Postnatal Depression

According to the NHS at least one in 10 women in the UK is thought to experience postnatal depression (PND) after they have a baby (i). But the true number could be even higher, as many women don’t ask for help, admit there’s anything wrong or tell others about what they’re feeling. Indeed, the mental health charity Mind suggests around one in five women will experience a mental health problem during pregnancy or in the year after giving birth (perinatal depression is the term used for depression experienced during pregnancy or after childbirth) (ii).

Many more women – up to 85 percent of new mums – are affected by what’s called the baby blues (iii). This is thought to be caused by sudden changes in hormone levels, and can make you feel emotional during the first week or so after having a baby. If you have the baby blues you may feel weepy, anxious, overwhelmed and generally a bit down. But while it can be worrying, the baby blues doesn’t last long. In fact, it’s so common it’s considered normal, and no treatment is usually required.

PND isn’t the same as the baby blues. Affecting fewer women, it usually starts during the first month after childbirth – though it may not be triggered for several months – and can develop suddenly or slowly (some women have symptoms that start so gradually, they don’t realise they have PND). Some have mild symptoms, while for others the symptoms can be very severe.

The main symptoms associated with PND include the following:

• Low mood or mood swings.

• Feelings of sadness or despair.

• Feelings of being unable to cope.

• Crying a lot.

• Panic attacks .

• Feelings of worthlessness, hopelessness or guilt.

• Feelings of anxiety, irritability or anger.

• Troubles sleeping properly or staying awake.

• Loss of appetite or increased appetite (comfort eating).

• Low energy, feelings of exhaustion.

• Lack of confidence in looking after your baby.

• Lack of interest in sex, your partner or even your baby.

• Loss of libido

• Alarming thoughts (eg. harming your baby, self-harm or suicide).

• Poor concentration, feelings of confusion.

However, women aren’t always the only ones who are affected. Research, says the NHS, has found that up to one in 10 new fathers also becomes depressed after their partner has a baby (i).

Meanwhile one in 1,000 women may develop postnatal psychosis (or puerperal psychosis), which is a severe form of mental illness (iv). Women who have bi-polar disorder, a family history of mental health problems or who have had a traumatic birth or pregnancy are thought to have an increased risk of developing postnatal psychosis. The symptoms include depression, mania and psychosis, and can be very frightening and overwhelming. If you have postnatal psychosis it’s essential to get help, as you may need to be admitted to hospital for treatment.

Find more information about depression and low mood here.

What causes PND?

Experts aren’t really clear about what causes PND in some women while others aren’t affected. Those who suffer from stressful feelings after the birth – including feeling isolated or worried about being responsible for a new baby – may be more likely to develop PND than others. There are also several other risk factors that could make you more prone to developing it, including the following:

• A history of mental health problems (including depression before or during pregnancy or previous PND).

• Having a mother or sisters who also had PND.

• Stressful events, such as a bereavement or moving house.

• Health problems caused by pregnancy or childbirth.

• Birth trauma.

• Relationship or financial problems.

• A lack of a support network (no family/friends/partner close by).

• Having a partner who is affected by depression.

• Trying a long time before becoming pregnant.

If none of these things applies to you, you may still experience PND – even if you didn’t have PND with a previous child – as having a baby is a major life-changing event, whether or not you had a simple or complicated birth, and can be tiring and stressful. Indeed sometimes there is no obvious cause why some women experience PND.

Meanwhile there’s also no evidence there’s anything you can do to prevent PND, though the NHS recommends following as healthy a lifestyle as possible (i) while the Royal College of Psychiatrists suggests going to antenatal classes may be helpful (iv). If you have a history of depression or other mental health problems (including mental health problems while pregnant), or if mental health problems run in your family (particularly PND), it’s important to talk to your GP or mental health team if you’ve just found out you’re pregnant or you’re thinking of having a baby. That way, you can be looked after and given any necessary treatment if you need it.

PND treatments

The good news is there are ways to treat PND successfully. Many women find the symptoms tend to get better within a few months without any help or treatment, though a small number – about five per cent – say they can last for up to three years (v). But if you do seek help you’ll not only help yourself to recover more quickly, you could also improve your relationship with your partner and your family, as well as your baby. It’s also important to remember that admitting you’re feeling depressed isn’t a sign of weakness, it can happen to anyone and it is never your fault.

The type of treatment your GP may offer you will depend on a number of things, including what symptoms you have (and how severe they are), whether you’ve had depression or other mental health problems before and what type of treatment you’d prefer. These include the following:

Psychological treatments

Counselling – often referred to as talking treatments – has been shown to be an effective treatment for PND. Cognitive behavioural therapy (CBT) – a combination of cognitive therapy (which claims the way you think may affect your health) and behavioural therapy (which aims to change unhelpful or harmful behaviours) is often recommended for PND. This may help if you have harmful or false ideas or thoughts that may be making you depressed, as it aims to change the way you think and avoid unhelpful thoughts by replacing them with more realistic and positive ones.

You may, however, have to wait for treatment – though guidance from the National Institute for Health and Care Excellence (NICE) says women with PND should ideally start psychological treatment for PND within a month of their initial assessment (vi).

Your GP or health visitor may also recommend a self-help course, many of which are based on the same principles as CBT. These courses tend to last anything up to 12 weeks.

Antidepressants

If your symptoms are moderate or severe – or if you have mild PND and a previous history of depression – your GP may recommend taking antidepressants. These work by balancing the chemicals in your brain, and are designed to relieve many of the symptoms of PND including low mood and irritability. This could help you cope better with having a new baby.

There are several types of antidepressant medicines you could take, so if one isn’t suitable your GP can prescribe another. Speak to your doctor about any concerns you may have about taking antidepressants while breastfeeding, as some antidepressants are more suitable than others for breastfeeding mothers.

It’s also worth being aware that antidepressants don’t usually work straight away, and you may need to take them for at least a week before you start to feel better.

 If your PND is very severe, you may be referred to a specialist mental health team who can offer other treatments.

PND: how to help yourself

If you have PND, there are things you can do yourself that may help. Talking about your feelings with your partner, friends and family members may be useful – you may find others can offer practical help that could make a big difference. If help is offered, accept it and try to get as much rest as possible – don’t worry about doing the cooking or housework (if the house isn’t perfect, it’s not worth beating yourself up about).

Having a new baby can seem overwhelming – whether or not you have PND – but it’s important to try and make time for yourself too. It’s essential to relax, especially when life is so hectic, so find some time to do things you enjoy, such as listening to music or reading a book or magazine.

A new baby can also put a strain on your relationship with your partner, as it can be difficult to find the time to spend together as a couple. Your partner may feel shut out if you don’t talk to them about how you’re feeling. Try to be open and honest with them, and plan activities – or even quiet nights in – that you can do together. If you’re a single mum, try to plan something you enjoy doing with friends and family members.

Eating as healthy as possible is also a must, and try to make sure you eat regularly and don’t go for too long without food, even if you don’t feel like eating. And while you may not be keen on doing much exercise when you have a new baby, try to get out in the fresh air for a walk at least once a day, as regular gentle activity has been proven to help boost mood (walking with your baby in the pram is good exercise).

Other things you can do include the following:

• Track your mood. Making a record of how you feel and what you’re doing at the time may make you realise that certain things help you feel better, or that you have more good moods than you think. Try downloading an app like MoodPanda , which you can use on your phone.

• Avoid using alcohol or drugs, which may make you feel better in the short term but can make depression worse.

• Mixing with other new mothers can also be helpful (your health visitor will suggest local groups you can join). If you’re depressed you may not feel like it, so ask a friend or family member to go with you.

• Get in touch with organisations that support women with PND, such as the following:

  • Association for Post Natal Illness (APNI)

  • Birth Trauma Association

  • Family Action

  • Mumsnet

  • Mind

  • National Childbirth Trust

  • Netmums

  • Pre and Postnatal Depression Advice and Support (PANDAS)

  • PND and me

Natural support for PND

The symptoms of PND can be difficult. But as well as getting treatment – whether in the form of medication or counselling – and using self-help measures, there are some natural supplements that may be useful.

Taking certain nutritional or herbal supplements may be useful to improve the symptoms of several types of hearing loss:

Vitamin D

Experts believe pregnancy can increase your risk of vitamin D deficiency, and there is some evidence that links low vitamin D levels with PND symptoms. For instance, some studies suggest being deficient in vitamin D mid-way through your pregnancy may be a factor that affects the development of PND (vii). Another claims your vitamin D status immediately after giving birth may play a part in whether or not you develop PND (viii). According to the NHS, pregnant and breastfeeding women need 10mcg of vitamin D a day and should consider taking an appropriate daily supplement between September and March (ix).

High-strength multivitamin and mineral

Even with the best intentions it can be difficult to eat a balanced diet when you have a new baby. This means you could be missing out on important nutrients that maintain your general health as well as support breastfeeding. Taking a good-quality, high-strength multivitamin and mineral supplement may be useful to make sure you’re meeting your needs for all essential nutrients.

5-HTP

If you’re not breastfeeding or have finished breastfeeding, a natural supplement containing the non-essential amino acid 5-hydroxytryptophan (5-HTP) may help with low mood. This substance is a natural compound that converts in the brain to serotonin, a hormone that’s thought to maintain mood balance. Indeed, many conventional medicines for low mood work by increasing serotonin levels in the brain. There is also evidence that 5-HTP may be as effective as conventional medicines for low mood (x).

NOTE: 5-HTP is not suitable for women who are breastfeeding.

Myo-inositol

A vitamin-like substance (also sometimes called a pseudovitamin) found in many natural sources, myo-inositol – often called simply inositol – is a carbohydrate with a molecular structure similar to that of glucose. It is found in high concentrations in the brain and there’s evidence it may be useful for low mood (xi), with researchers claiming it has “a significant antidepressant effect”. Myo-inositol is also used to treat panic attacks, anxiety and the symptoms of obsessive-compulsive disorder (OCD).

Fish oils

There is some evidence to suggest the omega-3 fatty acids found in oily fish such as salmon, fresh tuna, sardines, pilchards and herring may be more effective at reducing the symptoms of PND than a placebo (xii).

Experiencing postnatal depression is more common than you might think, so it’s important to keep speaking openly about it with your friends, family or even GP. For even more health articles just like this, feel free to visit our health library.

 

References:

1. Available online: https://www.nhs.uk/mental-health/conditions/post-natal-depression/overview/

2. Available online: https://www.mind.org.uk/media-a/2948/pnd-and-perinatal-mh-2016.pdf

3. Available online: https://www.hopkinsmedicine.org/health/wellness-and-prevention/postpartum-mood-disorders-what-new-moms-need-to-know

4. Available online: https://www.rcpsych.ac.uk/mental-health/problems-disorders/post-natal-depression

5. Available online: https://www.nih.gov/news-events/nih-research-matters/postpartum-depression-may-last-years

6. Available online: https://cks.nice.org.uk/topics/depression-antenatal-postnatal/

7. Gur. EB, et al. Mid-pregnancy vitamin D levels and postpartum depression. Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:110-6.
   
   Robinson. M. Low maternal serum vitamin D during pregnancy and the risk for postpartum depression symptoms. Arch Womens Ment Health. 2014 Jun;17(3):213-9.

8. Fu, CW, et al. Association between serum 25-hydroxyvitamin D levels measured 24 hours after delivery and postpartum depression. BJOG. 2015 Nov;122(12):1688-94. Available online: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.13111

9. Available online: https://www.nhs.uk/pregnancy/keeping-well/vitamins-supplements-and-nutrition/

10. Byerley. WF, Judd. LL, Reimherr. FW, et al. 5-hydroxytryptophan: a review of its antidepressant efficacy and adverse effects. J Clin Psychopharmacol. 1987 ;7:127-137.
    
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11. Levine. J, Barak. Y, Gonzalves. M, et al. Double-blind, controlled trial of inositol treatment of depression. Am J Psychiatry. 1995;152:792-4. Levine J. Controlled trials of inositol in psychiatry. Eur Neuropsychopharmacol. 1997 May;7(2);147-55.

12. Mukai T. et al., A meta-analysis of inositol for depression and anxiety disorders. Hum Psychopharmacol. 2014 Jan;29(1):55-63. Available online: https://onlinelibrary.wiley.com/doi/abs/10.1002/hup.2369

13. Su. KP, Huang. SY, Chiu. TH, et al. Omega-3 fatty acids for major depressive disorder during pregnancy: results from a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 2008 Mar 18.

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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