Understanding mental ill-health

Post-natal Depression

Download our Post-natal DepressionFactsheet here.

What is it?

• Postnatal depression (PND) is a serious clinical condition that usually starts soon after the birth of a baby, but can occur in the months following the birth.
• It is important to distinguish PND from ‘baby blues’, the brief episode of tearfulness that affects at least half of all women following delivery, especially those having their first baby. People with severe ‘blues’ are at more at risk of developing PND.
• PND can have any, or all, of the symptoms of general depression, such as feeling anxious, irritable, inadequate as a mother, or constantly sad. Physical symptoms are also common, such as headaches, fatigue, and loss of appetite.
• PND can involve the mother having frightening and irrational thoughts about her ability to cope with motherhood or care for her baby.
• Puerperal psychosis is a severe and rare form of PND, which normally requires hospitalisation.1 Symptoms can include loss of contact with reality, hallucinations, severe thought disturbance and unusual behaviour.2


Facts

• Postnatal depression affects around 10-15% of women; approximately 11,000 women in Scotland in any one year.
• Episodes of PND typically last from two to six months.3
• PND can happen in relation to any birth, not necessarily the first. Women who experience PND are at an increased risk of PND in subsequent births.
• A small number, around 1 in 5002, of births will result in the mother developing puerperal psychosis
• Suicide is probably the leading cause of postpartum maternal death in the UK4, which emphasises the seriousness of PND and the importance of seeking appropriate help.


Signs and symptoms

• The exact causes of PND are not known.
• Not enough is known about why women get PND to be sure who will or won't suffer from it. There is some evidence to suggest that part of the cause of PND is “biological” however one or more life stresses such as financial worries, lack of social support etc, may also have a causal effect.
• Previous depression is a risk factor, especially if it is paired with complications in pregnancy.
• PND cannot be prevented as such, but if the mother has had previous experience of PND, bi-polar disorder or depression, she can be monitored more closely and early action can be taken if symptoms occur. Previous history of severe PND may also be an indication to take antidepressants during/starting immediately after pregnancy.


Stigma and postnatal depression

• Women experiencing PND can often feel ashamed or guilty about their feelings, especially at a time when people around them expect them to be happy and smiling (PND is sometimes described as the ‘smiling’ depression).
• PND can be overlooked or dismissed as ‘baby blues’. This can prevent people seeking help and getting early treatment.
• It is common for the mother to feel that she is a bad mother who is incapable of raising her child(ren). This can lead to a fear that if she talks about her symptoms and feelings, she will be judged and her child(ren) will be taken away.
• A common misunderstanding is that mothers who experience PND are a danger to their child(ren) and may neglect or harm them. Although some mothers may fear that they will unintentionally harm the baby, actual incidents are very rare.


Recovery

• PND is very treatable illness and help is available.
• Lack of awareness about PND can lead to women experiencing feelings of guilt and isolation. This can prevent people from seeking help.
• Early detection and treatment will help making recovery faster and smoother.
• Treatments available for PND include CBT, therapy and antidepressants. Many people also find alternative therapies and counselling helpful. A GP or health visitor can offer advice on appropriate treatment. There may be additional considerations if the woman is pregnant or breastfeeding
• Often women find a combination of different treatments helpful.


Contacts

• Edinburgh Post Natal Depression Project – 0131 538 7288; This e-mail address is being protected from spambots. You need JavaScript enabled to view it
• Depression Alliance Scotland (also provide a booklet on PND) – 0845 123 2320; This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; http://www.dascot.org/pnd.html
• Overcoming PND – http://www.overcomingpnd.com/index.html
• The Royal College of Psychiatrists – http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/

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1 University of Birmingham (2004), Postnatal Mood Disorders Research Study
2 The Scottish Intercollegiate Guidelines Network (SIGN) (2002), 60 – Postnatal depression and puerperal psychosis: A national clinical guideline
3 BMJ (1998), Fortnightly review: Postnatal depression; 316; 1884-1886
4 The British Journal of Psychiatry (2003) 183: 279-281