Postnatal depression (PND)

What is postnatal depression?

Postnatal depression (PND) is sometimes confused with the baby blues. The baby blues are when you feel moody, weepy, tired or anxious during the first week after giving birth (BB 2014b). These feelings usually pass within a few days (Mind 2013).

Unlike the baby blues, however, PND is an illness that's unlikely to get better quickly, and without help. The sooner you recognise that you have PND, and find the support you need, the less likely it is to become a severe or long-term problem (Mind 2013).

How common is postnatal depression?

Up to one in seven mums in Australia experience some degree of depression after the birth of their baby, so it’s very common problem (BB 2014b).

You may have a biological vulnerability to depression. This vulnerability may be higher if you have, or someone in your family has, a history of depression or anxiety. When your biological vulnerability is combined with life stressors, this can bring about PND (Almond 2009, BB 2014a).

How will I know if I have PND?

Some of the signs and symptoms of depression overlap with the changes that come with being a mother, such as tiredness and changes in appetite (BB 2014b). Your friends or family may spot the signs before you do, but you may feel:

• sad or low
• unable to enjoy anything
• negative
• lacking in motivation, and feeling like everything is an effort
• hopeless or worthless
• a sense of guilt or inadequacy
• extremely tired, with no energy
• miserable
• tearful
• lacking in appetite or hungry all the time
• fear for the baby, or of being alone or going out
• anxious, including experiencing panic attacks
• suicidal thoughts
  (BB 2014b)

You may also find it hard to concentrate or go to sleep. Or you might sleep all the time (BB 2014b). It’s common to experience symptoms of anxiety as well as depression (BB 2014a).

Most mums have at least one of these feelings, some of the time. It’s normal to have good days and bad days. But if you've experienced some of these symptoms for two weeks or more, you could have PND (BB 2014b). Talk to your GP or child health nurse for advice.

When does PND usually happen?

PND often develops within the first few months of giving birth (SIGN 2012). But it could start at any time in the first year (Joy et al 2014).

You may have been really enjoying looking after your baby before depression crept up on you, or you may have been depressed while you were pregnant, and this has continued into the postnatal period.

What causes PND?

PND is a result of several factors, some biological, some psychological and some social.

You may have a biological vulnerability to depression, because you or someone in your family has a history of depression. When combined with life stressors, this can bring about PND.

You could be vulnerable to depression with your second baby, even if you were fine with your first, or vice versa (Mind 2013), depending on the life stressors you experienced with each baby.

What puts me at risk of developing PND?

Some of the things that may put you at risk of developing PND include:

• you’ve been depressed before, or have had problems with your mental health, or were depressed during or after a previous pregnancy
• you don’t have a supportive partner, or have no family or friends living nearby
• you’re having money, housing, work or relationship problems
• you had a difficult or traumatic labour, and health problems afterwards
• your baby was born prematurely, or is unwell
• you’re finding it difficult to breastfeed
• your baby is particularly unsettled, fussy or unwell
• you’re socially isolated, or unable to participate in your culture
• you’ve experienced stressful life events during pregnancy or in the postnatal period, such as loss of a loved one, moving house or renovating
  
  (BB 2014a, Mind 2013, RCP 2014)

How is PND treated?

With help, you can get better. Your GP or child health nurse will want to support you, so that you can look after yourself and your baby well. Be reassured that having PND doesn’t mean you’re a bad mother, or that you’ll have your baby taken away from you (Mind 2013).

If you have mild PND, your GP or child health nurse may suggest self-help strategies. These may include exercise, getting more support, taking time out for yourself or resting.

If you have moderate to severe PND, you’re likely to be referred to a psychologist experienced in treating pregnancy and postnatal (perinatal) mental health. Your GP can prepare a mental health treatment plan for you so that you receive a Medicare rebate for sessions with a psychologist. Your child health nurse might refer you to a facilitated or supported mother’s group, so you can share your experience with other women going through PND.

Treatment with a psychologist
Though talking to your partner or a friend can help, they may find it difficult to understand what you’re going through.

A psychologist who works with new mums will understand the physical and emotional demands associated with having a baby. She'll work with your thoughts and feelings as well as your relationship with your baby.

She may use cognitive behavioural therapy (CBT) to help you learn coping strategies, such as relaxation. CBT also helps you challenge or modify your thoughts, expectations or beliefs connected with your depression. You may work through difficulties in your past (including the way in which you were parented), and set goals for how you would like to live your new life.

Some psychologists provide interpersonal psychotherapy (IPT), which involves working with relationship difficulties that may be associated with your depression.

If your PND is more severe, you might be referred to a perinatal psychiatrist (NCCMH 2014, NHS 2014b).

Antidepressants
Antidepressants balance the chemicals in your brain. They raise levels of the hormone serotonin to lift your mood, help you sleep and make you feel less irritable.

Between five and seven out of every 10 women who take antidepressants find their PND symptoms ease within a few weeks of starting treatment (NHS 2014b). The first few tablets will make no difference, but after about two to four weeks of taking them, you should begin to feel better (Mind 2014).

Tricyclic antidepressants (TCAs) are considered safe to take if you’re breastfeeding (BB 2014b). Nortriptyline or imipramine are the TCAs that are usually recommended. Another type of antidepressant commonly prescribed for PND is a selective serotonin reuptake inhibitor (SSRI). SSRIs include:

• fluoxetine (Prozac)
• sertraline (Zoloft)
• citalopram (Cipramil)
• escitalopram (Lexapro)

All antidepressants may pass into your breastmilk, but in very small amounts. Sertraline is often recommended over fluoxetine for breastfeeding mums (NHS 2014b, SIGN 2012), as smaller amounts of it pass into breastmilk (Berle and Spigset 2011, Weissman et al 2004). If your baby seems sleepy or irritable after you’ve taken antidepressants, talk to your GP.

Many mums who take antidepressants do breastfeed because it improves their confidence and strengthens their bond with their baby. Feeling close to your baby can help you tackle PND (NHS 2014b).

Talk to your doctor to get a clear understanding of the risks and benefits involved in taking antidepressants if you’re breastfeeding, or seek advice from a perinatal psychiatrist (BB 2011, Mind 2014).

How can I help myself to overcome PND?

While seeking professional help, here are some things you can do for yourself that may help.

Try to get lots of rest
Sleep or rest whenever possible. If someone is able to look after your baby for a couple of hours, put on some soothing music, have a warm drink and relax. Try to nap when your baby is sleeping, and forget your to do list for a while (BB 2014b, Mind 2013). Accept offers of help, or ask your partner, family or friends for help.

Eat a healthy, well-balanced diet
With all the new demands on your body, eating well is important (BB 2014b). Try not to go for long periods without eating, to avoid a dip in your blood sugar levels. Food fuels your energy and immune system, so a balanced diet will prevent you becoming tired and feeling run down.

Do some gentle exercise
It may be the last thing you feel like doing, but exercise will help you feel better in mind and body (NHS 2014a, Norman et al 2010). It may be better to exercise with someone else if you’re feeling unmotivated (BB 2014b).

If it’s a struggle to get started, try to keep your goals manageable. Just going for a walk with your baby can help lift your mood. If you did yoga or Pilates classes while you were pregnant, you could go along again now. Look for mums and babies exercise classes if you find it hard to get someone to look after your baby. Your child health nurse will be able to tell you what's available near you. Check with your midwife or doctor before starting any new exercise, though.

Meet other mums
Having a baby can be isolating, but if you have PND you may feel particularly alone. Joining a baby massage group, playgroup or mothers’ group will help you to meet other mums (BB 2014b). Ask your child health nurse about supported mothers’ groups for women experiencing PND.

Be kind to yourself
Taking care of yourself and your baby are the most important things. Try not to load yourself up with tasks that aren’t essential. Leave any big decisions for when you’re better, and be realistic about what you can achieve. Try to treat yourself once in a while with something that you enjoy (Mind 2013).

How can my partner, friends and family help?

It can be hard for those closest to you to understand how awful you’re feeling. But they have an important part to play in helping you get better. Tell them what you’re going through and give them any information you have about PND. Your partner may also be struggling (Mind 2013), and understanding how to support you could help him to feel better, too.

Ask loved ones for help, because practical support, such as helping around the house or preparing food, can go a long way towards lifting your mood. Just an hour or so of babysitting relief, so you can rest or have time alone or with your partner, can help refresh you (RCP 2014).

Can I prevent PND?

Take care of yourself while you're pregnant, try to reduce your stress levels and accept any help that’s offered. The more support you have during your pregnancy, the stronger you’re likely to feel when you have your baby.

If you’ve had PND before, or felt depressed during pregnancy, tell your doctor or midwife. This will prevent a delay in diagnosis if you do develop depression, and you can be treated sooner (NHS 2014b, SIGN 2012).

If you have a history of depression, counseling during pregnancy can help you lower your risk of depression in the postnatal period.

Some doctors may prescribe antidepressants immediately after the birth if you’re at high risk of PND (NHS 2014b).

Where can I find out more about PND?

• PANDA (Perinatal Anxiety & Depression Australia) is a not-for-profit organisation offering information, support and referrals to women and their families who are experiencing post and antenatal mental health issues. Its helpline operates from 10am to 5pm (AET), Monday to Friday (Tel. 1300 726 306).
• Beyond Blue is a not-for-profit organisation providing information about mental health, support and referrals. Its 24-hour helpline offers free, confidential support with a mental health professional (Tel. 1300 22 4636).
• Just Speak Up is a Beyond Blue initiative for people to share their experiences with antenatal and postnatal depression and anxiety.
• The Blue Pages is full of information about treatments for depression, and links to free online self-help programs, such as MoodGYM and Ecouch.
• COPE (Centre of Perinatal Excellence) provides information to help you work through the emotional challenges of becoming and being a parent.
• You can call Lifeline on 13 11 14 for someone to talk to and ideas about where to seek help at any time of the day or night.
• Visit the BabyCenter postnatal depression community group to talk to other mums who know how you're feeling.