Seventy percent of new mothers experience baby blues, usually within the first week after birth. The cause is unclear, but physically it is likely linked to hormonal changes, and the come down from a surge of adrenaline during labour. Psychologically, giving birth is a massive emotional upheaval. As a new mother comes to terms with the massive change in responsibility, it can be an unnerving surprise not to feel as ecstatic as they perceived. Symptoms include: low mood, feeling emotional and tearful, insomnia, feeling anxious, restless and irritable.
The baby blues are not postnatal depression, and usually pass within a few days. However it is important to seek support from those around you. Friends and family should be sensitive and reassuring: offering help without taking over, encouraging rest, listening, and allowing the mother to cry.
Postnatal depression can start at any time in the first year after giving birth. It can develop gradually or come on suddenly. It is important to seek medical advice, and talk with friends and family, if you start to exhibit signs of postnatal depression. Symptoms include: intense sadness, low mood, loss of interest in everything, lack of energy, feeling tired but unable to sleep, poor concentration and indecisiveness, loss of appetite or increased hunger, feeling apathetic, agitated or irritable, and thoughts of self-harm or suicide. Postnatal depression takes control of the way you connect and bond with your baby. You can feel a sense of indifference in their company, this will then lead to feelings of guilt and hopelessness, with a sense of belief you are unable to care for your baby.
It is essential you speak to your GP or health visitor as soon as possible. Like any form of depression it takes hold of every aspect of your life: relationships, activities, work and chores. It will not go away on its own. Health professionals will help you access support, expressing you are not alone despite feeling like you are.
Traditional treatments are a combination of self-help strategies, therapy, and medication. In extreme cases mothers will be referred to a mental health team and possibly admitted into hospital. Babies can either remain with fathers, designated family members, or stay with the mother in a mother and baby mental health unit.
Guided self-help strategies on average takes 9-12 weeks to complete. It is a book or online course which focusses on problematic issues, offering practical advice to tackle them. The course can be worked through alone, or with a therapist.
Cognitive Behavioural Therapy (CBT) is a proactive therapy that takes 3-4 months to complete. It concentrates on how thoughts, feelings, actions, and personal sensations are connected. It considers how unrealistic and unhelpful thinking leads to negative behaviour. Unlike many therapies CBT focusses on the present oppose to the past. It aims to break down negative cycles and find proactive ways of thinking, that help you behave in a positive way. It can be beneficial to mothers suffering with postnatal depression, by addressing unrealistic expectations of themselves and motherhood.
Interpersonal Therapy is essentially a time limited and structured talking psychotherapy. It concentrates on the patients various types of relationships and how they affect them, considering on the flip side, how depressive mood impinges on the quality of relationships. The therapist will initially learn about the patient concentrating on building trust, before discussing what the patient needs help with. Throughout the process the patient will complete questionnaires, which they will then discuss with their therapist. The purpose of this is to gage progress, and flag up any unresolved issues. Sessions are usually done on a weekly basis, lasting 3-4 months. Therapists may chase up how their patient is doing after a 6 month cooling off period.
Antidepressants may be offered on there own, or alongside therapy. They alter chemicals in the brain to stabilize mood. It is important they are taken consistently and given time to work. But they can ease symptoms, and allow a person to function better on a day-to-day basis. Like all medication there can be side effects: blurred vision and dizziness, feeling sick, constipation, dry mouth, feeling agitated or shaky. They will usually be prescribed for a minimum of 6 months. It is important to take the advice of a doctor before weening off antidepressants, to avoid a relapse into depression.
Electroconvulsive therapy (ECT) is an invasive procedure that is used in severe cases of postnatal depression, usually only if all other treatments have failed. It involves sending an electric current through the brain to induce a seizure. Treatment is administered under a general anaesthetic and can relieve symptoms.
Postpartum Psychosis occurs in 1-2 of every 1,000 deliveries. It is an extremely serious mental illness, occurring suddenly within 2-3 weeks after birth. Symptoms include: delusions, hallucinations, mania, feeling irritated, decreased need for sleep or insomnia, difficulty communicating, paranoia and low mood. It is important to seek emergency medical treatment, and will likely be sought by an eye witness, as the mother will not consider herself unwell. The risk of postpartum psychosis rises by 25-30% if there is a family history of mental illness, the mother has previously suffered bouts of psychosis, or has any kind of brain disease. First time mums are more likely to develop psychosis. And complications during labour and birth, including caesarean sections, can increase the risk. Immediate treatment is imperative, usually in hospital. A full evaluation will take place, with a physical examination and laboratory tests to rule out a biological cause for psychosis. A full medical history including family members will be taken, and a neurological assessment completed. Treatment will be a combination of antipsychotic medications, mood stabilizers and therapy. Once the psychosis subsides patients usually suffer with depression, anxiety and low self esteem. At this stage GPs will usually make a referral for therapy. During recovery the support of family and friends is important, keeping the home quiet and calm. On average recovery time is anything between 6-12 months.
A List of Support and Advisory Lines
Action on Postpartum Psychosis
Association for Postnatal Illness (APNI)
Maternal Mental Health Alliance
Pre and Postnatal Advice and Support (PANDAS)
Royal College of Psychiatrists: Postpartum Psychosis