Frequently asked questions

1. What is Postnatal Depression (and anxiety) (PND)?

Postnatal Depression (PND) is an emotional, or mood disorder that occurs after the birth of a baby. Three types of PND (and Anxiety) are found:

The “Baby Blues”: About 75% of all new mothers experience postpartum blues. Symptoms occur on about 3-4th days after the birth, and include tearfulness, mood changes, irritability, agitation, and sleep disturbance. This is considered to be a biological response to changes in hormonal levels, associated with childbirth. It does not last long, and if the people around you are supportive and re-assuring, you should feel better within a week.

Postnatal/Postpartum Psychosis: Fortunately very few women (1 or 2 per 1000) develop this very serious illness. It develops very suddenly, soon after the birth, and the symptoms include hallucinations, delusions, severe insomnia, extreme anxiety, suicidal and homicidal thinking, and generally a loss of contact with reality. Mothers who develop postnatal psychosis need immediate and urgent medical attention. This will involve being hospitalized for the protection of the mother and those around her. With correct treatment, the mother will recover.

Postnatal Depression: Between 15 and 30 % of all mothers in all circumstances will have PND (Postnatal Depression). It can develop immediately after the birth (or she may have been depressed during pregnancy), or at any time in the first year after childbirth. PND is not “just hormonal”. Symptoms vary, but include unexplained feelings of sadness, feeling trapped and frustrated, feeling overwhelmed, incompetent, and helpless, feeling out of control, feeling disconnected from the baby, feeling numb, feeling unbearably anxious, panicky and scared, major changes in eating and sleeping patterns, feelings of loss of joy and motivation, and the experience of intrusive thoughts, and suicidal and homicidal ideas. PND is insidious, and may creep up slowly. It is very treatable with appropriate medication, support (including support groups), counselling and psychotherapy.

Postnatal Panic and Anxiety Disorders: Some women do not feel depressed, but extremely anxious. They may have panic attacks, with breathlessness, speeded up heart rates, and feelings of dizziness. The treatment is similar to that of Postnatal Depression (above).

Postnatal Obsessive-Compulsive symptoms: These are not uncommon. There may be repetitive intrusive thoughts of e.g., hurting the baby, that something bad will happen if you do not perform tasks in a set order, avoidance of certain people and situations because of irrational fears, scary and uncharacteristic. Again, treatment is effective, and will be likely to include medication, counselling and appropriate support.

2. What about medication?

Most women who are suffering from postnatal mental illness are unwilling to take medication, for fear of becoming dependant upon it, or of having to give up breastfeeding. Medication is extremely helpful in treating the symptoms of postnatal depression, and anti-depressants are not considered to be addictive. It is generally advisable to consult a psychiatrist when seeking medical treatment, in order to ensure that you are giving the correct drug in the correct dosage. It is important to take any medication exactly as prescribed, to refer to your physician if there are adverse side effects, or if it is not making you feel better. Remember, though, that it usually takes several weeks before the medication “kicks in”. It is also very important not to self-medicate, nor to give up your medication without medical supervision. Your prescribing doctor will discuss the desirability of continuing with breast-feeding, as well as advise you of the best course of action for you.

3. Will I get PND a second time?

Unfortunately, there are no guarantees that you will not. Research suggests a 50:50 chance of a subsequent episode of Postnatal Depression. That having been said, our experience is that if your first PND has been well managed, the chances are that a later episode will be identified earlier, and be less severe and of shorter duration than the previous depression. You will also, hopefully, have gained a better understanding of your own vulnerabilities, and will have made provision for good social, medical and instrumental support for yourself.

4. Will my baby be affected by PND?

Research shows that if the mother, as primary caretaker of the baby, is depressed and emotionally unavailable for the infant, over a prolonged period, the baby will show adverse effects in terms of its development. It is, therefore, of critical importance that the mother receives effective and appropriate help as soon as possible.

5. I would like to know whether men also suffer from PND, as my husband seems to be very edgy and irritable, even angry, particularly with my elder daughter and myself.

Yes, men can get depressed after a baby is born. It is a very big change in their lives, as well as a woman's, and they often feel overwhelmed and very anxious. Men often show their unhappiness by apparently being angry and irritable, rather than admitting to being sad and worried. Men often prefer to describe themselves as feeling “stressed” rather than “depressed” or “anxious”. (Because the word “depression” carries a stigma, in the opinion of some people, many women also prefer the “stress” label. If a man is suffering from difficulties adjusting to the birth of a baby, it is very important that he receives help. The first step is to seek out a sympathetic health professional, who will be able to assess where the difficulties lie, and whether he needs medication, talk therapy, or both.

6. I just went through the checklist and the score I got is an 87. I know this is bad, but I think it may get worse because I haven't even had my baby yet; I am due in a week. Is there anything I can do to keep from feeling the way I do? Is this serious enough to talk to my doctor about? Do you have any advice for me? Any information you can give me would be greatly appreciated.

I am so glad that you wrote. Yes, tell your doctor about it without delay, and also your loved ones. It is important that they are understanding and supportive at this time. It may well be necessary for you to be given medication immediately after the baby is born if you continue to feel so down and out of control. Also, make enquiries as to whether there are any support groups near you. These can be very helpful in making you feel less alone. I am assuming that these feelings have been present for some time - two weeks at the very least. Try not to blame yourself or feel guilty. This is not your fault.

7. This is a cry for help... I am 13 weeks pregnant and my life is getting out of control. My partner and I were looking forward to this pregnancy and were very happy when the test was positive, and we are both happy to expect this baby, so that is not a problem. I read an article in a magazine about "highs and lows" during pregnancy - and I have to say, I am only getting lower and lower! I haven't been doing much else but cry for last couple of weeks, and have not been able to cope with normal daily task nor deal with, for other people, normal problems. I just burst out crying instead, feeling and being hopeless. And when I do not cry, I am very irritable with other people, especially my nearest ones. I regret it after I've done it, and feel twice as bad, which only results in more and more crying. I feel hopeless, and my partner, though he's been very supportive, has had enough of this nonsense. I am experiencing a major crisis and want to get out of this depression, before it's too late! This is supposed to be a happy time, and I just cannot enjoy it fully. Also, I am getting worried that this depression during pregnancy could become a real PND after the birth, which I do not want.

Depression during pregnancy (ante-natal or pre-natal depression) is very common. As many as 1 in 10 pregnant women are depressed at this time, even if it a much-wanted baby. For a long time this was not recognised, but we now know that this is often a predictor of Postnatal Depression. Please make every effort to find a counselor who will take you seriously. Your gynaecologist or midwife needs to know how you are feeling, and should be ready to assist you in finding appropriate help. While doctors, generally, are very cautious about medication during pregnancy and breastfeeding, they will explain to you the risks and benefits. It might be very helpful for you and your partner to consult a couple therapist together, so that you can resolve your difficulties now, before your baby is born. Once you have a new baby is your home, you will probably be so tired and busy that you and your baby’s father will have little time for each other in the early months. You have been very brave in recognizing that you need help, and you deserve to have the best available.

8. I am seven months pregnant with my first child. It's my first marriage but my husband's second and I have two stepchildren, 10 and 12 years old. Since my pregnancy my stepchildren have been very demanding. Is this a sign of things to come and will they resent the baby? I feel as though my husband is not very interested in the pregnancy and when I went for my first scan, he said he could not come because he had to collect his daughter. I feel as though his children come first and I am competing with them all the time. I've been getting very depressed and I'm worried about how it will be when the baby arrives. Am I going to get postnatal depression?

You have raised some very important issues. I am so glad that you wrote, because now is the time to deal with the matters that are troubling you. Once the baby is born, you will be so busy (and tired) that you will not have the time or energy. Firstly, it sounds as though you are having a hard time, and that you are feeling lonely, and unsupported. It would be helpful to you, I believe, to talk to a counselor or trusted friend. You do not say whether your stepchildren live with you all the time, nor how long you and your husband have been together. Being a stepparent, especially a stepmother, is difficult at the best of times. Often, no matter how much they like you, stepchildren unconsciously, wish that things could go back to the way they were before, and that the stepparent would disappear. If there has been a divorce, they will feel divided in their loyalties. If their mother has died, you will have to live with their memories of her. A stepmother often has the task of managing the nitty-gritty of day-to-day living, taking the major parenting role with the children, which is often difficult for her and them. Now that their father is about to have another child, all kinds of feelings, again often unconscious, are likely to surface, like “Will Dad love the new baby more than us?” Even in “normal” families, children compete for their parents’ love and attention. Children tend to “behave” their feelings, rather than talk about them, so it is to be expected that they will be feeling insecure, and that they will, consequently, be demanding and often difficult to manage.

Your most important relationship at this time and in the future, is with your husband. He, too, may be having some anxious feelings about having a third child, and “dividing” his love and his time still further. I can understand that you feel hurt that he does not always have enough time for you, and that you feel rejected. I would urge you to talk to him about how you are feeling, but be careful how you put it. Try not to blame him. Talk to him about how it feels to be you, without laying guilt on him. He may well be trying to “do it all”, and to be fair to everyone.

The best protection against depression at the time of childbirth is a good relationship between the parents of the new baby. You might need to go together, to talk about your differences and difficulties with a counselor, a church minister or at least an objective third person.

Depression is very common during pregnancy, and is certainly a risk factor for postnatal depression. Talk to your gynaecologist or health professional about how you are feeling. Make sure that he/she takes you seriously.

Also, it is important to provide yourself, in advance, with lots of emotional and practical support for the time after the baby is born. Stay close to people who make you feel safe, and learn how to ask for what you need – without expecting others to mind-read!

9. I have been reading over your website regarding post-partum depression and have taken the "checklist" - Although I have a fairly low score, I really feel that I need to seek further help. I would rather not go through my general practitioner. What type of psychologist, psychiatrist would I look into discussing these feelings with? Thank you.

It is important to trust your instincts. Your GP may not be the right person to help you with anything that is not strictly medical. I would suggest that you make enquiries about a local psychologist, social worker or counselor who has a special interest in women's issues. You do not say where you live, but in most areas there is a listing of registered psychologists, or counselors.

I have no idea of what concerns you, so I have to guess: Many women experience a feeling of "spiritual emptiness". Would a skilled pastoral counselor be suitable? Are you a member of a religious congregation? If so, your priest, etc. might have ideas.

The important thing is to persist. Even when you do find someone who might be possible, remember that you are the "consumer", and if the person is not meeting your needs, try someone else. If you are a reader, there are many wonderful books that might be helpful. Have a look in your local library.

10. Two months ago, I had an emergency Caesar. My baby was due next week Monday. I understand about PND, but the tragedy is that he lived for 5 days. I have had to bury a child and can't cope with life at the moment. I'm told it's normal to grieve so long, but some say that I have to pull myself together and remember that I have two beautiful girls, ages 12 and 10 years. This baby was planned. Eventually we had our boy! Now God took him away and I'm battling to cope. Life is hell! I won't take anti-depressants at the moment, as I would like to try for another baby. Not to replace the baby we lost, but because we wanted another child.

How tragic for you to have lost your baby after only 5 days. And now is the anniversary of his due date. Of course, you need to grieve for this short little life. For people to tell you to pull yourself together is unfair and insensitive. I urge you to give yourself time to say goodbye, and to celebrate the brief moments that you had together. Your husband and daughters will also be sad. I guess what I am saying to you, is allow yourself to feel what you feel, to shed your tears, to rage against the unfairness of life, and not to try to numb the pain. Anti-depressants may well not be the answer at this time, though you might be having difficulty in sleeping, etc. Homeopathic or natural remedies can be helpful as an alternative.

I would urge you not to rush into another pregnancy. Allow the wounds some time to heal - give yourself some space, and then you will have space for another baby. Of course, I understand that you cannot replace that particular child. You need to say goodbye to him over time. Perhaps you have a good priest or confidant who can "hold" you at this time. If not, I would suggest a bereavement counselor.

I hope that this may be helpful.

11. I had a really bad delivery. They say I had post-traumatic stress syndrome. I was on anti-depressants, and I have been doing a lot better. Most of my issues are with the guilt I feel because I sometimes wish I didn't have a child. I do love him and have NEVER thought of hurting him or have I ever done anything. I have a huge family support group but sometimes you need to talk to other people who are going through the same thing, and who feel the same way. The guilt is killing me. I think so negatively about my child, which just adds to the guilt. He is a beautiful, healthy child, which makes it even harder. I thought my feelings would change by now and they did for a while, now I'm back at that frustrated part again and scared that I will never feel the way I think I should about my baby. Any suggestions?

It sounds as though you have had a really terrible time. Having a baby, even under the best circumstances, is a shock for most of us - nothing can really prepare us for what it is really like. And if, as you say, it was seriously traumatic, it will take time, and probably more than just medication for you to come to terms with your new life as a mother. There are various steps that you might take that could help you.

You are correct, to be with other women who understand how you are feeling, and can make you feel accepted, will be very helpful. It may be that there is a support group near you and I suggest that you make every effort to find one. Or contact me again, giving your physical address.

Secondly, I would recommend that you meet with a trained counselor, or psychologist, or skilled, compassionate, older woman, who can de-brief you about your birth experience. Not your family, which is too close to you.

Thirdly, I believe you, when you say that you love your baby, and wish him no harm. I am sure that you are a good mother, but it sounds as though you don't believe that this is true. So many myths and lies are told about being a mother. (I can recommend some good books that de-bunk some of the myths.)

The fact is that I believe that there are times when, if the truth were told, most of us have times of wishing we had never turned our lives upside down in this way. That does not mean you are a bad person - only that you are brave and honest. Your own child, whom you love, can and will be both the best and the worst, at times. You will feel the greatest joy and the greatest anxiety; happiness and anger. So many contradictions are involved. Do not beat yourself up about this - it goes with the territory - lots of other women feel the way you do, but few are brave enough to admit it. Being a mother is the most difficult job you will ever do. Few of us are prepared for the losses that go with becoming a parent.

When I interview women about this - and I have seen many 100s over the years, they talk about things like: loss of independence, loss of self; loss of their old lives; loss of intimacy with the baby's other parent; loss of joy, spontaneity, of self-esteem, of sleep, and so on. You also lost your dream of having a wonderful birth experience. So allow yourself the time to mourn; be gentle with yourself, and the healing will begin.

Try not to be a perfectionist! That might have been okay in the workplace, but perfectionism won't work for mothers. We have to trust our instincts, get the best advice we can, and learn as we go.

Try not to feel guilty. Guilt is appropriate when you have done something wrong, on purpose. You are doing the best you can, and one day you will look back on this time, and be glad for the hard lessons that you have learned through your pain. You are not to blame. Try to take one day at a time, and you will feel better. Good luck.

12. I have been depressed in the past, with 2 major episodes that needed therapy and medication, so I have been watching out this time. When my symptoms were not like they were before I thought - Ha, OK, you haven't got depression now. I came back to work full-time at the beginning of April when my child was 3.5 months old. I have to work since I am really the breadwinner. I am really not enjoying anything at the moment. My job seems terminally boring, and even when I am off like for this weekend, I am so demotivated I can't think of anything to do. I have an angelic child, but when he cries for quite a while and I don't know how to 'fix' it, I get irate. On Monday I was kicking over prams and baby gyms and swearing. Then when the baby is settled again I can't believe that I have made all this fuss. He has been screamed at already far too much and he's only 4.5 months old now. I also curse every morning when he gets me up at 5 a.m. I resent having to get up that early, especially when the night is broken, as it always is, by the baby waking up and crying for his dummy etc. And since he has been at crèche he has been sick non-stop, which doesn't help anything. I look fine so everybody thinks I am fine. I feel very unfulfilled/unhappy and am not sure what is influencing or impinging on what, or if its just a phase to be worked through. Can you please advise me where I should go from here - I can't make up my mind about anything!

I am so glad that you got in touch with us. We can certainly help you. I take your point about the difficulty of making an appointment for an assessment interview when you are feeling depressed and demotivated, but it is very important for you and your family that you get the right help as soon as possible. You and they deserve it, and if you have been diagnosed with clinical depression before, and are under stress, you are certainly vulnerable for PND. Remember that the first step to recovery is asking for help. The second is using the resources that are available.

It is very common to "fake" it, so that no one knows how you are really feeling under the competent, coping mask. That is one of the reasons why so many women suffer in silence, sometimes with tragic consequences. You will know that there are no "quick fixes", but the sooner you get help, the sooner you will recover.

13. My wife and I have been married for six years and our child is 15 months old. The birth plan fell to pieces. We went to pre-natal classes and watched videos of home births and so the scene was set for a perfect home birth. This was not to be. Baby would not arrive on time and eventually into hospital we went, along with mother-in-law. After an emergency Caesar our beautiful, healthy daughter was born. The Caesar was a result of baby lying breached and only picked up while my wife was in induced-labour. The midwife has still not been forgiven and has never been spoken to again by my wife. My Mom-in-law blamed me for causing all the drama and, as a result my relationship with my Mom-in-law has been strained. As a result of not bonding with baby, etc a clinical psychologist was visited on two occasions by my wife and on the third visit I went along as well. Afterwards my wife, refused to return to the psychologist. Our relationship has suffered in the last nine months. My wife does not want to go out to visit people or go away for weekends etc. Recently she has stated that she wants a divorce and believes that she cannot carry on in this marriage any longer, she has moved out. Could it be that my wife is still suffering from PND? I have stated that I will do what ever it is to save this marriage, but to date this has been a lost cause.

Thank you for contacting us. You and your wife have obviously been through a very tough time. When the birthing plan goes so wrong it can be very distressing for a women and one can feel incredibly disappointed and cheated by having to then have a Caesar. It very often happens that bonding with the baby takes a while. If postnatal depression is not treated it can persist and I would strongly suggest that your wife seeks further help. We offer wonderful support and have very caring counselors, many of whom have been through PND themselves. The counselor will do what we call a PND Interview Assessment and from that will be able to identify the problem areas and then make various recommendations, e.g. to see a psychiatrist for medication, attend a support group etc. You could perhaps also encourage your wife to make contact with us.

You, yourself, will need support at this time. Perhaps you could see a counselor yourself, and perhaps your wife would be persuaded to consider consulting a couple therapist together. If she is feeling depressed, it is very probable that she will take her angry feelings out on you. Try not to become discouraged.

14. My daughter has recently tried to kill herself by taking an overdose of her medication. She has a 5 month-old baby, and a devoted husband. The whole family is shocked and distraught, and, as her mother, I feel SO guilty. There is depression in her father’s family; is it genetic?

Whatever the timing may be of a depression, it is my belief that recovery depends on taking a very holistic approach. By that I mean medication will certainly help with the treatment of the symptoms - correcting the chemistry of the body/brain etc; but we are not just bodies, and it is usually not "just hormones", in my opinion.

At times of life transition, such as adolescence, childbirth, menopause, retirement, etc., huge adjustments have to be made in terms of redefinition of the self. The questions that all of us ask, consciously, or unconsciously, are the big ones. Who am I? Why am I in this world? Will I be happy? Why is life so hard? How do I fit into the scheme of things? And so on. Underneath all this questioning is the scared infantile part of us - and the biggest universal fear is of being alone, unloved and abandoned.

So my view is that to experience a depression is not a bad thing in itself - it is an opportunity to care for "the inner child", to embrace the fragile not-coping part of oneself and accommodate it. To pretend that you are okay when you are not is dangerous, because the demands of the "inner child" will, for sure, arise again.

Without exception, the women I work with have been depressed before and seldom treated - never effectively. Often most of their lives have been lived in a kind of twilight of a low-grade depression partly because the people around them could not tolerate their negative feelings.

Yes, depression may run in families to some extent. One cannot discount one's genetic predispositions. But how we deal with it is something else. With the right help, often including spiritual guidance of some kind, people do get better. As you may know, sometimes-drastic steps, like ECT and hospitalization may be necessary, and are effective in moving the patient into a new way of thinking and being.

There are many paths up the mountain, and no one can "cure" the depression beyond giving the patient the courage to carry on, and to wait for the light to dawn. She cannot "pull herself together"; she needs to be given psychological and spiritual help so that she finds her way out of the long black tunnel.

It is a hard journey, and there are no short cuts and many ups and downs; she needs your patience and your belief that she will get well, and that you will be there for her while she experiences her pain. She will want you to fix it; you will want to fix it, especially as you are a healing professional, but if she and you can allow her to face her fears, she will find her courage and grow strong again. What she is learning is that she does not have to do anything, just to learn to trust again. (You can't do it all - employ people like me to help her as well - there are lots of us.)

So psychotherapy, spiritual guidance and love will get her through it. If you can find a support group of some kind, that will also help. I am sure that this has affected everyone in your family, so all of you need help too. Try not to fall into the trap of what I call "the blame game". This is not your fault. We don't know why bad things happen to good people; we can't answer the big questions either. We have to trust in powers far beyond human comprehension.

I know the worst thing for a mother (or father) is not to be able to keep her children happy all the time. Just know that you are the right parents for her - she chose you - that you have all the wisdom you need in your intuitive self; open your heart, and try to give her the courage to carry on.

15. In the second trimester of my pregnancy I found myself experiencing mild symptoms of low mood. I wouldn't say I was depressed and fortunately with the support of my partner, family and employer came through the experience OK. I am a mental health nurse. I now feel fine; but, being in the business, so to speak, and seeing a lot of postnatal depression and psychosis, I am interested to know if you have any research/info about the incidence of postnatal problems following antenatal ones. Any information would be appreciated.

Thank you for your message. I am delighted to hear that you are feeling better - certainly, having a supportive partner will be a great help to you. There is quite a bit of research on depression during pregnancy. The more specific you are the better I will be able to answer your questions.

I want to urge you not to be embarrassed by your fragile feelings - depression around the time of childbirth is no respecter of persons - in my practice I have seen doctors, psychologists, nurses in plenty, accountants, lawyers, teachers and engineers. What seems to be one of the many vulnerability factors is being a high achiever! Many things play in to it, and one of the best protective factors against developing PND, especially after A-ND (Ante-natal Depression) is to look at one's "unfinished business" and previous experience of loss or bereavement, and to get one's personal, especially family relationships, in order.

16. My child is nearly two years old and I still feel inadequate and uncertain. Because of this, I still get very emotional and have difficulty to discipline my child. Every time he cries, I give in. I can never do enough for him. If I read one story to him, today, why didn't I rather read two? Did I play enough music, did I sing enough songs, and did I stimulate enough? He does not sleep through at night, so I never relax, because I know he is going to wake up, start crying and I feel helpless. It would be wonderful if I can get myself out of this situation and to feel that I am in control again.

It is very lonely to be going through depression, and to fell that no one else understands. It is also difficult to feel like a good parent when one is so tired and so desperate, and often so short of patience. Remember this is an illness, like diabetes - it is not your fault. You are not a bad person. I seriously recommend that you make enquiries to find out whether there is a support group near you, and that you share your feelings with a sensitive health professional. You may not need medication, although it is impossible to assess this except in a face-to-face assessment interview. Do not delay; you and your family deserve that you take care of yourself at this time. One in 10 mothers at least feels the way you do. You are not alone.

17. My husband and I are currently planning our second child, and having suffered severe PND with hospitalization and shock treatment with our first child, I am nervous about re-occurrence with a second birth. Do you have any statistics relating to the likelihood of re-occurrence please?

There is a 50:50 chance of PND recurring with a second child - particularly if the underlying psychological reasons for the depression have not been dealt with, or where there is a genetic or biological reason for the depression. I would strongly urge you to talk to your psychiatrist and psychologist about the preventive steps you might take. If you are able to set up a really good support system, that may help. However, some people, unfortunately, remain high risks for depression, no matter what they do. In such cases, a risks and benefit assessment may need to be done, in order to determine whether you need to be given prophylactic medication. Good luck.

18. I read about your research showing that an astonishing 8 out of 10 depressed mothers were the caretakers in their original families. This interested me. I survived PND after both my babies were born and am now also attempting to deal with certain aspects of my childhood and would be most grateful if you could pass on more information regarding this possible connection.

It is difficult to reply quickly to your question. My research has been going on for many years, looking at the possibility of there being a "profile" of women who may be vulnerable to PND. Many factors are inter-related, one of them being relationships in the family of origin. It seems as though childbirth wakens primitive needs in us to be cared for, as we care for our babies. If our own nurturing has been deficient, e.g. if we were the ones who had to take care of others always, it can be quite a shock to discover our vulnerabilities. But this is only one of many issues to do with our original families. Many women recognize that their own mothers were/are "needy" or "cold" in some ways, that their fathers were over-controlling etc.

Understanding PND

Help for Family and Friends

Help for Depression in Pregnancy