Postnatal depression

Also called Perinatal mental illness, PND, Postpartum depression

More than baby blues, and it happens to fathers and partners too. Postpartum psychosis is a different thing entirely and is an emergency.

What it is

Depression that begins during pregnancy or in the year after birth. It affects somewhere around one in ten mothers and a smaller but real proportion of fathers and partners.

It is not the baby blues. Those are tearfulness and mood swings in the first week or so, affecting most new mothers, and they pass. Postnatal depression comes on more slowly, lasts, and does not lift because something nice happened.

Anxiety is often the dominant feature rather than sadness, and intrusive thoughts about harm coming to the baby are extremely common, deeply frightening, and almost never a sign that anybody is dangerous. People do not disclose them because they are afraid the baby will be taken away, and that silence is the single biggest barrier to treatment in this condition.

**Postpartum psychosis is a separate illness and a psychiatric emergency.** It affects around one or two in a thousand, comes on fast, usually within the first two weeks, and involves confusion, mania, paranoia or hallucinations. It needs same-day assessment, and it responds well to treatment.

Suicide is a leading cause of death in the year after birth. That is the reason this entry does not hedge.

Signs you might notice

Persistent low mood, tearfulness, or feeling empty and disconnected.

Loss of interest and enjoyment, including in the baby.

Anxiety, panic, and constant checking.

Difficulty sleeping even when the baby sleeps, or sleeping too much.

Guilt, feeling a failure, feeling the baby would be better off with somebody else.

Intrusive frightening thoughts about harm.

Same-day, urgent: thoughts of suicide or of harming the baby; confusion; not sleeping at all for a night or more; grandiose or paranoid beliefs; hallucinations; behaviour that is out of character. Postpartum psychosis is a 999 or crisis team matter.

How it can affect day-to-day life

Health visitors and midwives ask about mood, and many people answer that they are fine because they are frightened of what saying otherwise triggers. Naming that fear out loud, and saying plainly that the aim is treatment rather than removal, changes what people disclose.

Partners get postnatal depression too and are almost never asked. Their risk is highest when the mother is also unwell.

Medication and breastfeeding are compatible far more often than people assume; several antidepressants are well studied and considered suitable. Stopping treatment in order to breastfeed, without advice, is common and harmful.

Traumatic birth is a distinct thing from depression and can cause post-traumatic stress disorder. It needs a birth debrief and trauma-focused therapy, not just an antidepressant.

Specialist perinatal mental health teams exist across England, and mother and baby units admit mother and baby together rather than separating them. Many people do not know that is an option.

Supporting someone well

Ask directly, more than once, and ask the partner too.

Say plainly that intrusive thoughts are a symptom, are common, and are not a reason anybody loses their baby. That single sentence unlocks more disclosures than any questionnaire.

Treat any suspicion of postpartum psychosis as an emergency. Same day, not next week.

Ask for referral to the specialist perinatal mental health team rather than a general service, and ask about the mother and baby unit rather than assuming separation.

Ask about medication and breastfeeding rather than choosing between them.

Protect sleep in blocks. Somebody else doing one feed so the person gets four unbroken hours does more than most advice.

Ask about a birth debrief if the birth was frightening.

Anybody with bipolar disorder or a previous postpartum psychosis needs a pre-birth plan; the recurrence risk is high and it is predictable.

Where to get help

The health visitor, midwife or GP. In England you can also self-refer to NHS Talking Therapies.

999 or the crisis team for suspected postpartum psychosis or thoughts of suicide.

PANDAS Foundation run a helpline for perinatal mental illness, for mothers and fathers.

Action on Postpartum Psychosis for postpartum psychosis, including peer support from people who have had it.

Samaritans on 116 123, any time.