Postnatal Depression

Explains postnatal depression, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family.

What is postnatal depression?

Having a baby is usually thought of as a happy time. However, as a new mother, you may not necessarily feel this straight away.

You may go through a brief period of feeling emotional and tearful – known as the ‘baby blues’. It usually starts 3-10 days after giving birth and affects around 85 per cent of new mothers. It is so common that it is considered normal. New fathers may also feel it. And, although having the baby blues may be distressing, it’s important to be aware that it doesn’t last long – usually only a few days – and is generally quite manageable.

However, around 10-15 per cent of new mothers develop a much deeper and longer-term depression known as postnatal depression (PND). It usually develops within six weeks of giving birth and can come on gradually or all of a sudden. It can range from being relatively mild to very severe.

Common signs of postnatal depression

You may experience one or more of the following symptoms. However, it is unlikely that you will go through all of them.

How you may feel

  • sad and low
  • tearful for no apparent reason
  • worthless
  • hopeless about the future
  • tired
  • unable to cope
  • irritable and angry
  • guilty
  • hostile or indifferent to your husband or partner
  • hostile or indifferent to your baby.

You may find that you

  • lose concentration
  • have disturbed sleep
  • find it hard to sleep – even when you have the opportunity
  • have a reduced appetite
  • lack interest in sex
  • have thoughts about death.

As babies need care and attention frequently, including during the night, it is common to feel tired in the months following the birth of a child. And lack of sleep can make you feel both low and irritable. This is normal, and it is important not to confuse this with PND. However, one indication that you are going through PND is if you find it hard to sleep even when you’re tired and have the opportunity to do so.

“My postnatal depression snuck up on me as a dark shadow, every morning waking up and noticing a heaviness and blackness to my mood. The only ‘comforts’ were private fantasies about ending it all, running away, escaping my responsibilities, tearing myself to shreds to try and grasp why I felt so bleak.”

If you experience thoughts about death or harming yourself or the baby, this can be very frightening, and may make you feel as if you are going mad or completely out of control. You may be afraid to tell anyone about these feelings. But it’s important to realise that having these thoughts doesn’t mean that you are actually going to harm yourself or your children. However difficult it is, the more you can bring these feelings out into the open and talk about them, whether to a family member, a friend or a health professional, the less likely you will be to act on them.

Diagnosing postnatal depression

Experience of depression or other mental health problems before your child is born can put you at greater risk of developing PND. Health professionals should therefore ask about your wellbeing and mental health, during your pregnancy. (If you feel depressed while you are pregnant or later, you may also information on Depression helpful.)

Postnatal depression is assessed, often by health visitors, using a questionnaire called the Edinburgh Postnatal Depression Scale. As a new mother, you may be asked to fill this in within the first two months after the birth, to check for early symptoms.

What causes postnatal depression?

There is no known cause for postnatal depression, and sometimes it can start for no obvious reason. However, some researchers have suggested a number of possibilities.

Some think it is likely to be biological; for example, changes in your 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 PND – so hormones are unlikely to be the single cause.

Others think the cause is linked to past experiences or social circumstances. Many suggest that a combination of different issues cause PND.

Some situations are considered to put you at particular risk of developing PND:

  • previous mental health problems
  • lack of support
  • experience of abuse
  • low self-esteem
  • poverty and poor living conditions
  • major life events.

Previous mental health problems

If you have experienced a mental health problem in the past – including during pregnancy – this may recur after you have given birth. It is also important to be aware that what caused your mental health problem in the past, can also put you at risk of PND.

If you experienced PND after the birth of one child, you are at increased risk of developing PND 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.

Lack of support

Several studies suggest that lack of support from a partner or other family members can put you at risk of PND. You are at particular risk if you are a single mother (especially if you’re young), recent immigrant, refugee or asylum seeker.

“Depression during pregnancy needs to be publicised more – because I was never ever asked how I was, even when they knew was about to be a single parent and aware that I had no support.”

Experience of abuse

If you experienced emotional, physical or sexual abuse while growing up, you may find it hard to relate to others, including your baby. If your own parents did not have good parenting skills, you may find it hard to adapt to your new role as a mother. For example, you may feel unsure how to respond when your baby is crying. You may even fear that you are going to harm your baby somehow, because you are unsure how to take care of them.

Domestic violence, including verbal, emotional and financial abuse, can trigger anxiety, depression and lower your self-esteem. It also puts you at risk of developing PND.

If you experienced abuse as a child or later in life you may also have posttraumatic stress disorder (PTSD), which can further add to your risk for postnatal depression. (For more information, see Post-traumatic stress disorder.)

Low self-esteem

If your self-esteem is low, you may doubt your ability to cope as a new mother. When your baby cries, for example, you may think it is because of something you have done wrong – or because of something you haven’t done. The way you think about yourself can put you at risk of developing PND. (See How to increase your self-esteem for more information.)

Poverty and poor living conditions

It can be difficult for anyone to deal with poverty. If you face life with a new baby while living in poor housing and with little money to spend, this adds stress to your life and puts you at risk of developing PND. You may feel that you are unable to provide your baby with everything that he or she needs, and you may feel that you are failing your baby. Dealing with poverty can be particularly difficult if you are also living alone with little or no support from others.

Major life events

Major life events can include:

  • an illness or death in the family
  • the break-up of a relationship
  • moving house
  • losing your job
  • having a baby.

Each of these events can add serious stress to your life. If you experience any of these in addition to having a baby, this can increase your risk of getting PND. However, increased risk does not mean that you will definitely develop PND.

Having a baby is a major life event in itself, as it is likely to involve many changes in your life. You may have had to give up your job and lose your financial independence. You may also have had to give up social activities and have limited or no opportunities to meet up with your friends. Being responsible for a baby 24 hours a day means that your day is likely to revolve around your child’s needs rather than yours.

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