• Dr Lucinda Green

Spotlight on Postnatal Depression

New parents often assume that having a baby will be joyful and exciting, and for many, it will be. However, it’s also common to feel anxious, overwhelmed, exhausted, low, and frustrated at times. Many people have very unrealistic expectations of what pregnancy and parenting will be like, not helped by pressure from social media. Birth and life with a new baby often do not go as planned. Having a baby brings changes to many aspects of your life, for example, your sense of identity, your body, and your relationships. Sleepless nights are hard and it takes time to build your confidence as a parent. It’s not surprising that this a time when it’s normal to experience many different emotions. If this happens for a few days it does not necessarily mean you have a mental illness, but if your symptoms persist you should ask your Midwife, Health Visitor, or GP for advice.


Mental health problems in the postnatal period are very common. It’s not your fault if you become unwell – it can happen to anyone. For some women this a continuation of an illness that started in pregnancy. It can also be a relapse of a mental illness you have had before, or it may be your first episode of mental illness. Women can have many different mental health problems in the first year after having a baby, just like at other times. Postnatal depression is just one of these and affects 10 to 15 in every 100 women. Partners can also have depression and other mental health problems in the postnatal period.

Many women find it hard to know whether their symptoms are a normal part of life with a baby or due to a mental illness. To have a diagnosis of Postnatal Depression you will have some or all of the following symptoms for 2 weeks or more:


  • Low mood most or all of the time

  • Irritability and anxiety

  • Sleep difficulties (not due to your baby waking you up) – not being able to get to sleep, waking intermittently, or waking early in the morning

  • Appetite changes – loss of appetite or comfort eating

  • Loss of motivation and loss of interest in things

  • Not enjoying things as much as usual

  • Not wanting to see people

  • Loss of interest in sex (which can be common after having a baby anyway)

  • Negative thoughts e.g. thinking you are not a good mum

  • Guilty thoughts e.g. that it’s your fault you are ill, or that your baby is unwell

  • Anxious thoughts e.g. that your baby may have a serious illness

  • Loss of confidence

  • Feeling hopeless about the future

  • Suicidal thoughts – these are common in depression – if you start to have plans to act on these thoughts you should seek urgent help.

  • Psychotic symptoms – a few women with the most severe episodes of depression may hear voices or have very strongly held, unusual beliefs (delusions). If this happens you should seek urgent help.

  • Postnatal depression can affect how you feel about your baby. You may worry that you are not bonding and you may find practical aspects of caring for your baby difficult.

There is a range of severity. Some women only have a few of these symptoms and can still look after their baby well. Women with very severe Postnatal Depression have most of these symptoms and may need a lot of support with basic self-care and care of their baby. They may be very withdrawn and not be able to function at anything like their usual level.


Why do some women have Postnatal Depression?


Many things can cause Postnatal Depression. There is often a combination of factors that contribute. These include:

  • A previous history of mental illness, before or during pregnancy

  • Lack of practical and emotional support

  • Relationship difficulties

  • Recent stressful life events, such as a bereavement or a relationship ending

  • Domestic abuse or a history of abuse

  • Pregnancy loss

  • Negative birth experience

  • Being a refugee or asylum seeker

  • Personality traits e.g. perfectionism


Where can I get help and treatment?


It’s really important to ask for help if you think you might have Postnatal Depression or another postnatal mental illness. Midwives, Health Visitors and GPs may ask you about your emotional wellbeing. Some women are worried about talking about symptoms of mental illness and some take far too long to access treatment. It’s common to fear being judged negatively as a mum. Some women even worry that their baby may be taken away. You should not worry about these things. You are doing the best for your baby if you have help and treatment for mental health problems. All healthcare professionals involved in the care of women in the postnatal period are very used to seeing women with mental health problems and will want to help you get any care and treatment you need. It’s just as important to have treatment for mental health problems as it is for physical health problems.


You can access help in the following ways:

  • Self-help – there are lots of resources and sources of support. For some suggestions see: https://www.rcpsych.ac.uk/mental-health/problems-disorders/post-natal-depression

  • Talk to your GP, Midwife, Health Visitor or Paediatrician. They can help you access the care and treatment you need

  • Self-refer to your local NHS talking therapies service

  • Depending on the severity of your illness, your GP, Midwife or Health Visitor can refer you to your local NHS perinatal mental health service. This is a specialist team that provides mental health care for women during pregnancy and in the postnatal period

  • If you are able to access private healthcare, you can see a private clinical psychologist or a perinatal psychiatrist

  • For urgent help, you can contact the 24-hour crisis support line for your local mental health trust, call NHS 111 or go to A&E

Treatment:


The treatment you will need depends on the severity of your illness. There is good evidence for:

  • Talking therapies such as Cognitive Behaviour Therapy

  • Antidepressant Medication – you can take antidepressant medication when you are breastfeeding

The earlier you seek help the better. With effective treatment and good support, you can expect to fully recover and, to enjoy family life.


For more information about Postnatal Depression and other mental health problems in pregnancy and after birth see the following:


Contributed and written by:

Dr Lucinda Green

Consultant Perinatal Psychiatrist

www.drlucindagreen.co.uk


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