What help is available
“I was too scared to tell anyone how I really felt in case they took my baby away.”
You may fear that your baby will be taken away if you admit to feeling depressed, anxious or having distressing thoughts, for example, about harming yourself or the baby. But fear of asking for help may be part of the problem, and you may need encouragement and support in getting it.
PND is not only a distressing condition, it can also be a disabling one, so the earlier you get help the better. If PND is acknowledged and addressed, it is likely to pass sooner and be less severe than if you get no help. It is then also less likely to affect the relationship between you and your baby.
“I thought I was a bad mother, until I told my health visitor how I was feeling. When she named ‘it’ postnatal depression and got me the right support, it felt like someone had opened the door and let a glimmer of sunlight in.”
There are many health professionals who are familiar with these issues and who can provide you with support in several different ways. These may include your doctor, midwife, health visitor, community psychiatric nurse, psychiatrist, psychotherapist or counsellor, or complementary practitioner.
Research suggests that the treatment most new mothers prefer for PND is a combination of practical support and advice, and counselling or psychotherapy. If necessary, antidepressants may be an option.
Counselling and psychotherapy
Talking treatments, such as counselling and psychotherapy, can offer you the opportunity to look at the underlying reasons that have contributed to the way you feel, as well as helping you to change and manage your feelings.
Many doctors have a counsellor or psychotherapist attached to their practice. They can also refer you to a psychiatrist or psychologist at Hospital Authority. Various organisations offer talking treatments, and some of them operate a low fee scheme for those who cannot afford to pay. Cognitive behavioural therapy (CBT) is increasingly popular as a short-term treatment that provides practical ways of dealing with problems. Talking therapies should be more readily available to you if you are pregnant or breastfeeding because of the increased risk of using medicines at these times.
Your doctor can prescribe medication to help you. It is important to discuss potential benefits and side effects fully, before taking any, and to keep monitoring your progress with them.
Medication may enter breast milk, and if you are breastfeeding you will need to bear this in mind when deciding whether or not to take it. Some drugs have known effects on infants, while others appear to be quite safe, so it is important to discuss this with your doctor. If you do decide to try medication, it may be necessary to try different drugs to achieve the best results.
All antidepressants take time to work. If you do take them, they can be very effective, but you should be prepared to take them for at least six months.
They also all have possible side effects, and when you stop taking them you should withdraw slowly, to avoid possible withdrawal effects which can be unpleasant.
Manufacturers advise that the following antidepressants should be avoided while breastfeeding: doxepin; phenelzine, isocarboxazid, moclobemide; citalopram, escitalopram, fluoxetine, fluvoxamine, sertraline; duloxetine, venlafaxine; flupentixol, mirtazapine, reboxetine, and agomelatine.
Mood stabilisers, such as lithium, should also be avoided while breastfeeding.
Sleeping pills and tranqullisers
If lack of sleep has become a habit you cannot break, your doctor may consider prescribing sleeping pills to help you. Any sleeping pills should be taken for brief periods only, and preferably not for several nights in a row, in order to avoid becoming dependent on them.
They should not be taken if you are breastfeeding because they are excreted in breast milk, and are then absorbed by the baby.
You may also be taking other medication for a mental health problem or physical condition. These can sometimes interact with drugs the doctor may wish to prescribe for postnatal depression. All drugs should be used with caution. Talk to your doctor if you need more advice about a particular drug or combination of drugs.
Electroconvulsive therapy (ECT)
ECT is a controversial treatment, but some psychiatrists favour it for PND because when it works it can relieve depression quickly. The treatment is done under anaesthetic and involves passing an electrical current through the brain. Many people are nervous of it, and it does not work for everyone. It can also have serious side effects.
Some women have found complementary therapies helpful when they experience PND. These are holistic therapies – treating you as a whole person to support your body and mind in healing. They include cranial osteopathy, herbal remedies, homeopathy, massage, traditional Chinese medicine, acupuncture, reflexology and aromatherapy. Some people find these therapies can help them relax and may reduce symptoms of, for example, depression and anxiety.