Postnatal depression refers to the onset of depression that occurs within the first three months of giving birth and can last anything from a few weeks to many years. The first few weeks after giving birth are an extremely vulnerable time for women due to the significant drop in hormones that they experience as well as the heightened challenges and demands that they now face in caring for a new child. After giving birth, mothers go through a huge adjustment period and during this time it is extremely common for women to experience the ‘baby blues’, which involves short periods of mood swings, irritability, fatigue, nausea, and loss of libido. However, postnatal depression refers to the more severe and persistent symptoms of depression that last more than just a few weeks and can significantly impact the mother’s ability to cope with daily routines. It is believed that postnatal depression affects approximately 10-30 percent of all women, however there is huge variation in terms of the symptoms, onset, causes, risk factors, intensity and duration of the disorder.
Signs and symptoms of postnatal depression
It is important to keep in mind that everyone is unique and will therefore experience differences in the nature, severity and duration of their symptoms, however some of the more common signs and symptoms are listed below.
1) Mood: Feeling low, sad, irritable or anxious for most of the day.
2) Sleep: Experiencing sleeping difficulties that are unrelated to the baby’s routine.
3) Appetite and weight: Either eating more or less than normal or gaining or losing weight.
- Energy: Feeling lethargic, drained and heavy.
- Enjoyment and pleasure: Losing interest in things that would normally bring pleasure and enjoyment.
- Self-esteem and confidence: Experiencing self-doubt and negative thoughts about oneself and one’s abilities.
- Motivation and concentration: Finding it difficult to start or persist with tasks and being unable to think clearly or make decisions.
- Libido: Little interest in sex or being intimate with one’s partner.
- Suicide or harming oneself: Urges to physically harm oneself or the baby or urges to end one’s life
- Harm or death to the baby or partner: Exaggerated fears about the health and safety of one’s baby or partner.
- Being rejected by one’s partner: Fearing rejection from one’s partner because of the way one is thinking and feeling.
- Escaping and running away: Urges to leave the baby and partner.
In addition, an individual with postnatal depression may experience feelings of:
- Hopelessness and being a failure
- Worthlessness, guilt and shame
- Helplessness and inadequacy
- Tearfulness and sadness
- Panic and fear
Postnatal psychosis is a serious but uncommon form of postnatal depression that is characterised by a sudden onset and severe symptoms that require immediate medical attention. This disorder affects approximately 1-2 out of 1000 women.
The symptoms of postnatal psychosis include:
- Highly agitated behaviours
- Exaggerated and unrealistic fears about the baby
- Extreme mood swings
- Heightened mood and energy levels (e.g., the individual appears manic and ‘hyped up’)
- Inability to sleep
- Psychotic behaviours (e.g., the individual’s behaviours or thoughts seem out of touch with reality.)
Causes and risk factors of postnatal depression
There are several possible causes or ‘triggers’ that are related to the onset of postnatal depression. Some causes may be biological or genetic whilst others are more to do with psychosocial influences including psychological factors (the individual’s thinking, personality, and coping styles), social factors (the strength of the individual’s key social supports and relationships) and environmental factors (the individual’s living situation and negative life events).
Some key risk factors for postnatal depression
- Stressful or negative life events and experiences (e.g., the death of a loved one, birth complications, financial difficulties, pregnancy loss, previous abuse).
- A previous history of depression, anxiety or other psychiatric disorder, especially if it occurred during pregnancy.
- Personality styles (e.g., perfectionists, self-critical individuals or those who have a strong need for control).
- Cognitive styles or thought processes (e.g., individuals who engage in a lot of negative or pessimistic thinking).
- Relationship difficulties (e.g., lack of support from partner or other key relationships).
- A baby that has a difficult temperament (e.g., the baby is difficult to settle, hard to feed, restless or sick).
Treatment for postnatal depression
Treatment for postnatal depression is very similar to the treatment of other types of depression. The most common options for treatment include cognitive behaviour therapy (CBT) and/or medication, however the use of medication whilst pregnant and breastfeeding needs to be discussed with a doctor and weighed carefully in terms of benefits and risks. CBT has been shown by research to be as effective as medication and better than medication at producing long lasting changes. CBT typically focuses on the relationships between an individual’s thoughts, feelings and behaviours, and aims to teach strategies for positive change in each of these areas.
Typical CBT techniques
- Education – providing information about postnatal depression (e.g., symptoms, possible causes, common difficulties that are experienced by parents, factors that are maintaining the depression, and what the treatment will involve).
- Increasing pleasurable activities and exercise within the daily routine.
- Identifying, challenging, and changing any unhelpful negative thoughts that may be causing and/or maintaining the depression.
- Identifying, challenging, and changing any unhelpful behaviours (e.g., social withdrawal, avoidance).
- Developing skills and techniques to improve coping and better manage stress (e.g., problem solving skills, strategies to help regulate mood, relaxation training).
- Developing strong and effective social supports.
- Planning for the future and preventing relapse.
If you would like to find out more about our treatment for postnatal depression, or to book an appointment with one of our clinical psychologists who provides treatment for these difficulties, please email or call the clinic on 02 9438 2511.