Parents
Postnatal mental health
Postnatal depression is common, treatable and frequently missed, and several other conditions are missed more often still.
Perinatal mental illness affects a substantial proportion of parents and remains one of the leading causes of maternal death in the year after birth in several high-income countries, largely through suicide.
The baby blues
Distinct from depression and very common.
A period of tearfulness, mood swings, irritability and feeling overwhelmed, typically starting around day three to five and resolving within a fortnight.
It is associated with the hormonal shifts after birth and does not require treatment.
What distinguishes it from depression is duration and severity: if it persists beyond two weeks, or is severe, it warrants assessment.
Postnatal depression
Affects a significant minority of mothers and a smaller but real proportion of fathers and partners.
It can begin at any point in the first year and frequently begins in pregnancy.
Symptoms: persistent low mood, loss of enjoyment, fatigue beyond the expected, sleep problems beyond those caused by the baby, appetite change, poor concentration, feelings of worthlessness or guilt, difficulty bonding, irritability and anger, hopelessness, and thoughts of self-harm.
Guilt and shame are prominent and are the main reason it goes unreported — the belief that a mother who is not delighted has failed.
It is treatable, with psychological therapy and, where appropriate, medication, several of which are compatible with breastfeeding.
Postnatal anxiety
At least as common as depression and diagnosed less.
Features: persistent worry about the baby's health or safety, intrusive frightening images, repeated checking, inability to rest even when the baby sleeps, physical symptoms, and avoidance.
Intrusive thoughts of harm coming to the baby are extremely common in new parents and are distressing precisely because they are unwanted.
They are not an indication that anyone will act on them, and clinicians distinguish them clearly from the very different presentation of psychosis.
Saying them out loud is frightening for parents and is exactly what allows treatment.
Postnatal post-traumatic stress
Following a traumatic birth, and affecting a meaningful proportion.
Features: flashbacks and intrusive memories of the birth, avoidance of reminders including medical settings, hyperarousal, and emotional numbing.
It is frequently mislabelled as depression.
Trauma-focused therapies are effective, and a birth debrief with a clinician who can explain what happened is helpful for some people.
Partners who witnessed a traumatic birth can also be affected, which is almost never asked about.
Postpartum psychosis
Rare and a medical emergency.
It usually begins in the first two weeks, sometimes within days, and can develop rapidly.
Features: confusion, not making sense, mania or severe agitation, severe depression, hallucinations, delusions — frequently involving the baby — paranoia, and behaviour that is out of character.
It requires immediate assessment, generally in hospital, ideally in a mother and baby unit.
It is treatable and most people recover fully.
Risk is substantially higher in people with bipolar disorder or a previous episode, which is why that history should always be disclosed in pregnancy so that a plan can be made.
Fathers and partners
Consistently under-recognised.
Rates of depression in fathers in the first year are meaningful and rise when the mother is also depressed.
Presentation more frequently involves irritability, withdrawal, working more, risk-taking and substance use rather than expressed sadness.
Screening is rarely offered, which means it usually has to be raised.
Adoptive parents and non-birthing parents in same-sex couples experience the same transition and the same risks.
What helps
Sleep, which is both a cause and a consequence — protecting one longer block of sleep for the affected parent is a genuine intervention.
Practical support, which reduces load more effectively than encouragement.
Social contact and peer groups, since isolation is a strong risk factor.
Psychological therapy, which has good evidence and which many services offer with priority for perinatal patients.
Medication where indicated, with informed discussion about breastfeeding — several antidepressants have substantial safety data in lactation.
Exercise and getting outside.
And specialist perinatal mental health services, which exist in many areas and which accept referrals for this specific population.
Asking for help
The barrier is almost always fear of judgement or of the baby being taken away.
Worth stating plainly: services exist to support families, and the overwhelming response to a parent disclosing depression or anxiety is treatment and support.
Health visitors, midwives, general practitioners and specialist perinatal services all take this seriously.
If there are thoughts of harming yourself or the baby, that needs help today rather than at the next appointment.
General information only, not medical advice. Consult a health visitor, midwife or clinician about perinatal mental health, and seek urgent help immediately for thoughts of harming yourself or your baby.
