Positive Relationships: A parent's guide to ... postnatal depression

WHAT IS POST-NATAL DEPRESSION

Postnatal depression (PND) is what happens when a mother becomes depressed after having a baby. There may be an obvious reason, but often there is none. It can be particularly distressing when you have looked forward to having your baby throughout pregnancy. You may feel guilty for feeling depressed, or even feel that you can't cope with being a mother.

Around one in every ten women has PND after having a baby. Most cases of PND begin within a month of giving birth, but it can start up to six months later. PND can last for weeks or several months.

WHAT DOES IT FEEL LIKE TO HAVE PND?

You could experience some of the following:

Depressed - You feel low, unhappy and wretched for much or all of the time. Occasional good days give you hope, but they are followed by bad days which make you despair.

Irritable - You may get irritable with other children, and occasionally, with your baby, but most often with your partner, who may not understand what is happening.

Tired - All new mothers get weary, but depression can make you so utterly exhausted that you feel physically ill.

Sleepless - Even though you are tired, you can't fall asleep. You wake early, even if your partner has fed the baby overnight.

Not hungry - You lose your appetite and forget to eat, which can also make you feel irritable and run-down.

Unable to enjoy anything - and it may take away any desire or enthusiasm for sex. If your partner does not understand this, they may feel rejected.

Unable to cope - PND can make you feel that you have no time, can't do anything well, and that you can't do anything about it.

Guilty - Depression changes your thinking and makes you see things negatively.

Anxious - You may worry so much that your baby might scream, or choke, or be harmed in some way, that you are afraid to be alone with her. Instead of feeling close to your baby, you may feel detached. You can't work out what she is feeling, or what your baby needs. Most new mothers worry about their baby's health, but PND can make this overwhelming.

WHAT CAUSES PND?

There is probably no single reason, but a number of different stresses may add up to cause it. You are more likely to have PND if you:

- have had depression (especially PND) before

- do not have a supportive partner

- have a premature or sick baby

- lost your own mother when you were a child

- have had several recent life stresses - bereavement, unemployment, housing or money problems

Even so, PND can start for no obvious reason, without any of these stress factors. And suffering these problems does not mean that you will definitely have PND.

DO WOMEN WITH PND HARM THEIR BABIES?

Depressed mothers often worry that they might hurt their babies, but this is rare. Occasionally, through utter tiredness and desperation, you might feel like hitting or shaking your baby. Many mothers (and fathers) occasionally feel like this, not just those with PND.

The real problem is more likely to be a crippling worry that you might harm your baby. If you do feel like this, tell someone - your health visitor or doctor will be able to help.

WHAT CAN BE DONE?

The first thing is to recognise the depression for what it is - and not to dismiss it as the 'baby blues'. You may not realise what is wrong, or feel ashamed to admit it. You may worry that, if you do, your baby will be taken away - but your doctor, health visitor or midwife is most concerned with helping you get better so you can enjoy and care for your baby at home. People are now more aware of depression in general, so PND shouldn't be missed.

WHAT CAN I DO TO AVOID PND

We don't yet know enough about PND to prevent it, but certain principles make sense.

During pregnancy:

- DON'T try to be 'superwoman'. Try to do less, and make sure that you don't get over-tired.

- DON'T move house (if you can help it!) while you are pregnant or until the baby is six months old.

- DO make friends with other women or couples who are expecting or have just had a baby.

- DO find someone you can talk to. If you don't have a close friend, you can turn to the National Childbirth Trust or MAMA (see box).

- DO go to antenatal classes - and take your partner with you.

- DO keep in touch with your GP and your health visitor if you have suffered PND before.

After the baby has arrived:

- DO tell someone about how you feel. Talk to your health visitor or GP as well.

- DO take every opportunity to cat-nap. Your partner can give the baby a bottle-feed at night; you can use expressed breast milk for this.

- DO eat well - plenty of fresh fruit and vegetables.

- DO find time to have fun with your partner.

- DO let yourself and your partner be intimate if you can: at least kiss and cuddle.

- DON'T blame yourself or your partner.

WHAT TREATMENT CAN I RECEIVE

If you have a more severe depression, or it has not improved with support and reassurance, an antidepressant drug will probably help. Antidepressants need around two weeks to start working and should be taken for around six months after you start to feel better.

It is not entirely clear how they work, but antidepressants affect the activity of two chemicals in the brain, serotonin and noradrenaline.

DO ANTIDEPRESSANTS HAVE SIDE EFFECTS?

Some may cause nausea or an increase in anxiety at first, but these usually wear off. Others can make you sleepy or give you a dry mouth. Make sure that your doctor knows if you are breastfeeding. For many antidepressants, there is no evidence that they cause problems for breast-fed babies, so breastfeeding is usually possible. Some people get withdrawal symptoms when they stop these medicines, so it's best to come off them slowly.

WHAT IF I DON'T WANT TREATMENT FOR PND?

There is some evidence that regular exercise can boost your mood and help you to feel less isolated. You may find it easier to do this with other people.

Most women will get better without any treatment after a period of weeks, months or sometimes longer. However, this can mean a lot of suffering. PND can spoil the experience of new motherhood, and strain your relationship with your baby and partner. It's important to get help as soon as possible, to relieve the depression, to support your relationship with your baby, and to help your baby's development in the long run. You should be told about all the likely benefits and risks of treatment so you can make the best choice for you.

FURTHER INFORMATION

- Royal College of Psychiatrists, www.rcpsych.ac.uk

- Association for Postnatal Illness, www.apni.org, helpline: 020 7386 086

- CRY-SIS, www.cry-sis.org.uk, helpline: 08451 228 669. Provides self-help and support for families with excessively crying and sleepless babies

- Meet-A-Mum-Association (MAMA), www.mama.co.uk, helpline: 0845 120 3746

- National Childbirth Trust, www.nctpregnancyandbabycare.co.uk, 0870 444 8707.

- The Samaritans, www.samaritans.org, 08457 909090. Confidential emotional support to any person who is suicidal or despairing.