causes, risk factors and treatments, as well as where you can find help and how family and friends can provide support.   

Baby blues vs postnatal depression

The baby blues refers to low mood, anxiety and tearfulness that many mothers experience within a week of giving birth. The baby blues is so common among mothers that it is considered a normal part of recovering after birth. It gets better on its own and usually within two weeks. 

In contrast, postnatal depression, which is also called postpartum depression, is very unlikely to get better without treatment. It has more severe symptoms than the baby blues, can develop anytime in the first year after birth and lasts much longer, anywhere from several months to over a year in severe cases. 

Symptoms of postnatal depression

Symptoms of postnatal depression often develop gradually, which can make it more difficult for you to realise that you’re depressed. It is, therefore, important to be aware of the symptoms and check in with yourself to see if your symptoms are getting worse. 

Common symptoms of postnatal depression include: 

• Difficulty sleeping at night and feeling drowsy in the day
• Difficulty caring for yourself and your newborn
• Losing interest in activities you usually enjoy and withdrawing from people
• Loss of appetite
• Low energy and fatigue
• Persistent low mood and unexplained crying spells

These symptoms can make bonding with your baby more challenging. However, it is important to note that not all mothers with postnatal depression struggle to bond with their babies, and conversely, mothers without postnatal depression can also find it difficult to bond with their babies. 

Risk factors and causes of postnatal depression

The exact cause of postnatal depression isn't clear but several risk factors have been identified. You’re more likely to experience postnatal depression if you have had mental health issues in the past or during pregnancy, and if you have experienced physical or psychological trauma (eg physical, sexual or mental abuse). 

Your risk of postnatal depression is also higher if you do not have a support network of friends and family, have been through a recent traumatic event (eg a bereavement or major illness in your family) or have a family history of postnatal depression.

However, even if you do not have any of these risk factors, it is still possible to develop postnatal depression as childbirth, sudden changes in your pregnancy hormones after birth, poor sleep, exhaustion and adapting to caring for a newborn can all put you at risk of feeling overwhelmed and becoming depressed. 

This can be compounded by having less time to maintain relationships that ordinarily are a source of support. This can include your relationship with your partner, close family and friends.

Postnatal depression in fathers and partners

Although less talked about, partners of the individual who has given birth can also develop postnatal depression. This usually occurs within six months after birth and has similar contributing factors as those experienced by mothers ie poor sleep, less time to maintain important relationships and feeling overwhelmed with the adjustments needed to care for a newborn. 

Partners are also more likely to develop postnatal depression if the mother has postnatal depression, if they are very young or older individuals, and if this is their first experience of being a parent. 

Symptoms of postnatal depression in partners often include feelings of helplessness, fear and uncertainty, difficulty sleeping, avoiding social interactions, irritability, angry outbursts and poor parenting behaviours. 

Physical symptoms in partners include headaches, nausea and changes in bowel habits.

Preventing postnatal depression

You can reduce your likelihood of developing postnatal depression by taking care of your physical and mental health during and after pregnancy. 

Follow a healthy, balanced diet, stay active and build a network of family and friends you can turn to for practical and emotional support. 

It can also help to meet other expectant parents who you can share common concerns and questions about pregnancy, childbirth and parenting with — the National Childbirth Trust runs groups nationwide to facilitate these connections. 

If you have a history of mental health problems or a family history of postnatal depression, it is important to make your GP and care team aware, so they can provide appropriate support as soon as possible. 

Treatments for postnatal depression

Postnatal depression is broadly treated in three different ways: self-help strategies, talking therapies and antidepressants.

Self-help strategies

This largely revolves around your lifestyle and daily routine. Make sure you follow a healthy, balanced diet with regular mealtimes and avoid becoming reliant on drugs or alcohol. 

Your sleep will be broken when caring for a newborn, so try to sleep or rest when your baby is sleeping or when someone else can look after them.

Accept support from your friends and family with household chores and/or looking after the baby, and let them know how you’re feeling. Remember, you don’t need to do everything yourself. 

Although life with a newborn is busy, try to find some time to look after yourself too, whether that’s enjoying a soak in the bath when you feel ready, reading a book or taking part in a hobby that relaxes you. 

Talking therapies

Talking therapies include guided self-help, cognitive behavioural therapy and interpersonal therapy, and usually take three to four months to complete. Your GP can help you decide which of these therapies will be most helpful in your circumstances; you may find that a combination of these therapies is most effective. 

With guided self-help, you follow an online course or read printed course material. The course will teach you how to cope with your current challenges. In some cases, a therapist may support you at certain points during your course. 

Cognitive behavioural therapy (CBT) aims to break negative thought patterns that lead to negative behaviour and develop more positive thought patterns. Your therapist can help you one-to-one or in a group setting to identify and break negative thought patterns (eg pressure you're putting on yourself to be a perfect parent). 

Interpersonal therapy involves talking to a therapist about your current challenges, and through this, identifying how issues with important relationships in your life are potentially contributing to your depression. This may include relationships with your partner, close family members or close friends. 

Antidepressants

If self-help strategies and talking therapies aren’t effective at resolving your postnatal depression, you aren’t comfortable trying these treatments and/or your depression is severe, your GP may recommend antidepressant medications. 

If your postnatal depression is mild, you may still be prescribed antidepressants if you have a history of depression prior to pregnancy and childbirth. 

It usually takes one to two weeks to start to notice the benefits of antidepressants and up to six weeks for the maximum effects. 

If you’re breastfeeding, low to very low levels of antidepressants will enter your breast milk. There is currently no evidence that this causes any short-term negative consequences for a developing baby. Your GP will discuss the risks and benefits so you can decide whether or not you’re comfortable taking antidepressants. 

Common antidepressants prescribed for postnatal depression include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and sertraline, and serotonin and norepinephrine reuptake inhibitors (SNRIs), such as desvenlafaxine and duloxetine. 
Once on antidepressants, you can't suddenly stop taking them after you feel better as this can trigger withdrawal symptoms and cause your postnatal depression to return. Your GP will advise you on when is the right time to stop taking your antidepressants and how to gradually reduce your dose until you can completely come off them. 

If none of these treatments are effective at resolving your postnatal depression, you will be referred to a specialist community perinatal mental health team.

How to manage postnatal depression as a couple

Postnatal depression in one or both partners can strain the relationship. Treating postnatal depression often resolves this strain but it is nonetheless important to continue communicating while you or your partner is undergoing treatment. 

Be aware that your relationship may be suffering due to postnatal depression and learn about the condition and its symptoms. Keep talking to each other about how you’re feeling and be patient with each other when it comes to mood swings or outbursts of emotion. 

It is important not to make any life-altering decisions during this time and it can also help to seek professional support and counselling.

How to support a parent with postnatal depression

If your loved one is experiencing postnatal depression, make time to talk with them and regularly check-in with them. Reassure them that their feelings are valid and don’t take any personal criticism or mood swings to heart. 

If you can, offer practical help and support around the house or with looking after the baby. Also, help them recognise when they may need some downtime and time away from visitors.

Support your loved one in maintaining a healthy lifestyle, for example, by providing healthy home-cooked meals or caring for the baby so they can relax for a while. 

If you’re concerned that their postnatal depression is getting worse or not showing any signs of improvement, encourage them to seek professional help. 

When and where to seek help

As postnatal depression most often does not get better on its own, it is important to seek help as soon as you notice any symptoms. 

Without treatment, your symptoms may worsen and the longer your symptoms persist, the greater the risk to your health and wellbeing and that of your baby. 

In the first one to two weeks after birth, you can speak to your midwife. After this you will be discharged to the care of a health visitor who you can speak with. Alternatively, you can see your GP.

You can also find support from UK charities such as the Association for Post Natal Illness (APNI), National Childbirth Trust, Pre and Postnatal Depression Advice and Support (PANDAS) helpline, mental health charity MIND and the Maternal Mental Health Alliance.