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Post Natal Depression

A Self Help Guide

“I spend a lot of time in tears. I just can’t get organised, the list of jobs I need to do is so long. I feel a complete failure as a mother.”

“I can’t seem to make a decision. My mind is such a muddle of confused thoughts, and I feel like I’m snapping at everyone all the time. I should feel happy, but I just feel miserable.”

“The baby cries and cries and I just can’t comfort her. I feel such a failure, but I get angry too. Then I feel unbearably guilty. Its not her fault, it's mine.”

“I feel like I’ve totally lost my confidence. I look awful and I feel awful too.”

How can this Guide help me?

Post-natal depression is a distressing condition experienced by at least one in ten women after they have a baby. The examples above are typical of the kinds of thoughts and feelings that women with postnatal depression experience.

This booklet is for women with post-natal depression and their friends and family.

This booklet aims to:

  • Help you identify whether you are suffering from post natal depression
  • Explain what can cause post natal depression
  • Help you consider the best way for you to help yourself
  • And suggest some other places to get help or support

What if I feel too depressed even to read?

If you are depressed you will probably find it hard to concentrate, even to read this booklet. Perhaps it looks too long and difficult? Please don’t worry. There is a lot of information here, so take it a bit at a time. If you find any parts hard to take in, perhaps you could discuss these with your Health Visitor or GP, or come back to them once you are feeling a bit better. If a counselor or therapist has given you the booklet, it might be helpful to go through the text with their help.

What is Post-Natal Depression?

Post-natal depression (PND for short) is a type of depression that happens after having a baby. Depression can sometimes begin during pregnancy, but it would only be called post-natal depression if it continues after you have had your baby.

Post natal depression is very common and we know that between ten and fifteen women in every hundred who give birth will experience it. The true figure may be even higher as many women don’t seek help or tell others about their feelings.

How is post-natal depression different from “ordinary” depression?

The symptoms of PND are the same as any depression. They include feeling low in mood and losing interest in things that are usually ok. The only difference is that these feelings normally start within the first three months after having a baby. It is also possible to have a post-natal depression that starts later, but if the symptoms begin more than a year after a woman has given birth then it is unlikely to be called post-natal depression.

As PND is very similar to “ordinary” depression, you may find our leaflets “Depression a self help guide” and “Depression, an information leaflet” useful. Please ask your therapist or GP about these.

The good news is that like other forms of depression, post-natal depression responds well to treatment, and most women make a full recovery.

Are there any other post-natal problems that women may experience?

There are two other distressing emotional conditions that women sometimes experience after having a baby.

Baby Blues

The first is extremely common, and is called the “baby blues”. This is a mild form of depression and occurs in up to eight out of ten of mothers during the first few days after they have had their babies. When suffering from the “baby blues” mothers usually feel very emotional and can burst in to tears for no particular reason. New mothers also often feel anxious, tense and exhausted and may have difficulty in sleeping.

Doctors think that the sudden changes in hormone levels around the time of birth bring on the baby blues, but there may also be other causes, such as the trauma of the birth itself and the upheaval a new baby can bring. It’s a time when you need lots of rest to get your strength back but you are least likely to get it!

The blues usually only last for a day or two and then fade away as quickly as they came. They are not a cause for concern unless the feelings continue or get worse, in which case they may be the start of post-natal depression.

Puerperal Psychosis

The second problem that women sometimes experience after giving birth is much less common. It is called puerperal or post-partum psychosis. This only happens to about one new mother in every thousand, and is more severe than post-natal depression. The problem usually starts very suddenly during the first two weeks after birth, with severely disturbed mood and behaviour. Women with post-partum psychosis can become extremely agitated and confused and often have unusual and upsetting beliefs about themselves and/or their baby.

This booklet is not intended for women with this sort of problem. They would need specialist help from a psychiatrist and should ask for help from their doctor at once. The usual treatment would include medication and a short stay in a mother and baby unit. It is important to remember that although post-partum psychosis can be frightening and worrying for the new mother and her family, this treatment is very effective endmost people recover completely.

What are the symptoms of post natal depression?

Women describe a number of symptoms, most of which are written below. These symptoms can feel quite overwhelming at a time when anew baby needs so much care and attention.

These are some of the signs or symptoms that you may have if you are suffering from post natal depression.

Emotions or Feelings

  • Feeling sad, upset, despairing
  • Crying a lot or feeling unable to cry
  • Feeling worthless
  • Mood going up and down
  • Feeling guilty
  • Loss of interest
  • Loss of pleasure/enjoyment
  • Feeling anxious or panicky and worrying
  • Feeling irritable and angry
  • Not feeling the way you want to about your baby

Physical or Bodily Signs

  • Lack of energy and feeling exhausted
  • Sleep disturbance
  • Slowed down, or
  • Speeded up, agitated and unable to relax
  • Lack of interest in sex
  • Appetite change – eating too much, or not enough

Thoughts – when people are depressed, they become “experts” in thinking in a very negative, gloomy way.

  • Criticising yourself – “I’m useless as a mother”, “I look a mess”, “I cant understand this booklet, I must be stupid!”
  • Worrying – “Baby isn’t feeding well enough”
  • Jumping to conclusions - “It’s my fault”
  • Expecting the worst – “Everything is going to go wrong - things are never going to get any better”
  • Hopeless thoughts – “Things are hopeless. Sometimes I think everyone would be better off without me”
  • Thoughts about others – “Everyone else is coping. No-one cares about me”
  • And the world – “What a terrible place to bring a child into…”

Thinking – is also affected by depression in other ways.

• Poor concentration

• Inability to make decisions

• Confused, cluttered thoughts

Behaviour

  • Avoiding people and not going out
  • Not doing things you used to enjoy
  • Not doing everyday tasks – or trying to do too much
  • Putting off making decisions
  • More arguments, shouting, loss of control

If you have ticked a number of boxes, and have felt like this for most of the time for the past two weeks or longer, it is likely that you are suffering from some form of depression. If this has occurred within a few weeks or months of having a baby, then it is quite likely that you have some form of post-natal depression.

Should I ask for help?

If you have post natal depression it is important that you recognise

this and seek help.

People often don’t recognise post natal depression. It happens at a time of great change, and new mothers often don’t know what is normal, or what to expect. The problem can creep on slowly, and often mothers think they are just not coping, rather than recognising that they are suffering from post natal depression.

Also, many women with post natal depression feel ashamed or embarrassed, and hide their symptoms from others.

The earlier you recognise that you have post natal depression the better, as there are very effective treatments and also steps you can take to help yourself.

Remember, post-natal depression is very common, and probably affect sat least one in five women. So please do talk to your family, your Health Visitor or Doctor and ask for help.

Who is at risk of developing post natal depression?

Anyone who has a baby can develop post natal depression. However, there are some factors that could mean you are at greater risk. These include:

  • If you have had depression before
  • If giving birth was particularly difficult and traumatic for you
  • If you are having problems with your relationship
  • If you are experiencing other difficult events in your life
  • If you are socially isolated, without family and friends who can help
  • If your own mother is not there to support you.

However, this does not mean that everyone who experiences these difficulties will develop post natal depression.

What causes post natal depression?

Having a baby is a time of great change. New mothers experience biological, physical, emotional and social changes. It is likely that postnatal depression is caused by a mixture of these things. Other stressful life events happening around about the same time may also contribute.

Biological Changes

Childbirth brings with it hormonal changes in your body. Post-natal depression may be linked to these changes. But while this may be part of the picture, evidence suggests that hormones are not the sole cause. Your individual and social circumstances are just as important.

However, antidepressants or other medication may be helpful. Ask your Doctor to discuss this with you.

Physical Changes

Childbirth itself can be exhausting, and sometimes results in physical problems eg post operative pain following caesarian delivery. Recovering from this is not always easy. Having a demanding infant to look after makes it difficult to rest and you may find that you are not getting enough sleep. If you have older children, they may react to the new baby by demanding more of your attention. This can make you even more tired.

Perhaps your appetite is poor and you aren’t eating well. When this happens it is easy to become physically run down.

Some women also feel less confident and less attractive following childbirth because their body shape changes and they don’t have time to look after themselves. At the same time, many women who suffer from post-natal depression take particular care over their own and their baby’s appearance to hide the sense of failure they may feel because of their depression. Keeping up appearances and smiling when you don’t feel like it can also be physically exhausting!

Emotional Changes

Women often don’t experience the feelings that they had expected when they have a baby. When they first hold their baby, a large number of women don’t feel an overwhelming rush of “mother-love”. They just feel tired and a bit detached. This is perfectly normal. Some mothers do love their baby at first sight, but others grow to love him or her more gradually.

The main thing is not to worry or be too disappointed if childbirth doesn’t live up to your expectations. And it is true that many women say they feel more emotional following childbirth, so when things do go wrong, they may feel much worse about it than they would normally.

Social Changes

Having a baby can cause great upheaval. The demands of a new infant can make it difficult to maintain an active social life. Having a new baby can also put a strain on the parents’ own relationship as it is often difficult to spend time together as a couple.

Because many people no longer live close to lots of other family members, a lot of new parents can be quite isolated, and new mothers may not have many people to help them. In particular those who don’t have their own mother’s support may find this time demanding. Even those who do have family and friends around may find it difficult to ask for practical help.

Newspapers, magazines and television programmes tell us that having a baby is a wonderful experience, but don’t always mention the more difficult parts. Because of what they hear in the media, and what other people may say about motherhood, women sometimes feel that it should be a “perfect” time. They think that everyone else manages to give birth naturally and easily and immediately becomes the perfect mother. This can make it very hard to ask for help.

But these myths about motherhood are very far from the truth for most people. Giving birth can be very stressful and becoming a mother is anew role that we have to learn to perform, just like every other new role in life.

Women nowadays may have even more demands made on them than mothers did in the past. They may be used to going out to work and feel isolated at home, missing mixing with colleagues. But if they do decide to return to work, they may find that juggling a job and a new baby can be very stressful.

Stressful Life Events

We also know that people who have experienced other stressful life events in the past or present may be more likely to experience post natal depression after they have a baby. For example, previous miscarriage, loss of own mother, financial problems, housing difficulties. Finally, it’s important to remember that one of the most common causes of stress is change, and nothing changes your life quite like a new baby.

What Can Help?

Remember that there is help available – and there are also steps that you can take to help yourself.

First steps

• Accept that there is something wrong

• Talk to your partner and/or a friend or member of your family about how you are feeling

• Remember that you WILL get better

• Talk to your health visitor or doctor

…And next

As we have seen, there can be many causes of post-natal depression, and so a number of different treatments may help.

Can Medication Help?

Anti-depressants can be really helpful, although you might not be able to take medication while you are breastfeeding. Talk to your doctor about this. They are particularly helpful if you are experiencing a lot of the physical symptoms of depression, such as poor appetite, sleeplessness, lack of energy.

If your doctor does prescribe anti depressants for you, remember that they take at least two weeks to begin to work. It is believed that this kind of medication is not normally addictive, although as with any drug it is important not to stop suddenly. It is important to take the full course, usually at least six months. Your doctor will talk all these issues through with you if it seems as though medication may be helpful.

Will I experience side effects?

Some people do experience side effects such as tiredness and a dry mouth, but these symptoms should stop within a few weeks. In the meantime, sucking a sweet and drinking lots of water can help. And although these side effects may feel unpleasant, the benefits can out weight this. In particular, taking anti-depressants can help other treatments, such as a talking therapy, to work better. Again, your doctor will discuss this with you.

What about therapy?

Research shows that counselling is a very effective treatment for post-natal depression. Your Health Visitor is often the best person to talk to and she may well have training in counselling skills. Or your doctor may refer you to a counsellor within your local surgery or a psychological therapist or community psychiatric nurse. Your counsellor may explore with you any issues that you feel are relevant from the past, as well as how you are feeling and thinking at the moment.

How can I help myself?

There are a number of practical steps that you can take that may make you feel better.

  • Talking about your feelings is important. It may seem difficult to talk to your partner, but if you keep your feelings to yourself all the time, he may feel shut out. This could be particularly true if you don’t feel like having sex, which is often the case when people are depressed.
  • Try not to be alone all day, every day. Make an effort to see your friends or to meet other mothers. Your health visitor will be able to tell you about local groups where you can meet other women. Sometimes there are support groups which can be very helpful. There are also voluntary organisations whose members can offer practical or emotional support (see addresses at the end of this booklet).
  • Take up every offer of practical help. Don’t be ashamed to ask for help or feel guilty about accepting it. Women who have severe depression may be eligible for some help with childcare or housework.
  • Don’t try to be the perfect housewife. Whether or not the house is immaculate isn’t important. Keep your workload as low as possible.
  • Get as much rest as you can, because tiredness seems to make depression worse.
  • Make sure you are eating a healthy diet.
  • Try to find time for yourself. This may sound totally unrealistic, but along bath, a brisk walk or even just reading a magazine for half an hour can help you to unwind.
  • Exercise is particularly helpful.

What else can I do?

It may be hard to make these changes, because of the way depression affects our thinking, our feelings and, in turn, the way we behave. The following techniques may also help to overcome depressive thoughts, behaviour and feelings.

1. Making a daily plan

When people are depressed they often don’t feel like doing anything. They find it hard to decide what to do each day and can end up doing very little.

If this is a problem for you, you can begin to tackle this by making a list of things you want to do, then plan out an action list. Start off with the easiest task at first and don’t aim too high. Work through your action list and tick off what you have done. At the end of the day, you will be able to look back and see what you have achieved. Physical exercise and activity can really help to lift your mood. Try and build a little into your plan each day. Mixing with friends, family and neighbours can also help. Organisations such as Family Link (see section on Where can I get further help?) can offer support and help you to begin mixing again.

Remember not to aim too high. Things that seemed easy for you before may feel much harder now. Start from where you are now, and buildup to where you were when you were well.

2. Achievements and pleasure

When people are depressed they often forget what they’ve achieved and what they enjoy. Most people have more things going for them than they are usually aware of.

When you have written down all events of the day on your action plan, put a P next to those which have given you pleasure and an A next to those activities where you felt you achieved something and did well.

Try not to be too modest. People who are depressed tend not to take credit for their achievements. Try not to compare yourself all the time to your old self, just praise yourself for whatever you are able to manage. When you are depressed, doing anything can be a challenge and should be recognized and rewarded, so try and build some pleasant events into your day each day. Treat yourself - it will help you.

3. The ABC of changing feelings

It is likely that someone suffering from post-natal depression will have gloomy thoughts that can cause low mood. This is true for someone with any kind of depression.

Try to think about a recent event that upset and depressed you. You should be able to sort out three parts of it:

A. The event.

B. Your thoughts about it.

C. Your feelings about it.

Most people are normally only aware of A and C. Let’s look at an example.

Suppose your baby won’t stop crying when you have done everything you can think of that might help.

A. The event – baby won’t stop crying.

B. Your thoughts – I can’t bear this. I want to shake her. I’m a useless mother. I don’t deserve to have her”

C. Your feelings – depressed, guilty.

How depressing! No wonder you feel bad! It is important to become aware of these three stages A, B and C. This is because we can change what we think about an event and therefore we can change how we feel about it.

4. Balancing

“Balancing” is a useful technique to try. When you have a negative, critical thought, balance it out by making a more positive statement to yourself. For example:

The thought: “I’m no good as a mother”, could be balanced with: “my health visitor says I am doing really well – and the baby is thriving”

Obviously, this is much easier said than done. When you are feeling negative it is often hard to shift those negative thoughts, but with practice it does get easier.

5. The double column technique

Another technique that may help, is to write down your negative automatic thoughts in one column – and, opposite each one, write down a more balanced positive thought.

Like this:

Negative automatic thoughts:

Balancing thoughts:

I’m not coping with everything– my home is a mess.

I am doing fine. It is alright for the house to be a bit untidier than usual.

You can take this a step further and keep a diary of events, feelings and thoughts. It may look a bit like the chart below. Use the approaches described to gain more balanced thoughts. Look out for errors in thinking similar to those mentioned on.

Event

Feeling or Emotion

Thoughts in Your Mind

Other More Balanced Thoughts

Example:

A mum at the clinic ignored me

Low and depressed

She doesn’t like me, no one does.

She’s probably got something on her mind- I am jumping to a conclusion that she doesn’t like me.

6. Try and remember details

Research tells us that someone who is depressed doesn’t remember the details about events but tends to think in general statements, such as “I’ve never been any good at anything”. Try and train yourself to remember details so that you can recall good times and experiences. A daily diary can help you to this. Make lists of achievements and good aspects of yourself such as “I’m always on time”, “I helped my friend on Tuesday”, “My partner complimented me on my work last week”.

In Summary

Using a daily plan, pleasure and achievement notes and keeping a diary of automatic thoughts and more balanced thoughts can help you to fight depression and the gloomy thoughts that go with it.

7. Solving difficult problems

Sometimes we feel overwhelmed by the very complicated and difficult things we have to do. One approach that helps is to write down each of the steps that you need to take in order to complete the job - then tackle one step at a time.

Even solving small problems can seem more difficult when you are depressed. If you have a particularly difficult problem, try to look back to times when you may have solved similar problems successfully and use the same approach. Or ask a friend what they would do in a similar situation. Write down all your possible options even ones that seem silly. Be as creative as possible. The more possible solutions you can generate the more likely you are to find one that works. After considering all the pros and cons choose what you feel is the best solution.

8. Long term beliefs

Sometimes people have long-held views about themselves that are very self-critical - for example, “I’m not a very clever person” or “I’m not a very lovable person”. These beliefs are often a product of our past experience and may not be true at all today. Try to challenge this self criticism, stop knocking yourself down and look for evidence that disproves these beliefs.

9. Where can I get further help?

We hope you will use the exercises and advice in this booklet. They should help you to begin to overcome your post-natal depression and take control over your thoughts and your life once more.

However, if you feel you need more help, go back to your family doctor or health visitor. As we have already mentioned, there are other treatments that could help you.

If you feel so depressed that you have thought about harming yourself for your baby you must visit your doctor as soon as possible. Remember that post natal depression responds very well to treatment and most people recover quickly.

Are there any other sources of help or support?

The following organisations and help lines may also be useful:

Association for Post- Natal Illness - for women who are experiencing depression following the birth of their baby:

Association for Post- Natal Illness

25 Jerdan Place

Fulham

London, SE6 1BE.

Tel: 0207-3860868

Mind - The mental health charity

15 - 19 Broadway,

London,

E15 4BQ

Tel: 0208-5192122

email: contact@mind.org.uk

Relate – help with marital or relationship problems:

Relate,

Herbert Grey College,

Little Church Street,

Rugby,

Warwickshire

CV21 5AP

Tel: 0845-4561310

www.relate.org.uk

Samaritans:

Linkline (local rate). Tel: 0345-909090

Confidential support for anyone in a crisis.

Email: jo@samaritans.org

Family Link:

A befriending Scheme offering support and a practical approach to families with young children in the north east of England.

Tel: 0191 232 3741

Local Organisations - Your Health Visitor or Local GP surgery may be able to give you contact numbers for local organizations able to help.

In addition

Baby massage may be available – ask your Health Visitor. This can be relaxing and helpful for both mother and baby.

The following are some books which you may like to buy or borrow from your local library. Relatives and friends who would like to help may also find these useful.

Cara Aike (2000). Surviving Post Natal Depression. Jessica Kingsley Publishers.

David Burns (1999). Feeling Good, The New Mood Therapy. Penguin. (2nd Edition)

Paul Gilbert (1997) Overcomming Depression. A self help guide using cognitive behavioural techniques. London, Robinson.

Kathy Nairne and Gerrilyn Smith (1994). Dealing with Depression. The Women’s Press.

Dorothy Rowe (1993). Depression: The Way Out of Your Prison. Routledge.

Christine Padesky and Dennis Greenberger. (1995) Mind over mood. London: Guildford Press.

This document was provided by Newcastle, North Tyneside and Northumberland Mental Health NHS Trust and written by Lorna Cameron and Lesley Maunder. www.nnt.nhs.uk/mh/