Frequently asked questions about postnatal depression

Postnatal depression (PND) is one of the most common perinatal complications. It is estimated that 1 in every 10 mothers will develop it, and this figure could be higher in developing countries.

“Baby blues” or “maternity blues” is a mild and transient disorder that is experience by 70-80% of mothers. It is very influenced by sudden hormonal changes and consists of mood swings throughout the day, desires to cry, nervousness, irritability, and difficulties in concentrating. These symptoms are usually more intense in the 4th or 5th day after the birth, and disappear spontaneously after two weeks. PND is characterised by the presence of depressive symptoms for most of the day for at least two weeks. One recent study demonstrated that, in many cases, it may take at least one year to recover completely.

The exact causes of postnatal depression are unknown, but it is considered that there are different vulnerabilities that can precipitate it. The hypothesis that try to explain the appearance and persistence of postnatal depression are included within the general model of vulnerability to stress. This model considers birth as a neurohormonal and immunological stress episode and the transition to motherhood as a psychosocial stress episode.

Antidepressant drugs are found in maternal milk and reach the infant. However, many of the antidepressants are compatible with breastfeeding, therefore, in general, it is not necessary to stop breastfeeding for pharmacological treatment with antidepressants. The main perinatal mental health clinical guidelines and those of international and Spanish scientific societies do not advise stopping the use of antidepressants during pregnancy or breastfeeding, and that an individualised evaluation must be made taking into account all aspects. The risks of the antidepressants and the untreated depression need to be assessed, as well as the benefits of maintaining breastfeeding and the effects of the antidepressants on maternal health.

No. Studies show that one-third of the mothers with a depressive episode in the postnatal period have difficulties starting and/or maintaining the bond with the newborn baby. The mothers can experience ambivalence or a lack of an emotional response towards the baby, to feel trapped in the current situation and begin to feel unable to care the newborn.

The main risk factors of postnatal depression are: the presence of anxiety and/or depressive symptoms during pregnancy, a personal history of a depressive disorder and a history of postnatal depression in first grade family members (mother, sister). In the case of having this history or having clinical signs of anxiety-depression during pregnancy it is recommended to talk to the midwife.

At the current time, the diagnosis of postnatal depression is made by mental health professionals (psychiatrists and/or clinical psychologists). There are no biological or imaging tests for its diagnosis. However, an overall medical assessment must be made in order to reject and treat other disorders that could aggravate the symptoms (such as thyroid disorders or anaemia).

Postnatal depression has a significant impact on the woman that has it: it negatively interferes in wellbeing, in the quality of life, and in the general functioning as a mother, as a partner, and as a worker. The depression may also have an impact on bonding with the newborn child, and some studies have associated the presence of persistent maternal depressive symptoms with psychiatric illness in minors during adolescence.

Being a mother does not protect from depression or thoughts of death and/or suicide. When the mother has a depression in the postnatal period it can lead to thinking that it is not worth living, may be afraid of hurting herself and even the newborn baby. These thoughts can be a symptom of postnatal depression, requiring appropriate treatment to help them disappear and be well again.

If you believe that you have postnatal depression, talk to a health professional (midwife, paediatrician, Primary Care) in order to make a primary assessment and to decide what may be the most appropriate treatment in your case.