Postnatal depression: symptoms, how long it lasts and treatment

The NHS lists the following as symptoms of postnatal depression. Not everyone has every symptom, and the NHS says it is important to get help even if only some of the signs are present.

• Low mood, and finding it hard to enjoy anything.

• Feeling hopeless, or that you cannot cope.

• Feeling guilty or worthless, or that you are a bad parent.

• Feeling fearful, anxious or worried all the time.

• Restlessness or irritability.

• Difficulty sleeping even when you have the chance to rest.

• Difficulty concentrating or making decisions.

• Difficult feelings about, or difficulty bonding with, the baby.

• Thoughts of suicide, or of harming yourself or the baby.

Postnatal depression, also called postpartum depression, is a depressive illness that develops around childbirth. The Royal College of Psychiatrists notes that its symptoms are similar to depression at other times, with low mood and other symptoms lasting at least two weeks.

Many new parents feel tearful, irritable and overwhelmed for a few days. The NHS describes this as the baby blues and says it usually goes away within 2 weeks of the birth. The Royal College adds that over half of new mothers experience baby blues, which usually starts 3 to 4 days after birth, and that those women do not need treatment.

Postnatal depression is different in that it persists, deepens or interferes with coping. If low feelings continue beyond 2 weeks, the Royal College advises telling the health visitor or GP so that they can check.

The NHS says postnatal depression usually gets better in 3 to 6 months, but that it can sometimes last for much longer, and that it is more likely to get better with treatment. NHS inform says that with the right support most people make a full recovery, although it can take time, and that it can take a lot longer to feel better if it is not addressed.

Treatment courses have their own timescales. NHS inform says guided self-help courses usually last 9 to 12 weeks, and cognitive behavioural therapy and interpersonal therapy usually last 3 to 4 months. The baby blues are different: the NHS says they usually go away within 2 weeks of the birth, and NHS inform says they do not last for more than 2 weeks after giving birth.

The Royal College explains that the help needed depends on how severe the illness is. Mild postnatal depression can be eased with extra support from family and friends. More unwell parents need the GP and health visitor, and a minority need a specialist service.

The NHS says treatment may come from a GP, a talking therapies service or a specialist community perinatal mental health team, perinatal meaning pregnancy and up to 12 months after birth. Treatments include talking therapies such as cognitive behavioural therapy (CBT) and antidepressants. Many antidepressants are safe to use while breastfeeding, and you should tell your doctor if you are breastfeeding so that a suitable one is chosen.

Only a few women need to be admitted to hospital. The Royal College says that in that case the mother should usually be admitted with her baby to a specialist mother and baby unit.

NHS inform says psychological therapies are usually the first treatment recommended. It lists guided self-help, CBT and interpersonal therapy, and says antidepressants may be recommended if you have moderate or severe depression, do not want psychological treatment, psychological treatment does not help, or you have mild postnatal depression and a previous history of depression. Your GP might also check your physical health, for example for anaemia after giving birth.

• Talk about your feelings with a friend, relative, health professional or counsellor.

• Ask for practical help with shopping, chores and childcare.

• Try for regular exercise, even a short daily walk, and rest when you can.

• Go to a local support group or a parent and baby group.

• Avoid using alcohol or illegal drugs to manage symptoms, since the NHS advises against it.

There is probably no single cause. The Royal College says a number of stresses may add up. It lists factors that make postnatal depression more likely: previous mental health problems, including depression; depression or anxiety during pregnancy; poor support from partner, family or friends; a recent stressful event such as a bereavement, job loss or relationship ending; and experience of domestic violence or previous abuse.

Some physical conditions can mimic or contribute to low mood, such as an underactive thyroid or low vitamin B12, and these are easily treated once found. Equally, the illness can arise with none of these factors, and having them does not mean it will definitely happen. It is nobody's fault.

The Royal College describes how exhaustion in depression is different from ordinary new-baby tiredness: you can be utterly worn out yet unable to sleep, lying awake worrying or waking before the baby does. Appetite can drop, or comfort eating can follow by guilt. Some mothers avoid friends, make excuses to miss groups, or lose interest in sex.

Anxiety is often prominent. Worries may centre on the baby being ill, not gaining weight, crying too much, being too quiet, or being harmed. Physical anxiety such as a racing pulse and breathlessness can occur. Some women feel they do not love the baby or resent the baby, and feel intense guilt about it. These feelings are symptoms of the illness and do not make anyone a bad parent.

Many parents fear that admitting to this will lead to their baby being taken away. The NHS says this is very rare, and the Royal College says the GP, health visitor and midwife want to help you get better and care for your baby at home.

GPs, midwives and health visitors usually ask new parents about their mental health. The NHS says you may be asked questions about how you have been feeling and may fill in a questionnaire. The Royal College gives examples of the questions, such as whether in the last month you have been bothered by feeling down, depressed or hopeless, or by having little interest or pleasure in doing things.

Answering honestly is what lets help be offered. If answers suggest depression, the GP asks more questions to confirm the diagnosis and may check for physical causes. The NHS says that if you are 18 or over (or 16 or over in some areas), you can refer yourself to an NHS talking therapies service without a GP referral.

Postpartum psychosis is the most severe mental illness after childbirth. The Royal College says it affects around 1 in 1,000 women, starts within days or weeks of the birth, can develop in a few hours and can be life-threatening, so it needs urgent treatment. Symptoms include rapid mood swings, delusions and hallucinations. The risk is higher in women with previous severe mental illness, particularly bipolar disorder.

Perinatal obsessive compulsive disorder affects 2 to 3 in every 100 women after having a baby, according to the Royal College, and often involves unwanted thoughts of the baby being harmed. It is treated with CBT and sometimes medication. Anxiety disorders and pre-existing conditions can also flare after birth, so mention any past history.

Call 999 or go to A&E if you or someone you know has a plan to end their life, has seriously harmed themselves, or has lost touch with reality, such as hearing voices or holding frightening beliefs. The NHS also directs people to its pages on where to get urgent help for a mental health crisis, and lists Samaritans for someone to talk to.

If you cannot look after yourself or your baby, the Royal College advises being seen urgently by your GP, a mental health service or the local emergency department. Telling someone how you feel is the first step, and a health visitor, midwife or GP will know that these feelings are common and treatable.