Depression after childbirth – What can help?
Pregnant women usually expect the days and weeks following the birth of their child to be a happy time. But many have also heard of the “baby blues”: sadness and severe mood swings that often start a few days after giving birth. If the sadness doesn’t go away, it might be the start of depression.
Depression after childbirth is called postnatal (or postpartum) depression. It's very similar to the kind of depression that can affect people in any phase of life. Except for one major difference: Mothers often feel very guilty and worry about not being able to care properly for their baby. Many mothers feel too ashamed to speak with others about how they are feeling. They are afraid of not living up to the idea of a “good mother” and might become more and more withdrawn. Some women say that they no longer recognize themselves.
Taking care of a newborn baby is a real challenge. Some women don’t get the emotional and practical help that they need. It's not always easy to deal with all of the changes that need to be made to care full-time for a new baby. Coping with the everyday stress and getting used to your new life can be very difficult – and sometimes it may even be depressing.
But these phases usually don’t last long, and go away by themselves once things have settled down a bit. If it turns into a lasting depression, though, it can greatly affect the mother’s relationship with her child. So it's important to take deep unhappiness and mood swings after childbirth seriously, and get more support.
The first step towards doing that is to accept that there is a problem. Sometimes people who are depressed don't realize that they need help. One of the features of depression is that it can be hard to recognize that you are depressed, and that your mood swings are no longer “normal.”
Or you might feel so bad that you aren’t able to reach out for the help you need. So it might be a doctor, midwife, partner, friend or family member who realizes what is happening, and helps you get more support.
How can you tell if a new mother is becoming depressed?
After giving birth, women may feel down for a few days or even up to two weeks. But this depressive mood will usually go away and they start feeling more normal again. Before that happens, crying, mood swings and irritability are all common: Almost half of all women who have just given birth are affected. Support and understanding are usually enough to help them through.
- Feeling down (deep sadness and crying)
- Not enjoying things that you usually enjoy
- Loss of appetite
- Poor concentration
- Low self-esteem
- Thoughts of harming yourself or your baby
It's only considered to be depression if someone has been feeling this way for several days.
Up to 15 out of 100 women will get depressed in the first three months after giving birth. About half of these women (8 out of 100) will have mild or moderate depression, and around 7 out of 100 will have more severe depression.
Without treatment, postnatal depression will often be over within four to six months, although women might still have some symptoms up to a year later. Women who do not have treatment are more likely to develop chronic depression.
Many women who have postnatal depression already experienced a depressive phase during their pregnancy.
Is postnatal depression dangerous?
No, postnatal depression is usually not dangerous for the woman or her baby. It's not that unusual for a new mother to have unwanted thoughts about harming her baby. But if she is depressed she may have these types of thoughts more often. As long as she doesn’t act on these thoughts, this is not a sign of serious mental illness. But people who have very severe depression are in danger of staying depressed for a long time, or even becoming suicidal. If anyone starts having serious thoughts of suicide, they need urgent medical help.
There is also another serious condition that can occur after childbirth, known as postpartum psychosis or puerperal psychosis. This mental illness is rare; it occurs in about 1 to 2 out of 1,000 women. But the risk is higher for women who have previously had manic depression (bipolar disorder).
People who develop psychosis become delusional. They lose touch with reality and have trouble communicating and interacting with other people. Their feelings and behavior are out of character and sometimes bizarre. If you suspect that someone has psychosis, it’s important to get psychiatric help fast.
What can cause postnatal depression?
There are many theories about what causes depression after childbirth, but none have been clearly proven. For a long time it was thought that hormonal changes were the main reason, but it’s not clear whether this is true.
Motherhood is often seen as something that is natural and fulfilling, and it quite often is. But motherhood can also be difficult and challenging at times, both physically and mentally. And women often don’t get the support and help they need. So it isn’t surprising that some women react to the struggles and difficulties they are having by developing depression after a while. Some women become depressed “out of the blue” too. That can happen at any time of life, not just after giving birth.
The following women are more likely to develop postnatal depression:
- Women who have already had anxiety disorders or depression in the past.
- Women who experienced stress and stressful situations during pregnancy and after childbirth.
- Women who are in a bad relationship or who don’t live with their partner, as well as those who have experienced domestic abuse and who generally have less social support.
Can postnatal depression be prevented?
Research shows that social and psychological support can help to prevent postnatal depression from developing in the first place. Frequent visits from a midwife or a specially trained nurse can help. Treatments like interpersonal psychotherapy (described below) can play a role in keeping someone from sinking into depression too. Studies involving women who were at higher risk of developing depression showed the following:
- An average of 3 to 4 out of 100 women who had completed a support program were diagnosed with depression.
- An average of 7 out of 100 women who had not participated in a support program were diagnosed with depression.
In other words, support programs prevented depression in an average of 3 to 4 out of 100 women. But these numbers also show that support programs don’t always prevent depression. Research has suggested that it might be a good idea to only offer these programs to women who are considered to be at greater risk of depression. But it’s not clear how best to identify which women are at greater risk.
How much do support and psychological treatments help?
In mild depression, getting more emotional support and practical help in everyday life is often enough to help a woman through things. Here it's very important that the person offering support doesn’t judge or criticize her. It might help to talk with other women who have gone through the same thing – either people you know or women in a self-help group.
But it's still important to get medical or psychological help, particularly for moderate or severe depression. Researchers have found that many women feel at least somewhat better after getting help from trained psychotherapists and counselors.
Cognitive behavioral therapy (CBT) has also been proven to help. A trained CBT therapist is a psychotherapist or counselor who works with the woman to change thoughts, beliefs and behaviors that are making her life more difficult.
Interpersonal psychotherapy has been shown to help too. Here the woman has weekly sessions with a psychotherapist to try to find out what might be making it harder for her to adjust to the changes in her life, and to develop a strategy to help her in everyday life. Studies have shown that about 57 out of 100 women who didn’t have treatment still had depression after one year. For comparison: About 40 out of 100 women who had psychological treatment were still depressed after one year.
Can medication help? Can it harm the child?
Antidepressants are very important for some women. They can help relieve depression after childbirth. But doctors are generally quite hesitant to prescribe these medications for pregnant and breastfeeding women. Often, not enough is known about how these medications may affect the baby.
Women who take antidepressants while breastfeeding should talk with their doctor about what they ought to bear in mind. Small amounts of medication may be passed on to the baby in breast milk, and this could cause side effects in the baby. Although there have only been very few reports of breastfed children with problems that may have been caused by antidepressants, there have been some individual reports of children who were restless or drowsy after their mothers had taken certain kinds of antidepressants. These symptoms disappeared when they started drinking infant formula milk from a bottle.
There is a lack of good research on whether St John's wort (hypericum) is effective in the treatment of postnatal depression. Products containing St John’s wort have been shown to help in some people with milder forms of depression. But there is not much research on their use during pregnancy or when breastfeeding, and little is known about the potential side effects. Interactions with other medicines are possible too.
It is not a good idea for women who were taking antidepressants before getting pregnant to stop using them abruptly. They may be able to continue taking them at a lower dose instead, for instance. If a woman is taking antidepressants and becomes pregnant, she can talk to her doctor or midwife about the options. It is important that women tell their doctors, midwife and people close to them if they decide to stop taking medication during pregnancy and while breastfeeding. Then they can all keep an eye on how she is doing and coping in everyday life.
Hormone products containing estrogen and progestin are sometimes recommended for the treatment and prevention of postnatal depression. But this recommendation is based on the unproven assumption that postnatal depression could be caused by a hormonal imbalance. There is currently no known good reason to take hormones: Only very few studies have looked into the use of hormone products. But these suggest that taking them for prevention could even have a negative effect on the woman’s mood. It is therefore not clear whether taking hormone products for postnatal depression has any benefits, and they can have side effects too.
Are there other treatment options?
There are a number of other treatments and strategies that women who have postnatal depression try out. Sports and exercise can reduce the symptoms of depression, but it’s not clear whether this is also true for postnatal depression. Studies have shown that omega-3 fatty acids are not effective. There is too little research on things like massages, acupuncture and bright light therapy to be able to say whether they help or not. Bright light therapy involves spending a certain amount of time near a special lamp or light box with your eyes open, so that the light shines on the retina of your eyes.
How do other women and families cope with depression?
Postnatal depression can be a very lonely experience, particularly if you spend a lot of time at home alone with the baby. Many women are reluctant to tell even the people who are close to them how they are feeling. Although this may be the right approach for some women,
in many cases it stops them getting the extra support they may need to help them enjoy their life and their new baby again. Partners may also be having a difficult time and need support too.
A lot of women who have postnatal depression say it feels like their life is out of control. They are afraid that things will never get “back to normal” and wonder whether they will ever be able to enjoy anything again. Many women no longer feel like having sex, which can lead to relationship problems.
Other women report that they were gradually able to shake their depression by simply fighting to get by one day at a time. They slowly managed to regain control over their lives.
Postnatal depression doesn’t last forever. It's important to get enough support and practical help in everyday life. Although it can be hard to reach out to other people if you’re depressed and ashamed of how you’re feeling, most women find someone they know or a professional who doesn’t judge them, and instead helps them to cope with the difficult situation.
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