Do I have postnatal depression?
The arrival of a new baby is usually a happy event but it can also be a stressful time during which many adjustments have to be made. Unfortunately many women and men are not aware that mood changes are common after childbirth and vary from mild to severe. In fact, in the year after childbirth a woman is more likely to need mental health care than at any time in her life.
Sometimes there is confusion about how postnatal depression compares to the normal ups and downs after birth, such as baby blues, right through to the very serious end of postpartum psychosis. So how are they different?
At one end of the spectrum is ‘baby blues’, affecting about 80 percent of new mothers and occurring between the third and tenth day after birth. This is considered to be a normal part of the early days and symptoms can include:
- mood fluctuations
The ‘blues’ will usually pass on their own with lots of understanding and support.
At the other end of the spectrum is puerperal or postpartum psychosis. This affects 1 in 500 mothers, usually in the first three to four weeks after delivery. Postpartum psychosis is a serious condition. The mother herself may be unaware she is ill as her grasp on reality is affected. Symptoms include:
- severe mood disturbance (either marked elation or depression or fluctuations from one to the other)
- disturbance in thought processes
- bizarre thoughts
- inappropriate responses to the baby
There is risk to the life of both mother and baby if the problem is not recognised and treated. Postnatal psychosis requires a hospital stay. With appropriate treatment women suffering from postnatal psychosis fully recover.
Between the ‘blues’ and psychosis lies postnatal depression. Most women and men find adjusting to life with a new baby very difficult, but more than one in seven mothers and one in 20 fathers will be diagnosed with postnatal depression.
Many parents do not know that postnatal depression can occur unexpectedly after delivery and typically blame themselves, their partners or their baby for the way they feel. Some try hard to ‘snap out of it’ without understanding that a person with postnatal depression has little control over the way they are feeling.
It is very important for all new parents to learn to recognise the signs and symptoms of postnatal depression so they can ask for help as early as possible. With good support most new parents make a full recovery.
What do we know about postnatal depression?
- Postnatal depression occurs in all cultures and all socio-economic classes and can happen to child-bearing women and men of all ages.
- It is not a modern condition. Each generation calls it something different. What we call postnatal depression today may have been called a 'nervous breakdown' fifty years ago.
- Postnatal depression can be mild, moderate, or severe. Symptoms of depression can begin during pregnancy (antenatal depression), suddenly after birth or gradually in the weeks or months following delivery. Symptoms can emerge at any time during the first year after birth but most cases have their onset in the first four months.
- It can happen after miscarriage, stillbirth, normal delivery, or caesarean delivery. Pregnancy is the common factor.
- Postnatal depression happens not only after a first baby. It can occur after a third or fifth baby. Sometimes it happens after a first baby only. Sometimes it happens with a third baby, but not with the first two.
- A woman who has had postnatal depression has a 40 percent chance of recurrence with a subsequent pregnancy. If a woman becomes pregnant again before recovering from postnatal depression, the condition will continue through the pregnancy and may worsen. Women should delay another pregnancy until they have recovered completely. It is wise to wait at least a year after discontinuing medication before falling pregnant again.
Symptoms of postnatal depression
Postnatal depression is an illness and the severity of the illness depends on the number and combination of symptoms, their intensity and the extent to which they interfere with daily life. For each woman and man, their experience of postnatal depression will be unique, which can contribute to the difficulty in identification and diagnosis.
Symptoms for women are outlined below and many of these are the same for dads, with the addition of increased anger, use of drugs or alcohol, withdrawal and relationship conflict.
- Sleep disturbance unrelated to baby’s sleep needs - most women with a young baby fall asleep as soon as they are able to. Women with postnatal depression often lie awake for hours feeling anxious while the baby sleeps. Some women have trouble falling asleep or they wake early in the morning, and may have bad dreams.
- Appetite disturbance - women may feel totally uninterested in food. Sometimes women overeat in an attempt to control their anxiety or they forget to eat.
- Crying - a woman may feel sad and cry without apparent reason. Tears come easily. She may cry watching news coverage of a plane crash.
- Inability to cope - daily chores and demands seem insurmountable. A woman may feel like running away.
- Chronic exhaustion or hyperactivity - a woman may feel either overwhelmingly exhausted or unable to relax and settle, driven by anxiety.
- Irritability - a woman with postnatal depression may snap at her partner, baby or family, often without cause.
- Anxiety - she may feel a ‘knot in the tummy' most of the time and panic without cause. Some women experience heart palpitations so severe that a heart attack is feared. She may be anxious about her own health or her baby's even after reassurance that nothing is wrong. Many women describe anxiety as their most obvious symptom and reject the term postnatal depression. They deny being 'depressed'. The term 'postnatal disorder' might more accurately describe the way some women feel.
- Negative obsessive or morbid thoughts - a woman may be afraid to let her partner go to work in case he has a car accident or be afraid to leave the baby with a friend in case something happens to him.
- Fear of being alone - many women go out a lot with their baby because they are afraid of being alone at home.
- Fear of social contact - not wanting to go out and may find being with groups of people overwhelming.
- Memory difficulties and loss of concentration - a woman may forget what she wanted to say mid-sentence or be unable to concentrate on simple tasks.
- Feeling guilty and inadequate - a woman may feel she is a ‘bad mother’ even when those around her comment on what a good job she is doing.
- Loss of interest in sex
- Loss of confidence and self-esteem - a woman may panic or feel anxious at the thought of having to do things she once enjoyed. She may feel that she is no longer sure she is able to do it. A woman who enjoyed having friends over may panic at the thought of visitors. Some women feel like they have lost themselves somewhere along the way.
- Feelings of self harm, harm to the baby or suicide - this may be fleeting or very detailed in plans. A woman may feel like life has no meaning. It is important to assess the risk to the mother and her baby’s well being, and to intervene.
Some women sum it all up by saying "There is no joy in anything any more".
Am I at risk of postnatal depression?
Postnatal depression can happen to any new parent, but some are more vulnerable than others. Some risk factors are:
- previous experience of postnatal depression
- family history of psychiatric illness (bipolar disorder, schizophrenia, postnatal depression). Just as women are asked whether they have a family history of multiple births or diabetes, they are increasingly being asked in the antenatal period if anyone in the family (mother, sister) has suffered from a mental illness.
- stressful life events, for example a recent death in the family
- history of pre-menstrual tension
- difficult marital or family relationships
Women and men with risk factors should be encouraged to talk with their doctor before the birth of their baby.
Treatments for postnatal depression
The earlier the postnatal depression is identified and treatment is commenced, the earlier women will commence their recovery and the negative impacts of postnatal depression will be reduced. All women with postnatal depression need emotional support from family and friends.
If a new parent does not feel the way she expected to feel after having a baby it is very important that she talks to her GP or Maternal and Child Health Nurse. It could simply be that she is having trouble adjusting to the changes in lifestyle that occur when a baby is born and to the demands that a new baby makes. If she is experiencing postnatal depression, it is important that she receive appropriate help as soon as possible. Postnatal depression is not something to be ashamed of. It should be seen as one of the many complications of pregnancy and delivery. With appropriate help women with postnatal depression do recover.
Psychological treatments such as counselling or support groups are important to support the woman to understand what has contributed to postnatal depression and strategies for recovery, especially if they have experienced traumatic events in their childhood or more recently.
Antidepressant medication is also an important part of treatment for many women. Unfortunately there are many misconceptions about antidepressants and many women who could benefit from them may refuse to take them because they are afraid the medication is harmful. Antidepressants are not addictive and some can be safely taken while pregnant or breastfeeding.
This type of medication does not ‘change the personality’; it simply corrects the chemical imbalances in the brain that are thought to be responsible for symptoms of depression and anxiety. It is important to understand that women cannot ‘snap out of’ depression any more than they could ‘snap out of’ diabetes!
Partners need support too
Living with a woman suffering postnatal depression is difficult. Partners too need a lot of support. They often feel confused, lost and helpless. It is important that partners be included by the health professionals treating women with postnatal depression. Partners are much more supportive if they understand what the problem is and what they can do to help. Sometimes it can be very difficult to know how to help and partners may feel that whatever they say or do is not helping her to feel better.
Find more articles on postnatal depression
This article was written by Belinda Horton, Chief Executive Officer, PANDA (Post and Antenatal Depression Association) for Kidspot, New Zealand's best parenting resource.
Last revised: Friday, 18 March 2016
This article contains general information only and is not intended to replace advice from a qualified health professional.