Depression after childbirth – What can help?

In postnatal depression, these negative feelings are much stronger than in a short bout of the baby blues. The following are signs of postnatal depression:

• Constantly feeling down (deep sadness, frequent crying)
• Not enjoying things that usually make you happy
• Anxiety
• Insomnia
• Loss of appetite
• Poor concentration
• Low self-esteem
• Spending a lot of time thinking things over
• Thoughts of harming yourself or your baby

A mother is only diagnosed with postnatal depression if her symptoms have lasted at last two weeks.

Up to 15 out of 100 women will get depressed in the first three months after giving birth. The depression will be mild for some and more severe for others.

Without treatment, postnatal depression typically lasts four to six months. Some symptoms are still around even a year later. Women who don’t have treatment are more likely to suffer a longer period of depression.

The symptoms of postnatal depression are almost exactly the same as depression in other life phases. One major difference is: Mothers often feel very guilty and worry about not being able to care properly for their baby. They might not be able to react to the child in a caring way. Many mothers feel too ashamed to speak with others about how they’re feeling. They’re afraid of not living up to the idea of a “good mother” and sometimes become increasingly withdrawn. Some women say that they no longer recognized themselves.

Sometimes the depression is so bad that the mother can’t actually seek help. When this happens, it’s good if others around her – the doctor, midwife, partner, or friends, for instance – recognize the symptoms and make sure she gets more support.

Motherhood can be difficult and challenging at times, both physically and mentally. So it isn’t surprising that some women eventually react to the struggles and difficulties they’re having by developing depression.

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 an unhappy relationship or who don’t live with a partner, as well as those who have experienced domestic abuse and who generally have less social support.

It isn’t clear what role hormonal changes after childbirth play.

Postnatal depression isn’t normally dangerous. But it is very distressing for the mother and it can have a negative impact on her relationship to her child. Especially if she has trouble responding to the child’s needs.

Obsessive thoughts aren’t unusual either. Some mothers think about hurting their child though most of them would never actually do so. But just having the thought can frighten them and stop them from doing things like bathing the baby on their own. It can be a relief to know that people don’t usually act on these thoughts.

When the depression is severe, there’s a risk it could last longer and the mother might even attempt to take her own life (suicide). Although this is rare (especially if she’s still breastfeeding), anyone who’s seriously thinking of killing themselves needs urgent medical and psychotherapeutic help.

Another serious illness that can occur after childbirth is postnatal (or postpartum) psychosis. This mental health illness is rare; it occurs in about 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 hallucinations. Some of them start to think they’re being followed. Others behave inappropriately, say strange things, or have extreme mood swings. If you suspect that someone has psychosis, it’s important to get psychiatric help fast.

Research shows that professional 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. Psychotherapeutic support can help prevent depression too.

Research has been done to explore whether this type of support can help women who have a higher risk of depression – due to earlier depression or a difficult pregnancy and miscarriage, for example. In some of this research, the women began receiving support while they were still pregnant. The researchers found the following:

• About 3 out of 100 women who completed a support program were diagnosed with depression.
• About 7 out of 100 women who did not attend a support program were diagnosed with depression.

In other words, the programs succeeded in preventing depression in some women but not in all women.

In Germany, there are “early prevention services” to support pregnant women and parents who are under a lot of strain. This includes mothers who get hardly any support from others, and couples who are very unsure about how to look after the child. The early prevention services (Frühe Hilfen) are free of charge and include things like support from a family midwife or special meet-ups for parents. This short video (in German) explains the services in a bit more detail.

When a mother has the baby blues or mild depression, getting more emotional support and practical help in everyday life is often enough to help her through things. It is very important that the people providing the support encourage her and show understanding for what she’s going through. It might also help to talk with other women who have gone through the same thing – either people you know or women in a support group.

But it's still important to get medical or psychological support, particularly for moderate or severe depression. It can help with things like improving the mother’s self-esteem and her relationship with her child. Researchers have found that many women feel at least somewhat better after getting help from trained psychotherapists or counselors.

Some of the most effective approaches are:

• Cognitive behavioral therapy (CBT): This involves working with a psychotherapist on thoughts, beliefs, and behavior patterns that are making life difficult for you.
• Interpersonal psychotherapy: This focuses on the mother’s current situation and relationships. The aim is to develop a personal strategy to help her cope with stress factors in everyday life.
• Parent-infant psychotherapy: The goal here is to improve the relationship between the parents and the child, and to foster the child’s development. Research indicates that this also helps ease the symptoms of depression. But more research is needed on the long-term impact of this form of therapy.

Psychological and practical support from midwives and nurses can have a positive effect as well. Other mothers can be an important source of support too.

Antidepressants can help relieve depression after childbirth. But they’re usually only prescribed if the symptoms are so severe that the support provided by family and friends or psychotherapy is not enough. The medication given might depend on what the main symptoms are. So whether the mother is more exhausted and lethargic, or whether restlessness and trouble sleeping are more the problem.

Products containing St John’s wort can help 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. For instance, taking St John’s wort can stop the contraceptive pill or other hormonal contraceptives from working properly.

Women who take antidepressants while pregnant or breastfeeding should talk with their doctor about what they ought to bear in mind. Most antidepressants are not harmful to the child but the doctor will prescribe as small a dose as possible just to be on the safe side. Small amounts of the drug may be passed on in breast milk, and this could cause side effects in the baby. 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. Another possibility is to reduce the dosage or switch to another antidepressant.

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, especially endurance sports like cycling, Nordic walking, or swimming. Even just going for regular walks can have a positive effect. Research indicates that yoga can have an effect on postnatal depression too.

It is not clear whether Omega-3 fatty acids are effective. A number of research studies have looked at them but the findings were not conclusive.

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.

People with depression often have trouble asking for help. Their families tend to feel helpless too and unsure about who to turn to. But most women find someone they know or a professional who is sympathetic and helps them to cope with the difficult situation.

Women with postnatal depression might contact their family doctor first, or perhaps a gynecologist or psychotherapist. They can get a first appointment for an initial psychotherapeutic consultation without asking a doctor for a referral or applying to their health insurer. That way, they can talk to the psychotherapist about their problems first and find out whether psychotherapy would help.

Counseling centers for pregnant women and families can provide support after childbirth too. The German Federal Centre for Health Education (BZgA) helps people find counseling centers near them. The elternsein.info website offers information about life with a child – including negative feelings after childbirth. The “Schatten & Licht e. V.” organization has a website full of information on mental health problems connected to childbirth and the help that’s available.

Lots of women who had postnatal depression before worry that they might get it again when they have another child. It is important that they take time during the pregnancy to make sure they’re well prepared for the first few weeks with the new baby. With support from healthcare professionals and the people around them, it’s possible to keep postnatal depression from coming back.