What help is available?
I was too scared to tell anyone how I really felt in case they took my baby away.
You may fear that your baby will be taken away if you admit to feeling depressed, anxious or having distressing thoughts, for example, about harming yourself or the baby. But fear of asking for help may be part of the problem, and you may need encouragement and support in getting it.
PND is not only a distressing condition, it can also be a disabling one, so the earlier you get help the better. If PND is acknowledged and addressed, it is likely to pass sooner and be less severe than if you get no help. It is then also less likely to affect the relationship between you and your baby.
I thought I was a bad mother, until I told my health visitor how I was feeling. When she named ‘it’ postnatal depression and got me the right support, it felt like someone had opened the door and let a glimmer of sunlight in.
There are many health professionals who are familiar with these issues and who can provide you with support in several different ways. These may include your GP, midwife, health visitor, community psychiatric nurse, psychiatrist, psychotherapist or counsellor, or complementary practitioner.
Research suggests that the treatment most new mothers prefer for PND is a combination of practical support and advice, and counselling or psychotherapy. If necessary, you may want antidepressants. In rare cases, you may be offered electroconvulsive therapy (ECT).
Counselling and psychotherapy
Talking treatments, such as counselling and psychotherapy, can offer you the opportunity to look at the underlying reasons that have contributed to the way you feel, as well as helping you to change and manage your feelings.
The NICE (National Institute for Health and Clinical Excellence) guidelines on antenatal and postnatal care say that healthcare professionals should, before and during pregnancy if possible, and after the birth, ask specific questions designed to detect signs of depression, and follow this up as appropriate.
Many GPs have a counsellor or psychotherapist attached to their practice. They can also refer you to a psychiatrist or psychologist on the NHS. Various organisations offer talking treatments, and some of them operate a low-fee scheme for those who can't afford to pay. (For more information, see Talking treatments.) Cognitive behaviour therapy (CBT) is increasingly popular as a short-term treatment, and provides practical ways of dealing with problems (see Cognitive behaviour therapy.)
Talking therapies should be more readily available to you if you are pregnant or breastfeeding because of the increased risk of using medicines at these times.
Your GP can prescribe medication to help you. But it's important to discuss potential benefits and side effects fully, before taking any, and to keep monitoring your progress with them.
Medication may enter breast milk, and if you are breastfeeding you will need to bear this in mind when deciding whether or not to take it. Some drugs have known effects on infants, while others appear to be quite safe, so it is important to discuss this with your doctor. If you do decide to try medication, it may be necessary to try different drugs to achieve the best results.
All antidepressants take time to work. If you do take them, they can be very effective, but you should be prepared to take them for at least six months. They also all have possible side effects, and when you stop taking them you should withdraw slowly, to avoid possible withdrawal effects which can be unpleasant.
Manufacturers advise that the following antidepressants should be avoided while breastfeeding: doxepin; phenelzine, isocarboxazid, moclobemide; citalopram, escitalopram, fluoxetine, fluvoxamine, sertraline; duloxetine, venlafaxine; flupentixol, mirtazapine, reboxetine, and agomelatine. (See Antidepressants for more information.)
Mood stabilisers, such as lithium, should also be avoided while breastfeeding.
Sleeping pills and tranquillisers
If lack of sleep has become a habit you can’t break, your GP may consider prescribing sleeping pills to help you. Any sleeping pills should be taken for brief periods only, and preferably not for several nights in a row, in order to avoid becoming dependent on them.
They should not be taken if you are breastfeeding because they are excreted in breast milk, and are absorbed by the baby.
See Sleeping pills and minor tranquillisers for more information.
You may also be taking other medication for a mental health problem or physical condition. These can sometimes interact with drugs the doctor may wish to prescribe for postnatal depression. All drugs should be used with caution. Talk to your doctor or a pharmacist if you need more advice about a particular drug or combination of drugs. (Also see medication more details on individual drugs for mental health problems.)
Electroconvulsive therapy (ECT)
ECT is a controversial treatment, but some psychiatrists favour it for PND because when it works it can relieve depression quickly. The treatment is done under anaesthetic and involves passing an electrical current through the brain. Many people are nervous of it, and it does not work for everyone. It can also have serious side effects. The NICE guidelines suggest that ECT should only be offered if you experience severe depression and if other treatments have not helped. (see Electroconvulsive therapy.)
Some women have found complementary therapies helpful when they experience PND. These are holistic therapies – treating you as a whole person to support your body and mind in healing. They include cranial osteopathy, herbal remedies, homeopathy, massage, reflexology and aromatherapy. Some people find these therapies can help them relax and may reduce symptoms of, for example, depression and anxiety. (See the Complementary and Natural Healthcare Council)
What can I do to help myself?
Postnatal depression usually gets better in time, although it may take up to a year. Where you feel you can, ask for and accept help from those around you. Love, practical and emotional support from family, friends and community can be vital in helping you to cope.
Meet other parents
Talking to other new mothers and fathers, and finding that other new parents share the anxieties and frustrations you are experiencing, can be very reassuring. It can also give you a chance to share skills and experiences, to realise you are not alone, and above all to get some emotional and practical support. It can help to affirm you in your new role.
You can develop your own network of support; for example, by keeping in touch with people you may have met at your antenatal classes, and going to parent-and-baby groups locally. There are many organisations that can put local mothers in touch with each other, including Netmums and Home-Start. Having a baby can be a wonderful way to make new friends.
I suffered badly from postnatal depression, I felt very lonely and frightened. My health visitor got me into a baby massage class to help me bond with my baby and also meet other mums suffering. It really helped to meet and talk through our experiences. It made me realise I was not alone.
Get help to shop and cook
Difficulty in concentrating and lack of appetite are common symptoms of depression. The first can make it difficult for you to prepare food; the second can make it difficult to eat. Lack of food can make your condition worse. You may also be anaemic, which will make you feel tired and make it harder to relate to your baby. You may also be lacking vitamin B, calcium and magnesium.
Accept offers of help from relatives and friends to help you prepare or buy food. People often like to do something practical to help you and this is one great way.
Get help with feeding your baby
If your baby takes a bottle, you could ask your partner or other family member to take over the night feeds, if only for a night or two. If you are breastfeeding only, you can have the baby’s cot next to your bed, so that you can feed with the minimum of disruption. In time, you and the baby are likely to fall into a more natural rhythm of sleeping and waking, and this will make the night feeds much less stressful and tiring.
Do less housework and rest when possible
It can help if you don’t try to do too much round the house; you and the baby are much more important. If you are having many broken nights, you can try to sleep when the baby does, and, if at all possible, have people to help you out with daily responsibilities, so that you can rest during the day.
The postnatal depression seemed to go on forever, but I did sleep more eventually, and my 'depression' magically lifted. I think a lot of new mums just need more help – and definitely more sleep – than they get!
It might seem impossible to find the time, but if you can, physical activity can work as an antidepressant, especially if it's enjoyable. Do anything you find fun, e.g. walking fast with the pram, dancing to the radio at home. Or try to arrange for a time for yourself to go to a class or for a run, while your partner or friend looks after the baby. (Also see Tips: physical activity.)
Learn to relax
- Learning simple breathing or relaxation techniques, such as those you learn in antenatal classes can be helpful. (Also see How to manage stress.)
- Giving yourself a relaxing bath with candles and scented foam while the baby is asleep or is being entertained by someone else, can help recharge your batteries.
- You can try to find something to do, just for the fun of it. It doesn’t matter whether it’s five minutes with your feet up and a glass of orange juice, reading a book or listening to music, as long as it gives you pleasure.