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Postnatal Depression

postnatal depression

What is meant by postnatal depression?

Having a baby is a very emotional experience. You may feel tearful and your mood may feel low. There are three causes of low mood after childbirth:

Baby blues. This is very common and almost considered normal. Symptoms include being weepy, irritability, anxiety and feeling low. It usually starts around the 3rd day, but usually goes by the 10th day after childbirth. It does not usually need any medical treatment.

Postnatal depression. It usually develops within the first four weeks after childbirth. However, it can start several months following childbirth.

Postnatal (puerperal) psychosis. This is an uncommon, but severe form of depression. It develops in about 1 in 1000 mothers. It is discussed briefly at the end of this leaflet.
The baby's father may also develop postnatal depression.

What are the symptoms of postnatal depression?
The symptoms are similar to those that occur with depression at any other time. In postnatal depression, symptoms are usually there on most days, for most of the time, for two weeks or more.

  1. Low mood. Tends to be worse first thing in the morning, but not always.
  2. Lack of interest in yourself and your baby.
  3. Lack of motivation to do anything.
  4. Often feeling tearful.
  5. Feeling irritable a lot of the time.
  6. Feelings of guilt, rejection, or inadequacy.
  7. Poor concentration
  8. Feeling unable to cope with anything.
  9. You may also have thoughts about harming your baby. Around half the women with postnatal depression have these thoughts. If things are very bad you may have ideas of harming or killing yourself. This only happens in very rare cases. If you have such thoughts, you must ask for help.
  10. In addition, you may also have: less energy, disturbed sleep, poor appetite, and a reduced sex drive. However, these are common and normal for a while after childbirth, and on their own do not necessarily mean that you are depressed.

Why should you do anything about postnatal depression?

If you do nothing about the depression, (or do not even know that you are depressed) you are likely to get better anyway in 3-6 months. Some people take longer. There are a number of reasons to ask for help:

To help yourself recover quickly. You need not feel like this. It is not a sign of weakness to admit that you are depressed.

To help your partner or family. If you are depressed, it can cause problems in your relationships, your job, and life in general.

To help your child (or children). If you are depressed, your relationship with your baby may not be as good as it could be. You may not give as much attention to your baby as you would like to. As a result, your baby's development may not be as quick as it should be. There is evidence to suggest that developmental problems that occur in the baby because of a mother's depression may persist into adolescence.

Many women are able to hide their postnatal depression. They care for their baby perfectly well, and appear fine to those around them. However, they suffer the condition as an internal misery. Do seek help if you are like this.

What causes postnatal depression?

The exact cause is not clear. Any mother could develop postnatal depression, but women are more prone to develop it just after childbirth. The main cause seems to be stressful events after childbirth such as feelings of isolation, worry, and responsibility about the new baby, etc.

You may also be at greater risk of developing postnatal depression if:

You have had mental health problems in the past (including depression, previous postnatal depression, bipolar disorder or schizophrenia).
Your family tends to suffer from postnatal depression.
You have had marital or relationship problems.
You have no close friends or family around you.
You have money troubles.
You have had physical health problems following the birth (such as anaemia, incontinence, etc).

However, in many cases, there is no apparent cause.

What are the treatments for postnatal depression?

The type of treatment that is best for you can depend on various things including:

How severe your depression is and what symptoms you have.
The impact of your symptoms on your ability to function (to look after yourself and your baby).
Whether you have had depression or other mental health problems in the past.

Support and advice

Understanding and support from family and friends can help you to recover. It is often best to talk to close friends and family to explain how you feel rather than bottling up your feelings. You may also benefit from some help from family and friends in caring for your baby. This may give you some time off to rest and/or to do some things for yourself. Support and help from a health visitor can also help. Do tell your health visitor if you feel depressed as they may be able to talk things through with you.

Antidepressants

Antidepressant medication is often prescribed for postnatal depression, especially if the depression is moderate or severe. Symptoms such as low mood, poor sleep, poor concentration, irritability, etc, are often eased with an antidepressant. This may then allow you to function more normally, and increase your ability to cope better with your new baby.It takes 2-4 weeks before their effect builds up fully. A common problem is that some people stop the medication after a week or so as they feel that it is doing no good. You need to give it time. Also, if it is helping, follow the course that a doctor recommends. A normal course of antidepressants lasts up to six months or more after symptoms have eased. Some people stop treatment too early and the depression can quickly return.

There are several types of antidepressants including tri-cyclic antidepressants (for example, imipramine, lofepramine) and SSRIs (for example, fluoxetine, citalopram). They all have pros and cons. For example, they differ in their possible side-effects. (The leaflet that comes in the medicine packet provides a full list of possible side-effects.) If the first one that you try does not suit, then another may be found that is fine. Therefore, tell your doctor if you have any problems with an antidepressant. Antidepressants are not tranquillisers and are not thought to be addictive.

Counselling andPsychological treatments

Specialist and hospital based treatments

If your depression is severe, or does not get better with treatment, your doctor may suggest that they refer you to a specialist mental health team. They may be able to suggest other treatments such as specialist medication. Occasionally, admission to hospital may be needed. Ideally this would be to a mother and baby unit so that your baby can stay with you.

Some dos and don'ts about depression

* Don't bottle things up and go it alone. Try and tell people who are close to you how you feel. It is not weak to cry or admit that you are struggling.
* Don't despair. Most people with depression recover. It is important to remember this.
* Do try and distract yourself by doing other things. Try doing things that do not need much concentration but can be distracting such as watching TV. Radio or TV is useful late at night if sleeping is a problem.
* Do eat regularly, even if you do not feel like eating.
* Don't drink too much alcohol. Drinking alcohol is tempting to some people with depression as the immediate effect may seem to relieve the symptoms. However, drinking heavily is likely to make your situation worse in the long run.
* Don't make any major decisions whilst you are depressed. If possible, delay any major decisions about relationships, jobs, or money until you are well again.
* Do tell your doctor if you feel that you are getting worse, particularly if suicidal thoughts are troubling you.

Will it happen again?

If you have an episode of postnatal depression you have a greater than average chance of it happening again if you have another baby. About 3 in 10 mothers who have postnatal depression have another episode of depression if they have another baby. However, you and your doctor are more likely to be aware of the possibility in future pregnancies. This means that you are more likely to be diagnosed and treated promptly should it recur.

What is postnatal (puerperal) psychosis?

Postnatal psychosis is an uncommon, but severe form of depression that can occur after childbirth. As well as symptoms of severe depression, there are also other serious symptoms such as delusions (false beliefs), hallucinations (such as hearing voices), odd behaviours, and irrational thoughts. Affected mothers may not recognise that they are ill. Postnatal psychosis usually occurs within the first month of giving birth. Women generally need to be admitted to hospital with their baby for treatment.


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