Postnatal Depression and Postnatal Psychosis

Approximately 1 in 7¹ women suffer from postnatal depression. Successful treatment is available and seeking help is nothing to be afraid of. We can help.

¹ Postpartumdepression.org

What is postnatal depression?

Postnatal depression, also known as postpartum depression, is a serious mental health condition that can occur in the following situations:

1. Mothers following birth of a live child
2. Mothers following miscarriage or stillbirth
3. Fathers following birth of a live child
4. Fathers following miscarriage or stillbirth
5. Adopted parents

Postnatal depression is sometimes referred to as the ‘Baby Blues’ – however the symptoms of postnatal depression are much more severe than the baby blues – which is often a short period many women (about 75%) will go through in the first few weeks following the birth.

Symptoms of postnatal depression usually start within the first 2 weeks post-delivery but can also start later than this. Baby blues usually occur within the week after the baby is born but should not last longer than a fortnight. If symptoms persist longer than 2 weeks, then this could be postnatal depression.

The key point about postnatal depression is that it can have a much greater impact on the woman and her family than depression experienced at other times in her life.

This is because of the strain it can put on relationships and family life, the mother – infant bond and even to later child development.

Postnatal depression symptoms

The ‘baby blues’ and postnatal depression can often be confused, which can prevent or delay parents from seeking the help they need, early on, before symptoms become severe.

New parents and mothers in particular, may feel under a lot of pressure – to fall instantly in love with their child, to cope and to ‘enjoy’ parenthood.

However, postnatal depression is a diagnosable mental health condition, sadly very common, but also treatable.

Causes of postnatal depression

There are several factors that could cause postnatal depression to develop in mothers:

1. Hormones: during pregnancy a woman’s hormones are at about 20-30 times greater than at normal times. Following the birth these drop rapidly and it is this drop in hormones that is thought to play a role in the development of PND.
2. High Expectations: being pregnant can be a truly exciting time but the reality of a looking after a small baby can be overwhelming and very different to expectations.
3. A difficult birth: births that were difficult or traumatic have been linked to a number of mental health conditions, such as postnatal depression and PTSD.
4. A ‘Difficult’ baby: if you are caring for a baby that has health problems, such as being pre-term, having colic or an illness, you are more likely to develop postnatal depression.
5. Previous mental health conditions: Mothers who have a history of bipolar, anxiety or depression are 30%² more likely to develop postnatal depression.
6. History of postnatal depression: mothers who have already had postnatal depression are more likely to develop PND in subsequent pregnancies.
7. Developing symptoms of postnatal depression during pregnancy: a woman is 50% more likely to develop postnatal depression if she started to develop symptoms during her pregnancy.

²https://www.hopkinsmedicine.org/news/media/releases/genetic_predictors_of_postpartum_depression_uncovered_by_johns_hopkins_researchers

Postpartum Psychosis

Postpartum psychosis or puerperal Psychosis (PP) is the most serious mood disorder following child birth but is also thankfully the rarest, occurring in about 1 in 1000³.

Mania, severe depression, persecutory beliefs about the child, delusions and confusion are prominent symptoms of postpartum psychosis. Puerperal psychosis seems to be highly heritable, with 10–25% of relatives of women with puerperal psychosis having some kind of severe psychiatric disorder.

Most importantly, for its correct management, it also tends to recur, with a chance of about 1 in 4 in each subsequent pregnancy. Treatment should be sought as soon as possible if a mother starts experiencing symptoms of low mood post delivery.

³ Verywell Minds

Postnatal Depression Treatment

It is important to seek professional help and postnatal depression support as soon as possible as early treatment for postnatal depression can help resolve the problem.

Not only can postnatal depression put huge pressures on the family, but it can have lasting implications for the wellbeing of the child. For instance, studies⁴ have shown that infants who have a parent who has postnatal depression may have slower developmental rates.

If left untreated the symptoms of postnatal depression can last for a significant length of time, becoming more severe and, for some, developing into puerperal psychosis.

Medical professionals are much more aware of the postnatal depression than they were 30 years ago – postnatal depression and postnatal psychosis are taken seriously, and treatment is available and can be effective.

⁴ Murray, L., (1992)

Male postnatal depression

Postnatal depression isn’t just something that affects the mother – fathers or partners can also develop postnatal depression. Exhaustion, a difficult or traumatic birth, changes in hormones (yes – they affect men as well) and financial pressures can all cause male postnatal depression.

Risk factors for developing postnatal depression:

• Partner with postnatal depression – (partner is up to 50% more likely to develop depression)
• Personal history of mental illness
• Relationship difficulties with mother of child

The signs of postnatal depression differ in men; often fathers may turn to alcohol or drug use, become angry or aggressive, withdraw from social situations and feel hopeless about the future.

It can be much harder for men to come forward and see help for postnatal depression, however, left untreated the symptoms of postnatal depression can escalate and, as with mothers, are likely to impact on the development of the child.

Women usually have high expectations of being good mothers after giving birth. This period can be very stressful and cause anxiety. Mothers can experience feelings of being overwhelmed and not being good enough which in turn can result in low mood. Seeking help as early as possible is important as this group of patients can also develop postnatal psychosis placing both them and their babies at risk of harm. Unfortunately, patients are reluctant to see a psychiatrist as they may consider doing so having failed as a mother.”

Dr Olukemi Akanle

MBBS, MRCPsych

Consultant Psychiatrist

London

Dr Olukemi Akanle is a knowledgeable Consultant Psychiatrist currently working for Central and North West London NHS Foundation Trust. She has a Medical Degree and is a Member of the Royal College of Psychiatrists.