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Postnatal Depression (Postpartum Depression)

A type of clinical depression that occurs after childbirth.

PubMed Health Glossary
(Source: NIH - National Cancer Institute)

About Postnatal Depression (Postpartum Depression)

Pregnant women usually expect the days and weeks following the birth of their child to be a happy time. But many have also heard of severe mood swings that often start a few days after giving birth, known as the baby blues. If the sadness does not go away, it might be the start of a depression.

Depression after childbirth is called postnatal (or postpartum) depression. It is quite similar to the kind of depression that can affect people in any phase of life. Except for one major difference: mothers often feel very guilty about not being able to care for their baby because they are so unwell. Many mothers feel too ashamed to speak with others about how they are feeling. They are afraid of not living up to the idea of a "good mother" and might become more and more withdrawn. Some women say that they no longer recognized themselves.

Taking care of a newborn baby is a real challenge. Some women do not get the emotional and practical help that they need. It is not always easy to deal with all of the changes that need to be made to care full-time for a new baby. Coping with the everyday stress and getting used to your new life can be very difficult — and sometimes it may even be depressing... Read more about Postnatal Depression

What works? Research summarized

Evidence reviews

Depression: The Treatment and Management of Depression in Adults (Updated Edition)

This clinical guideline on depression is an updated edition of the previous guidance (published in 2004). It was commissioned by NICE and developed by the National Collaborating Centre for Mental Health, and sets out clear, evidence- and consensus-based recommendations for healthcare staff on how to treat and manage depression in adults.

Depression in Children and Young People: Identification and Management in Primary, Community and Secondary Care

This guideline has been developed to advise on the identification and management of depression in children and young people in primary, community and secondary care. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, carers, and guideline methodologists after careful consideration of the best available evidence. It is intended that the guidelines will be useful to clinicians and service commissioners in providing and planning high-quality care for children and young people with depression while also emphasising the importance of the experience of care for patients and their families.

Hypnosis during pregnancy, childbirth, and the postnatal period for preventing postnatal depression

Mental illness during pregnancy and the postnatal period can consist of a short period of mood swings, crying spells, irritability (baby blues), depression and postnatal psychosis. Postnatal depression (PND) falls along this spectrum. The morbidity caused by PND is enormous. Possible symptoms can include depressive mood, loss of interest or pleasure in daily activities, anxiety, irritability, insomnia, feelings of guilt, and thoughts of suicide in the first three months after giving birth. These can negatively impact on infant feeding, maternal‐infant interaction and the mother's perceptions of infant behaviour. Several psychological or psychosocial interventions appear to be effective for treating the disorder, such as cognitive‐behavioural therapy, counselling with or without antidepressants, health visitor‐led counselling, peer support, and interpersonal psychotherapy. In regard to prevention however, psychosocial or psychological interventions have not shown a clear benefit in preventing the development of PND. Although hypnosis has been used for a long time to reduce pain during labour and birth, the effectiveness of hypnosis for preventing PND has not yet been evaluated. Hypnosis can be described as a heightened state of focal concentration and receptivity to the suggestions of another person. This person brings about the hypnotic state by focusing the person's attention on a monotonous routine. This review included one study (involving 63 women) but it did not contribute any data to this review. There is insufficient evidence from randomised controlled trials to determine whether hypnosis is effective for preventing PND when compared with usual antenatal, birthing, or postnatal care procedures. Two trials are currently underway however, which may provide further information in the future.

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Summaries for consumers

Hypnosis during pregnancy, childbirth, and the postnatal period for preventing postnatal depression

Mental illness during pregnancy and the postnatal period can consist of a short period of mood swings, crying spells, irritability (baby blues), depression and postnatal psychosis. Postnatal depression (PND) falls along this spectrum. The morbidity caused by PND is enormous. Possible symptoms can include depressive mood, loss of interest or pleasure in daily activities, anxiety, irritability, insomnia, feelings of guilt, and thoughts of suicide in the first three months after giving birth. These can negatively impact on infant feeding, maternal‐infant interaction and the mother's perceptions of infant behaviour. Several psychological or psychosocial interventions appear to be effective for treating the disorder, such as cognitive‐behavioural therapy, counselling with or without antidepressants, health visitor‐led counselling, peer support, and interpersonal psychotherapy. In regard to prevention however, psychosocial or psychological interventions have not shown a clear benefit in preventing the development of PND. Although hypnosis has been used for a long time to reduce pain during labour and birth, the effectiveness of hypnosis for preventing PND has not yet been evaluated. Hypnosis can be described as a heightened state of focal concentration and receptivity to the suggestions of another person. This person brings about the hypnotic state by focusing the person's attention on a monotonous routine. This review included one study (involving 63 women) but it did not contribute any data to this review. There is insufficient evidence from randomised controlled trials to determine whether hypnosis is effective for preventing PND when compared with usual antenatal, birthing, or postnatal care procedures. Two trials are currently underway however, which may provide further information in the future.

Antidepressant prevention of postnatal depression

Postnatal depression is a common and important disorder with negative implications for the mother, the infant and the wider family. Women who are not depressed, but at high risk of postnatal depression, such as those with a previous history of a postpartum mood disorder, may wish to consider antidepressant prevention during pregnancy or early postpartum. This review addresses the effectiveness of such treatment. Only two small trials met the criteria for inclusion. Both trials used medication immediately postpartum. The drugs were nortriptyline, a tricylic antidepressant (TCA) and sertraline, a selective serotonin reuptake inhibitor (SSRI). Both drugs were compared only to placebo. Nortripyline was not shown to have any benefit over placebo; there was some evidence that sertraline was effective both in reducing the incidence of recurrent postpartum depression and in increasing the time to recurrence. However, both trials involved only very small numbers of women and did not use intention to treat analyses. There is, therefore, no clear evidence for the use of these antidepressants in the prevention of postnatal depression.

Psychosocial and psychological interventions for postpartum depression

Postpartum depression affects approximately 13% of all new mothers. Many women desire to try treatment options other than medication. Results from nine trials involving 956 women found that both psychosocial (e.g., peer support, non‐directive counselling) and psychological (e.g., cognitive behavioural therapy and interpersonal psychotherapy) interventions appear to be effective in reducing symptoms of postpartum depression. The long‐term benefits are unknown. Larger trials evaluating psychosocial and psychological treatments for postpartum depression are needed to provide clear conclusions about specific intervention benefits.

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More about Postnatal Depression

Photo of a young adult woman

Also called: Puerperal depression, Post-partum depression, Post-natal depression, PPD

Other terms to know:
Depression, Major Depression (Major Depressive Disorder), Pregnancy (Gestation)

Related articles:
Depression After Childbirth: Treatment Approaches

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