Postnatal depression is depression that begins during pregnancy or in the first year after having a baby. It brings low mood, loss of enjoyment, exhaustion and difficulty coping that last more than two weeks and do not lift on their own. It is different from the baby blues, which pass within about two weeks.
Key points
- Postnatal depression starts in pregnancy or the first year after birth and does not lift on its own.
- The baby blues are different: mild, affecting 30 to 80% of women, and gone within two weeks.
- Anxiety often occurs with it and is under-recognised.
- Around one in ten fathers and non-birthing partners are also affected.
- NICE recommends talking therapy before medication, and specialist perinatal services for moderate to severe illness.
- Postpartum psychosis is a separate, rarer condition, and a medical emergency.
Symptoms
- Low mood or emptiness most of the day, loss of interest or pleasure, hopelessness, guilt or feeling like a bad parent.
- Exhaustion that rest does not relieve, trouble sleeping even when the baby is asleep, difficulty feeling connected to the baby.
- Anxiety: constant worry about the baby, repeated checking, a racing heart, or unwanted frightening images of harm to the baby.
Causes and risk factors
- Previous depression, anxiety or another mental health problem; severe sleep loss and the physical demands of a newborn.
- Rapid hormonal change after birth is a plausible contributor but not established as a cause on its own.
- Little support, relationship difficulties or domestic abuse; a difficult birth, or a baby born premature or unwell.
Treatment
- Mild to moderate: facilitated self-help. Moderate or severe: a high-intensity psychological intervention such as CBT.
- Medication may be considered if preferred or if psychological treatment is declined; breastfeeding is not treated as a reason to withhold treatment.
- Specialist perinatal mental health teams treat the illness and support the parent-baby relationship, in England up to 24 months after birth.
When to speak to a professional
- Low mood, tearfulness or anxiety has lasted more than two weeks after the birth.
- You feel guilty most of the time, or that you are failing as a parent.
- Get help the same day if you have thoughts of harming yourself or your baby, feel confused, or have beliefs others do not share - possible signs of postpartum psychosis.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.