Postnatal depression can affect women in different ways. It can start at any point in the first year after giving birth and may develop suddenly or gradually.

Many women feel a bit down, tearful or anxious in the first week after giving birth. This is often called the "baby blues" and is so common that it's considered normal. The "baby blues" don't last for more than 2 weeks after giving birth. 

If your symptoms last longer or start later, you could have postnatal depression.

Common symptoms of postnatal depression

The main symptoms include:

• a persistent feeling of sadness and low mood
• loss of interest in the world around you and no longer enjoying things that used to give you pleasure
• lack of energy and feeling tired all the time
• trouble sleeping at night and feeling sleepy during the day
• feeling that you're unable to look after your baby
• problems concentrating and making decisions
• loss of appetite or an increased appetite (comfort eating)
• feeling agitated, irritable or very apathetic (you "can't be bothered")
• feelings of guilt, hopelessness and self-blame
• difficulty bonding with your baby with a feeling of indifference and no sense of enjoyment in their company
• frightening thoughts – for example, about hurting your baby; these can be scary, but they're very rarely acted upon
• thinking about suicide and self-harm

These symptoms can affect your day-to-day life and your relationships with your baby, your family and friends.

If you think you may be depressed, talk to your GP or health visitor as soon as possible so you can access the support you need.

Don't struggle on alone and hope the problem will go away. It can continue for months or years if nothing is done.

Fathers and partners can also become depressed after the birth of a baby. You should seek help if this is affecting you.

Read more about treating postnatal depression.

Spotting the signs in others

Postnatal depression can develop gradually and it can be hard to recognise. Some parents may avoid talking to family and friends about how they're feeling because they worry they'll be judged for not coping or not appearing happy.

Signs for partners, family and friends to look out for in new parents include:

• frequently crying for no obvious reason
• having difficulty bonding with their baby, looking after them only as a duty and not wanting to play with them
• withdrawing from contact with other people
• speaking negatively all the time and claiming that they're hopeless
• neglecting themselves, such as not washing or changing their clothes
• losing all sense of time, such as being unaware whether 10 minutes or 2 hours have passed
• losing their sense of humour
• constantly worrying that something is wrong with their baby, regardless of reassurance

If you think someone you know is depressed, encourage them to talk about their feelings to you, a friend, their GP or their health visitor.

Related conditions

As well as postnatal depression, a number of other mental health conditions can also develop after giving birth.

These include:

• anxiety disorders – including generalised anxiety disorder (GAD), social anxiety, post-traumatic stress disorder (PTSD) and panic disorder
• obsessive compulsive disorder (OCD) – unwanted and unpleasant thoughts, images or urges that repeatedly enter a person's mind, causing them anxiety and leading to repetitive behaviours
• postpartum psychosis – a combination of bipolar-like symptoms (feeling depressed one moment and very happy the next), delusions (believing things that are obviously untrue and illogical) and hallucinations (seeing and hearing things that aren't really there)

Speak to your GP or health visitor if you think you may have developed an anxiety disorder or OCD.

Contact your GP immediately if you think that you or someone you know may have postpartum psychosis, as it's a medical emergency. If this isn't possible, call NHS 111 or your local out-of-hours service.

If you think there's a danger of immediate harm, call 999 and ask for an ambulance.

Speak to a GP or your health visitor as soon as possible if you think you might have postnatal depression.

With appropriate treatment and support, most women make a full recovery, although it can take time.

The 3 main types of treatment are:

• self-help strategies
• therapy
• medication

Talk to your GP about the pros and cons of different treatments so you can decide together what's best for you.

They might also want to check your physical health to see if there are any problems that may need to be addressed as well.

For instance, you may be anaemic after giving birth and that could add to any feelings of depression you might have.

Self-help for postnatal depression

Looking after a baby can be stressful and challenging for anyone, and it can be even tougher if you're dealing with postnatal depression as well.

There are a number of things you can try yourself to improve your symptoms and help you cope.

These include:

• talking to your partner, friends and family – try to help them understand how you're feeling and what they can do to support you
• not trying to be a "supermum" – accept help from others when it's offered and ask your loved ones if they can help look after the baby and do tasks such as housework, cooking and shopping
• making time for yourself – try to do activities that you find relaxing and enjoyable, such as going for a walk, listening to music, reading a book or having a warm bath
• resting when you can – although it can be difficult when you're looking after a baby, try to sleep whenever you get the chance, follow good sleeping habits and ask your partner to help with the night-time work
• exercising regularly to boost your mood
• eating regular, healthy meals and not going for long periods without eating
• not drinking alcohol or taking drugs, as this can make you feel worse

Ask your health visitor about support services in your area. They may be able to put you in touch with a social worker, counsellor or local support group.

It can be reassuring to meet other women who are going through something similar.

Psychological treatments

Psychological therapies are usually the first treatment recommended for women with postnatal depression.

Guided self-help

Guided self-help involves working through a book or online course on your own or with some help from a therapist.

The course materials focus on the issues you might be facing, with practical advice on how to deal with them.

The courses typically last 9 to 12 weeks.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a type of therapy based on the idea that unhelpful and unrealistic thinking leads to negative behaviour.

CBT aims to break this cycle and find new ways of thinking that can help you behave in a more positive way.

For example, some women have unrealistic expectations about what being a mum is like and feel they should never make mistakes.

As part of CBT, you'll be encouraged to see that these thoughts are unhelpful and discuss ways to think more positively.

CBT can be carried out either 1 to 1 with a therapist or in a group. Treatment will often last 3 to 4 months.

Interpersonal therapy

Interpersonal therapy (IPT) involves talking to a therapist about the problems you're experiencing.

It aims to identify problems in your relationships with family, friends or partners and how they might relate to your feelings of depression.

Treatment also usually lasts 3 to 4 months.

Antidepressants

Antidepressants may be recommended if you have moderate or severe depression and you do not want to try psychological treatment or psychological treatment does not help.

They may also be used if you have mild postnatal depression and a history of depression.

Antidepressants work by balancing mood-altering chemicals in your brain. 

They can help ease symptoms such as low mood, irritability, lack of concentration and sleeplessness, allowing you to function normally and helping you cope better with your new baby.

Antidepressants usually need to be taken for at least a week before the benefit starts to be felt, so it's important to keep taking them even if you do not notice an improvement straight away.

You'll usually need to take them for around 6 months after you start to feel better. If you stop too early, your depression may come back.

Antidepressants and breastfeeding

If you're breastfeeding, talk to your doctor about suitable medicines, as not all antidepressants are safe to take while breastfeeding.

Your doctor should explain any risks of taking antidepressants and you should be offered the type with the least risk for you and your baby.

Side effects

General side effects of antidepressants include:

• feeling sick
• blurred vision
• a dry mouth
• constipation
• dizziness 
• feeling agitated or shaky

These side effects should pass once your body gets used to the medicine.

Severe postnatal depression

If your postnatal depression is very severe and does not respond to the treatments above, you'll probably be referred to a specialist mental health team.

Your team will be able to try additional treatments, such as:

• more intensive CBT
• other psychological treatments, such as psychotherapy
• therapies such as baby massage to help you bond better with your baby, if this has become a problem
• different medications
• electroconvulsive therapy (ECT) – where electrodes are placed on your head and pulses of electricity are sent through the brain, which may improve your mood by changing the balance of chemicals in your brain

If it's thought that your depression is so severe that you're at risk of harming yourself or others, you may be admitted to hospital or a mental health clinic.

Your baby can either be looked after by your partner or family until you're well enough to return home, or you can stay in a specialised mother and baby mental health unit.

Charities and support groups

There are a number of national support groups that you can contact for advice.

You can also use them to attend events with other parents affected by postnatal depression.

These groups include:

• Association for Post Natal Illness (APNI) – helpline on 020 7386 0868 (10am to 2pm, Monday to Friday) or email info@apni.org
• Pre and Postnatal Depression Advice and Support (PANDAS) – helpline on 0843 28 98 401 (9am to 8pm, Monday to Sunday)
• NCT – helpline on 0300 330 0700 (8am to midnight, Monday to Sunday)
• Mind, the mental health charity – infoline on 0300 123 3393 (9am to 6pm, Monday to Friday) or email info@mind.org.uk

You can also search for local support groups and find details of national telephone or email support lines on the Maternal Mental Health Alliance website.