Postnatal depression - Treatment 

Treating postnatal depression 

CBT expert

Professor David Clark explains how cognitive behavioural therapy (CBT) works and who could benefit from it.

Media last reviewed: 24/04/2013

Next review due: 24/04/2015

St John's wort

St John's wort is a herbal remedy that some people take for depression. However, it's not recommended as a treatment for depression.

Although there's some evidence that St John's wort is beneficial in treating mild or moderate depression, it's not tested as rigorously as a medicine.

The strength of the active ingredients in different preparations of St John's wort varies. As a result, uncertainty exists about appropriate doses and how long its effects last for.

It can also cause serious problems if taken with other medications, such as oral contraceptives, anticoagulants and anticonvulsants.

Speak to your GP, midwife or health visitor as soon as possible if you think you have postnatal depression.

It's important for you and your family to remember it can take time to recover fully from the condition.

Common treatments and help for postnatal depression are detailed below.

Support and advice

The most important first step in managing postnatal depression is recognising the problem and taking action to deal with it. The support and understanding of your partner, family and friends plays a big part in your recovery.

However, to benefit from this, it's important for you to talk to those close to you and explain how you feel. Bottling everything up can cause tension, particularly with your partner, who may feel shut out.

Support and advice from social workers or counsellors can also be helpful. Self-help groups can provide good advice about how to cope with the effects of postnatal depression, and you may find it reassuring to meet other women who feel the same as you.

Ask your health visitor about the services in your area.

Exercise

Exercise has been proven to help depression, and it's one of the main treatments for mild depression.

Your GP may refer you to a qualified fitness trainer who will be able to provide you with a suitable exercise programme.

Read more about exercise for depression and getting started with exercise.

Psychological treatments

Psychological therapies are usually recommended as the first line of treatment for mild-to-moderate postnatal depression for women with no previous history of mental health conditions.

Some common ones are discussed below.

Guided self-help

Guided self-help is based on the principle that your GP can "help you to help yourself".

For example, your GP can provide self-help manuals detailing types of issues you might be facing and practical advice on how to deal with them. They also contain information on using cognitive behavioural techniques to help combat feelings of helplessness (see below for more information).

Your GP may also give you details about an interactive computer programme that's available on the internet, called Beating the Blues. This also takes a cognitive behavioural approach to battling depression.

Talking therapies

Talking therapies are where you're encouraged to talk through problems either one-to-one with a counsellor or with a group. You can then discuss ways to approach problems in a more positive manner.

Cognitive behavioural therapy (CBT) and interpersonal therapy are two talking therapies widely used in the treatment of postnatal depression.

Cognitive behavioural therapy

CBT is a type of therapy based on the idea that unhelpful and unrealistic thinking leads to negative behaviour.

CBT aims to break this cycle and find new ways of thinking that can help you behave in a more positive way.

For example, thinking there's a perfect ideal of "motherly behaviour" that is both unrealistic and unhelpful. All mothers are human and humans make mistakes. It's neither necessary nor helpful to try and be “Supermum”.

CBT is usually provided in four to six weekly sessions.

Interpersonal therapy

Interpersonal therapy (IPT) aims to identify whether your relationships with others may be contributing towards feelings of depression.

Again, IPT is usually provided in four to six weekly sessions.

Antidepressants

Antidepressants may be recommended if:

  • you have moderate postnatal depression and a previous history of depression
  • you have severe postnatal depression
  • you've not responded to counselling or CBT or would prefer to try tablets first

A combination of talking therapies and an antidepressant may be recommended.

Antidepressants work by balancing mood-altering chemicals in your brain. They can help ease symptoms such as low mood, irritability, lack of concentration and sleeplessness, allowing you to function normally and helping you cope better with your new baby.

Contrary to popular myth, antidepressants aren't addictive. A course usually lasts six to nine months.

Antidepressants take two to four weeks to start working, so it's important to keep taking them even if you don't notice an improvement straight away. You should also continue taking your medicine for the full length of time recommended by your doctor. If you stop too early, depression may return.

Between 50-70% of women who have moderate to severe postnatal depression improve within a few weeks of starting antidepressants. However, they're not effective for everyone. 

Antidepressants and breastfeeding

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressants that are often recommended for breastfeeding women.

However, some SSRIs, such as fluoxetine, should be avoided while breastfeeding. The doctor who is treating you will prescribe an SSRI that is suitable for you to use.

Side effects of SSRIs include:

These side effects should pass once your body gets used to the medication.

You should discuss feeding options with your GP when you're making decisions about taking antidepressants.

Many mothers are keen to continue breastfeeding because they feel it helps them to bond with their child and boosts their self-esteem and confidence in maternal abilities. These are important factors in combating symptoms of postnatal depression.

Severe postnatal depression

Referral

You may be referred to a mental health team if you have severe postnatal depression, or if it doesn't respond to treatment. These teams are usually made up of a range of specialists, including psychologists, psychiatrists, specialist nurses and occupational therapists.

The specialist team will be able to provide you with a more intensive course of CBT to help you overcome your depression. If necessary, other types of talking therapies, such as psychotherapy, can be given at a later stage.

If it's felt your postnatal depression is so severe you're at risk of harming yourself or your baby, you may be admitted to hospital or referred to a mental health clinic. If you have the support of your partner or family, it may be recommended they care for your baby until you're well enough to return home.

If you don't have support available to help you care for your baby, or your mental health team feels separation from your baby would adversely affect your recovery, a transfer to a specialised "mother and baby" mental health clinic may be recommended.

Your baby may have to sleep in a separate nursery until you're well enough to look after them. Once your symptoms begin to respond to treatment, your baby will sleep in your room.

Medication

A small number of women develop symptoms of psychosis after giving birth (being unable to tell the difference between reality and their imagination).

This is termed puerperal psychosis and if this happens to you, you may be treated with a combination of:

  • mood-stabling medications, such as lithium or an anti-epileptic medication 
  • an antipsychotic (this helps combat the symptoms of psychosis)
  • a tranquiliser, such as a benzodiazepine, to help relax you

You can't breastfeed while taking these types of medications, so your baby will have to be bottle-fed.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) may be recommended if you have severe postnatal depression. However, it's only used when antidepressants and other treatments haven't worked.

If ECT is recommended, you'll be given a general anaesthetic and medication to relax your muscles. Electrodes will be placed on your head and a pulse of electricity passed through your brain. Most people have either six or 12 sessions of ECT, usually with two sessions a week.

For most people, ECT is effective in relieving severe depression, but it's necessary to take antidepressants afterwards to keep symptoms under control. It's unclear how ECT works, but the generally agreed view is that electricity changes the chemical composition of the brain in such a way as to elevate mood.

Some people experience unpleasant side effects after having ECT, including headaches and both short-term and long-term memory loss. Due to the risk of memory loss, your memory will be assessed at the end of each ECT session.

If it looks like your memory is being affected, or you experience other adverse side effects, the ECT sessions will be stopped. However, most people tolerate ECT very well.




Page last reviewed: 17/03/2014

Next review due: 17/03/2016

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DNAR said on 11 July 2012

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