Pregnancy-related depression is not just confined to after the baby’s birth, but can begin during pregnancy, according to the Mother and Baby Unit at the South London and Maudsley NHS Foundation Trust (SLaM).

A study recently published in the British Journal of Psychiatry found that women who have suffered a miscarriage or stillbirth are more likely to suffer from depression during and after subsequent pregnancies.

SLaM’s Mother and Baby Unit regularly sees women who have developed depression during pregnancy or a relapse of a serious mental illness triggered by becoming pregnancy.

Dr Trudi Seneviratne, consultant psychiatrist in SLaM’s Mother and Baby Unit, said that while depression usually followed the birth of a child, this was not always the case.

“Postnatal depression is understood to be, as the name suggests, depression that is triggered by the birth of a child,” she said.

”While depression following birth is the most common form of pregnancy-related depression, it can also begin during pregnancy, or months after giving birth. Pregnancy can also trigger other mental health conditions or cause women with a previous history of mental illness to relapse.”

The Mother and Baby Unit at the South London and Maudsley NHS Foundation Trust (SLaM), treats both expectant and new mothers suffering from severe depression. Part of SLaM’s Perinatal Service, the unit offers specialised care and treatment for women from across the UK, who develop a mental illness or have a relapse of serious mental illness during pregnancy and the postnatal period.

Despite the prevalence and awareness of postnatal depression, the reality is that women who are actually experiencing it, feel very, very alone. It is estimated that postnatal depression (PND) affects around one in 10 mothers in the UK, and also a small number of fathers who are struggling to cope with a new baby or supporting their partner.

PND usually develops in the first four to six weeks after childbirth, although in some cases it can develop some months later. It may also start in pregnancy and continue into the postnatal period. If untreated, the mother’s depression can have significant effects not only on her own mental health, but on the relationship with the baby, the baby’s development, as well as affecting her partner and wider family.

Dr Seneviratne said it is important to differentiate PND from the ‘baby blues’ or postnatal ‘blues’, which is common , affecting 60-70% of women and usually occurs in days following birth and usually resolves after a few days.

“It is very important for new mothers struggling with depression to understand that having PND does not mean they do not love or care for their baby,” Dr Seneviratne stressed.

“Most women aren’t aware when they are experiencing PND, which means it is extremely important for partners, family and friends, along with healthcare professionals, to recognise the signs of PND as early as possible, and recommend treatment. Women often feel guilty about expressing their feelings as having a new child should be a ‘happy’ time,” she said.

Most women experiencing PND following the birth of a child are treated at home through a combination of therapy and medication. Only the most extreme cases of PND require inpatient hospitalization, and such cases, a specialist service like the one at SLaM is able to provide more intensive care.

“PND can be a lonely and scary experience for new mothers, but it is not a permanent condition. With time and treatment, you will recover,” Dr Seneviratne said.

There is no single cause for PND, and it can be triggered by a number of factors such as social factors including relationship worries, money problems or having limited support from family and friends. Indeed, having a baby itself is a life-changing event that can be extremely exhausting and stressful.

“Some women feel unable to look after their baby, or maintain their relationship with their partner. They may feel anxious about leaving the house, or that they simply cannot cope,” Dr Seneviratne said.

The most common symptoms of postnatal depression include low mood, overwhelming guilt, feeling unable to cope and difficulty sleeping. While most mothers will experience some form of exhaustion and possibly mild depression,–prolonged low moods are an indication of a more serious problem.

Dr Seneviratne said it was important for new mothers who are struggling to cope with their new baby, and the changes to their life, to seek help from their GP.

If a new mother has been feeling down, depressed and hopeless, and is unable to take interest in normal interests and pleasures, they are most likely suffering from PND. They may not enjoy their baby and struggle with maintaining societal cultural pressures such as maintain breast feeding. A GP should ask questions and look for common symptoms of PND, then offer the most appropriate form of treatment.

Psychological interventions or therapy are often recommended, although the most important step is simply recognising the problem and talking it through with family and friends and helpful professionals. Medication, such as antidepressants, can be used to treat PND. It is important that the mother is adequately supported and that any treatment plan is tailored to her wishes

Dr Seneviratne said in more serious cases, women may experience frightening thoughts about harming themselves or their baby.

“Thinking about hurting yourself or your new child can be extremely alarming for new mothers, although it is surprisingly common. Again, women experiencing these thoughts must talk to their GP who can recommend treatment,” she explained.

Part of SLaM’s Perinatal Service, the unit offers specialised care and treatment for women from across the UK, who develop a mental illness or have a relapse of serious mental illness during pregnancy and the postnatal period.

The service helps mothers struggling with depression to develop a relationship with her child, and reduce the impact of the mother’s illness on the child. Fathers and partners are encouraged to be involved in the treatment. Babies are accepted on to the ward with their mothers. Other times it is more appropriate to admit the mother without their baby and begin a programme of gradual reintroduction of the baby to the mother while on the ward.

In addition to PND, SLaM’s Perinatal Service also treats less common forms of mental illness among new mothers, such as postnatal psychosis or pre-existing mental health conditions. Postnatal psychosis is rarer, and can include symptoms such mood changes (irritability, elation, depression) delusions (false beliefs), hallucinations and irrational or suicidal thoughts.

www.national.slam.nhs.uk/services/adult-services/perinatal

Symptoms of postnatal depression:

The symptoms of postnatal depression usually include one or more of the following:

· Low mood for long periods of time (a week or more)

· Feeling irritable for a lot of the time

· Tearfulness

· Panic attacks or feeling trapped in your life

· Difficulty concentrating

· Lack of motivation

· Lack of interest in yourself and your new baby

· Feeling lonely

· Felling guilty, rejected or inadequate

· Feeling overwhelmed

· Feeling unable to cope

· Difficulty sleeping and feeling constantly tired

· Physical tension, such as headaches, stomach pains or blurred vision

· Lack of appetite

· Reduced sex drive

Myths surrounding postnatal depression

PND is commonly misunderstood. Some of the most common myths around the conditions include:

· PND is less severe than other types of depression

– in fact PND is just as serious as other depressions.

· PND is entirely caused by hormonal changes

– there is no one factor, PND it is triggered by a number of factors.

· PND will go away by itself – usually, treatment is needed for PND.