Post-natal Depression, also known as post-partum depression, is thought to affect at least one-in-ten women after the birth of a child. The figure may be far higher, as a large number of sufferers do not admit to having a problem, or wait until it is very serious before seeking help.

It is not difficult to understand the hesitation these mothers can feel in coming forward. On top of fears common to other kinds of depression, such as, 'Will I be taken seriously?' or 'Will people think I'm going mad?', there is the greater stigma of appearing unnatural. Motherhood is idealised in our society; new mothers are expected to bloom, and new babies are expected to be a source of constant delight. A mother suffering from post-natal depression carries the added guilt of 'I should be happy' and 'Everyone else is delighted, why aren't I?'. The answer is not because she is unnatural, or a hopeless mother, but because she is suffering from a very common but not very widely publicised illness.

What is Post-natal Depression (PND)?

Quite simply, Post-natal Depression is the onset of depression after childbirth. It usually starts within a month or two of the birth, although in some cases it may not appear until several months afterwards. Untreated it can last for years, but early treatment can be very effective.

PND should not be confused with the much milder, and more common, form of depression usually referred to as the 'baby blues'. This usually strikes within a few days or weeks of the birth, and finds the mother bursting into tears for no reason. It is characterised by phrases like, 'I don't know why I'm crying'. No one really knows what causes the baby blues, but the trauma of birth followed by lack of sleep and settling hormones may well be the culprit. The baby blues usually wear off after a few days.

Similarly PND should not be confused with a much severer, and rarer illness known as Puerperal Psychosis which causes the sufferer to have delusions and hallucinations, and requires immediate urgent medical assistance.

The cause of PND is not known, although doctors have suggested many possible causes. Some mothers get it suddenly after their second or third child, having been fine after their other pregnancies. Some mothers get it following an unplanned or difficult pregnancy, but others may have been planning and trying for a baby for years yet still get depressed. It may be affected by external factors, such as social and cultural issues, or personal factors, such as housing or personal history, or biochemical factors, such as hormone levels. In fact, nobody has ever proved what causes PND, and it seems to affect mothers from all backgrounds.

Symptoms

Post-natal Depression may start off mildly, but will continue to worsen if untreated. Like any form of depressive illness the symptoms vary greatly from one sufferer to another, but often include several of the following:

• Depression - This is obviously the most common symptom and ranges from feeling low and having a few off-days, to feeling that life is not worth living, and that nothing can ever improve.

• Despondency - Often, following on from depression, a mother may become less and less like her old self, taking no joy in anything. A previously glamorous woman may stop caring for her appearance; a previously sociable woman may not want to chat with anyone. Answers to questions are often only a grunt or a shrug.

• Insomnia - The arrival of a new baby often brings broken nights, but a PND sufferer will often be unable to sleep even when the baby is sleeping. Often the other symptoms will seem worse at night, lying awake and alone with no distractions. When she finally does get to sleep she may well be woken by nightmares.

• Irritability - The slightest thing can spark anger or tears, usually the partner is the one who suffers most from this, although other children, relatives, and, in some cases, the baby may also feel its force.

• Anxiety and/or Panic Attacks - These are often connected to worry over the wellbeing of the baby: for example, a fear that the baby has stopped breathing every time it is silent (all new parents have such anxiety to some extent but to the PND sufferer it becomes compulsive and she cannot rest until she has checked, then checked again and again.) Sometimes, situations which were everyday - such as being alone in the house or visiting a crowded shop - can bring on panic attacks. These can cause breathlessness, dizziness, headaches and/or sweating.

• Guilt - This is very common, and of course it compounds all the other symptoms. There is guilt about not being a good mother, guilt about being irritable and despondent and guilt that you are not managing better or meeting other people's expectations. Women may mislead people because they do not want to admit they have PND, and then feel guilty for not being honest about it.

• Detachment from baby - One of the most distressing symptoms of PND is feeling detached from, or indifferent to, the new baby. The mother may be totally cold and disinterested towards the child, or in severe cases not even recognise them as their own. This lack of maternal feeling only serves to compound the other more general symptoms.

The symptoms often create a vicious circle, or a self-fulfilling prophecy. A mother feels she is incapable of looking after her baby, and panics when left alone with him. Her family and friends, meaning to help, take charge of the baby, helping to dress, change and feed him. They make sure never to leave her alone with him. By doing this they are in fact in many cases enforcing her belief that she is incapable of managing alone.

What to do

The most important thing for any PND sufferer to do is to admit she has a problem, first to herself and then to others. As mentioned above, it is often difficult to tell anyone how you are feeling, but it may be impossible to make a quick recovery if you do not. Many women tell their partner first, and then their doctor or health professional.

Having someone to talk to can be a huge step towards recovery. The mother can finally feel that she is not alone, and recognise that many other women feel exactly what she is feeling. Doctors, health visitors, counsellors and community psyciatric nurses can all provide listening on a one-to-one basis, and may suggest other forms of therapy. There are specialised charities for PND sufferers¹. Often women find the anonymity of cyberspace makes it easier to be frank about how they are feeling, and many parenting sites (such as parentsoup) have message boards and virtual communities for PND suffers, as well as articles and advice.

It is also important for the new mother to take physical care of herself. Adequate food and rest are essential, but the symptoms of the depression may make it harder to eat and sleep. All recent mothers - not just those who suffer from PND - should make use of all the friends and relatives popping in to see the baby, by getting them to make ther own drinks or snacks, and getting her one while they're at it, or by asking them to help with the chores. Mum should also accept that sleep is more important than housework, and catch a few minutes whenever the baby naps rather than trying to keep the place spotless. Dad may be able to take responsibility for some night-time or early-morning feeds, leaving the mother to catch up on her sleep. It is all too easy to leave meals untouched due to a screaming baby, or to nibble at snack foods all day rather than keeping a balanced diet, but a recent mother - especially if she is breast-feeding - needs to keep well-nourished. It is a very difficult lesson to learn, but a crying baby really will not be hurt by waiting five minutes while you finish your dinner.

'Me-time' can be very beneficial. Taking some time each day to do something alone provides a much needed chance to relax. Even if it is only a long bath, with the baby being entertained by a partner, friend or relative in another room, it can break the cycle of negative thoughts and anxiety.

Setting herself challenges and arranging events to distract herself from her own negative thoughts will also help. For example, a mother could begin by forcing herself to get up and dressed each day. The next challenge would be to go out, with baby, each day, starting with a walk in the park and progressing to mother and baby clubs or swimming lessons. Making lists, mental or actual, of things that help - such as 'I am a good mother', 'I will smile when I look at my baby no matter how I feel inside', and referring to this list during bad spells, is another preventative method.

Some doctors may prescribe medication, and while this is undoubtedly helpful in many cases mothers should think carefully before taking them. Most common anti-depressants, such as Prozac or Seroxat, are not safe to take while breast-feeding, and it is important to be sure that the medicine will make up for any feeling of guilt that may be caused by ceasing to give the baby the best, most natural food available to it. In the UK at present the only drug breast-feeding mothers can take for depression is dotheipin. This not only combats the depression, but has a sedative effect which helps the insomnia. However, it can cause side-effects, the most common of which is very heavy sweating, which can cause discomfort and embarrassment to the mother. Testing medicines on breast-feeding women is ethically prohibited, so the situation surrounding medicines is not likely to change any time soon.

How to Help if a Partner/Friend/Relative Has PND

Any new mother needs the support of her partner, family and friends. New mothers who are suffering from PND need even more help. As well as the practical ideas suggested above you can provide much needed emotional support. However, it is vital to remember that a sufferer is in a fragile emotional state, and thoughtless remarks or actions will make her far worse. Don't try to jolly her along or act as if its something she should be able to switch off. Try not to rise to it when she gets irritable and snappy. Let her know that you care and are trying to understand, and accompany her to the doctors or counsellors if she wants you to. Look after the baby while she has her 'me time', and be available if she gets stressed out while alone with the baby. Let her know that she is getting better. Remind her of what she can do for the baby, and of all the things she has done for him/her that no one else could. Above all remember that she is ill, not mad.