See also our Q&A on depression and bipolar disorder
After the birth of a baby around one in seven women experience a mood disorder that can have symptoms of anxiety and depression that last more than a week or two and interfere with ability to function in day to day activities. This mood disorder is called postnatal depression and there are different types that vary in timing of onset, nature and severity of symptoms, and response to treatments.
See the Fact Sheet: Depression in pregnancy and the postnatal period
Some women do experience onset of clinical depression during pregnancy and this is called antenatal depression. The symptoms can include anxiety as well as depression and if left untreated the disorder may carry over into the postnatal period.
The "baby blues" are not the same thing as postnatal depression. The "baby blues" are quite common (50-80% of women) with onset during the early days after childbirth. They usually clear spontaneously within the first week to ten days without treatment and are not regarded as a clinical disorder. When symptoms of depression are severe after childbirth and persist for longer than a week or two professional assessment is needed to establish if this is the onset of postnatal depression or another type of postnatal disorder.
When a woman has an episode of postnatal depression following the birth of a baby there is an increased risk that she may experience another episode following a subsequent birth. This does not happen in every case and it is necessary to talk to an expert about the level of risk since this will vary depending on the type of postnatal depression, the severity, previous history and the response to treatment. Steps can be taken to minimise the risk and to closely monitor women who have had a previous episode to ensure that any symptoms are identified and treated early if they cannot be prevented.
Puerperal psychosis is the name given to a type of psychosis that occurs following childbirth in around 1 in 1000 women. A psychosis is a severe disorder that often starts quite suddenly soon after childbirth and symptoms can be severe with mood swings, agitation, disturbed patterns of thinking (delusions), fearfulness, and restless behaviours. The safety of mother and baby need to be assessed as a matter of urgency as a mother with these symptoms may not be able to care for herself or for her baby. Specialist assessment and treatment by a medical practitioner and a psychiatrist is indicated in the first instance.
If you are concerned that you may be experiencing symptoms of postnatal depression your GP will be able to advise you about the need for treatment. There are different types of postnatal depression that respond to different treatment approaches. Some types with melancholic features are more likely to require specialist help, medication and possibly care by a psychiatrist. Non-melancholic types may respond to psychological therapies with or without medication and may not need. It is important to obtain the most effective treatment for your symptoms.
See the Fact Sheet: Safety of Antidepressants in Pregnancy and Breastfeeding
When a woman is pregnant or breastfeeding careful consideration is given to the nature and severity of any symptoms before a decision is reached about the use of medications. This is because the foetus and the breastfed infant do receive small doses of any medication used. In some cases the severity of symptoms makes it essential for treatment to be commenced with medication and your GP or psychiatrist will know which are the safest medications and dosages to be used in those situations. Wherever possible psychological approaches to treatment and increased levels of social support will be used to manage symptoms.
See Fact Sheet: Safety of Antidepressants in Pregnancy and Breastfeeding
Ideally it is preferable to avoid the use of medications for treatment of depression when you are attempting to conceive as these are transmitted to the developing embryo. For this reason if you have symptoms that can be managed without medication your doctor will possibly advise you to reduce medication use under medical supervision. Sometimes there is a risk that symptoms of a disorder such as Bipolar Disorder will reoccur if medication is ceased which is why medical advice is required before you make your final decision.
See Fact Sheet: Safety of Antidepressants in Pregnancy and Breastfeeding
Some types of postnatal depression have a genetic basis and are more likely to run in families for example the melancholic subtype. Bipolar disorder and puerperal psychosis are also caused by genetic factors in combination with life stresses. The non-melancholic subtypes of postnatal depression are due more to the interaction of life stresses and personality factors during pregnancy and after childbirth rather than genetic factors. Your doctor will be able to advise you further about this subject or can refer you to a genetic counsellor if indicated.
When a mother becomes depressed this can affect her ability to cope with normal routines including caring for her baby, herself, other young children, home and work demands, and relationships with her partner, family and friends. For these reasons it is important to seek help early if you think you are becoming depressed in order that additional practical help and emotional supports can be provided along with treatments if indicated. This will help to control symptoms and reduce the impact of the depression on all members of the family.
There are a number of steps you can take that will help you to stay emotionally well during pregnancy and after the birth. These can include the following:
When a woman is pregnant or has a new baby there are a number of physical and emotional changes that take place that require adjustment and can require changes to existing routines and patterns of relationships. Prospective fathers will also experience new emotions and face challenges to their current routines and methods of coping. The most effective method to aid couples facing these changes is to keep the communication going and to provide enough time for one another so that this can happen. This can result in both partners feeling understood and emotionally connected at this important time. Women may need to make changes to physical routines involving lifting and carrying such as shopping, lifting other young children.
Fatigue, mood swings, sleep disturbance, and reduced interest in sex are all quite common for men and women at these times and require mutual understanding and consideration. Going together to appointments or to talk to a health professional can strengthen the relationship.
Page last updated: 19-Jan-2009
Depression and Bipolar Disorder Information Australia - Black Dog Institute.
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