Postnatal depression

What causes postnatal depression, signs to look for, how to determine if you have a problem and treatment options.
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Found in: Mental Health Conditions
Date: November 2019

About postnatal depression

Postnatal depression affects 10-20% of new mothers. Living through postnatal depression can be overwhelming, with feelings of great sadness and pain.

There are three types of childbirth-related depression:

  • Postnatal or maternity blues are very common. A new parent feels down and tearful in the week after her baby is born. This feeling passes after a few days.
  • Postnatal depression, a more serious condition, is also common. The person becomes seriously depressed in the first months following the baby's birth. It can occur any time during the baby’s first year. 
  • Postnatal psychosis (sometimes called post partum psychosis) is rare and involves symptoms of psychosis (being out of touch with reality) as well as changes in mood – either a depressed or an extremely high mood. It usually begins in the first two weeks after the child is born. It can be managed well – particularly if help is sought early.

This page is about postnatal depression

People who have never been mentally unwell before can experience postnatal depression after pregnancy. Others may have had depression or a psychotic illness in the past. Regardless of whether you have prior experience of mental distress, the symptoms and treatment of postnatal depression are similar.

The major difference between this form of depression compared to other forms is you have a newborn baby to look after while you’re experiencing depression. It’s very important to get help and support as early as possible.

Because postnatal depression can affect how you feel about and care for, your baby and other children it is important not to ignore any signs that something may be wrong. You’re not a bad parent and postnatal depression doesn’t mean you don’t love your baby. It just means you’re human and you need some extra support. Talk to your midwife or doctor as soon as you can.

If you fear you might harm or kill yourself it is vital that you seek help immediately by dialling 111.

Postnatal depression is common, can be easily treated and you will get better with the right support and a little time.

What causes postnatal depression?

While anyone who gives birth is vulnerable, there are certain factors that increase the chances of developing postnatal depression.

Risk factors before pregnancy and birth:
  • Past history of depression or other mental health problem(s).
  • Relationship difficulties, especially with the father of the baby or with own mother.
  • Having little social support.
  • Onset of depression during pregnancy.
  • Hormonal problems.
  • Life stresses or difficulties such as money or housing problems.

Risk factors related to the birth:
  • Birth complications, such as caesarean delivery can lead to experiencing ‘birth trauma’.
  • The birth did not live up to expectations, e.g, birth in hospital or with medical intervention
  • when the person wanted a home or natural birth.
  • Baby has health problems, including damage caused by birth

Risk factors after birth:
  • Ongoing postnatal blues.
  • The mother experiences sleep problems.
  • The baby is fussy, has problems feeding, or has colic or reflux.


Signs to look for (symptoms)

The signs of postnatal depression are the same as for depression, which can occur at any other time. These may vary between over time or from person to person.

  • Feeling low, sad or depressed.  You might feel sad or empty, you might not feel anything at all. You might experience pain that’s hard to describe or locate. You may cry for no apparent reason. Some people feel sad or low all the time, others have periods where they feel better that do not last longer than a day or two. People from non-European cultures might have different words to describe this feeling. If you’re Māori, you might think of it as feeling wainuku (really low or down in the dumps), whākama (shame) or whākamaemae (emotional pain or distress).
  • Losing interest and pleasure in usual activities. This means you don’t enjoy things you usually would. 
  • Feeling irritable or angry for no reason. Some people find this is the main sign that something is wrong following childbirth. It can make dealing with the frustrations of caring for a young baby more difficult and can cause harm to other relationships.
  • Change in sleeping patterns. The most common change is reduced sleep, with difficulty getting to sleep, disturbed sleep, and/or waking early and being unable to return to sleep. While it is usual for new parents to have their sleep interrupted by a waking baby, people with postnatal depression often find they cannot sleep even when the baby is settled. You may lie awake worrying about the next feed or the next day.
  • Not feeling connected to baby or feeling overly anxious about baby. Some people experience both these things These feelings can cause whākama or shame and can mean some people are too ashamed to ask for help or share how they’re feeling. Understanding it’s a common part of experiencing postnatal depression and not a sign you’re a bad parent can be the first step toward recovery.
  • Change in appetite, often not feeling like eating and, as a result, lose weight. Some people will have increased appetite, often without taking any pleasure in eating. 
  • Decreased energy, tiredness and fatigue is common. You may feel that the smallest and simplest things are impossible. This makes caring for a baby more difficult.
  • Physical slowing or agitation often comes with severe postnatal depression. You may sit in one place for periods and move, respond and talk very slowly; or you may be unable to sit still, pace and wring your hands.
  • Feeling worthless or guilty involves loss of self-confidence, and this may make you withdraw from friends and whānau. You may also feel you’re a bad parent or doubt you can care for your baby.
  • Having thoughts of hopelessness and death and feeling there is no hope in life. 
  • Difficulty thinking clearly - you may have difficulty in concentrating or in making simple, everyday decisions.
  • Feeling anxious – there are different kinds of anxiety you may be feeling.They may include:
    • Excessive worry or fear (often about your baby) sometimes with physical symptoms such as muscle tension, pounding heart or dry mouth.
    • Panic attacks, with sudden episodes of extreme anxiety and panic and physical symptoms of fear. Often this will involve panicking about your baby.
    • Phobias. Specific fears about situations, fear of open spaces, confined spaces, heights, objects, animals.
    • Excessive concern about physical health. You may worry you are physically ill in some way, or your baby is ill or has something terribly wrong with him/her.

How to decide if you have a problem

If you are concerned, or suspect you (or a loved one) has postnatal depression it is important to talk to your midwife, doctor or Plunket nurse.

Remember, depression is a serious illness and you do need to see your doctor if you suspect you may be suffering from it. If you have any concerns or questions, you can contact a PlunketLine nurse 24 hours a day and free from any phone: 0800 933 922

Treatment options

Treatment of postnatal depression can involve different things, each of which can be tailored to your individual needs.

Your GP will recommend a mix of treatment options which best suits you. If you are not happy with the treatment you’re receiving, talk to your GP before stopping.

Try to work with them to identify what isn’t working for you and find a compromise that supports your recovery. If you are on medication, don’t stop taking it without consulting your doctor. Stopping some medications suddenly can make you feel worse.

Therapy, such as counselling

Supportive counselling is an effective treatment for milder forms of postnatal depression – in fact, it is as effective an antidepressant medication.

More specific therapies such as cognitive behaviour therapy, (CBT) are very effective to help people recover from postnatal depression. It teaches you to use your skills and resources to cope and recover.

Learning more about postnatal depression

Education about postnatal depression can be extremely important to help the new parent and their family/whānau and supporters to understand and help in their recovery. Talking about it with friends and family/whānau will help.


Your doctor may prescribe you with antidepressants. Finding the right medication can be a matter of trial and error – there is no way to predict which medication will be effective and tolerated (have fewer troublesome side effects) by any one person.

If you are prescribed medication you are entitled to know:
  • the names of the medicines
  • what symptoms they are supposed to treat
  • how long it will be before they take effect
  •  how long you will have to take them for and what their side effects (short and long-term) are. 

If you are breast feeding no medication is entirely safe. Before making any decisions about taking medication talk with your GP about the potential benefits and problems. 

It is important not to stop taking antidepressants suddenly without medical advice.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. 

These could include mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy. These have all been shown to have some effect in alleviating mental distress. 

When considering taking any supplement, herbal or medicinal preparation you should consult your doctor to make sure it is safe and will not harm your health, for example, by interacting with any other medications you are taking. 

What can I do to help myself?

You’re the expert in your own mental health and wellbeing. Taking charge of your recovery and doing things that make you feel better, stronger and more in control will help your recovery from postnatal depression.

When you have depression, it can be hard to find the energy or motivation to look after yourself.

Start small – return a text message, open a window, close your eyes and listen to the birds singing.

Slowly build up to bigger things and try to notice what makes you feel better.

Make a list of things that feel good and keep it on your phone, your diary or on the fridge. When you’re struggling, check your list and pick one thing you can do right now that might help.

These may include:
  • Learning about postnatal depression and read/listen to stories of other people who have found a way through.
  • Learning your particular early warning signs or triggers by keeping a mood diary.
  • Identifying and reducing stressful activities.
  • Ensuring you are eating healthy food.
  • Using relaxation exercises, yoga, meditation or massage.
  • Getting enough sleep (this can be difficult for new parents, but sleeping when you can is important).
  • Spending time in nature – even just sitting in the sunshine listening to the birds singing for a few moments can be really helpful.
  • Getting some exercise.
  • Peer support (e.g. support groups).
  • Support from people with the same background as you (if you feel that is important to you; e.g. age, ethnic group, sexual orientation).
  • Getting support from family/whānau, friends, therapists.
  • Humour: comedies on TV, funny movies.
  • Cut back on non-prescribed drugs and alcohol.
  • Fun: Make sure you regularly do things that you enjoy and that give your life meaning.
  • Being kind to yourself and others.
  • Practices from your own culture (e.g. Māori or Pasifika therapies).
  • Write a ‘relapse plan’.

Having a “Wellbeing Plan”

Many people find that having a written plan, developed together with your GP/psychiatrist can help you to feel you’re in control if difficult feelings return.

Make sure others (i.e. family/whānau, partners, and community mental health staff) are aware of your plan and what you’d like to happen if you become unwell again. Plans can detail (in your own words) symptoms, what can trigger these feelings and what things help you. 

They can also list the numbers of support people, helplines and more, and outline what you’d like to happen if you need professional support.

Family/whānau support and involvement

The level of family/whānau support and involvement you need is up to you.

Family/whānau members may be struggling to know how to help. If there are specific things that would help you, try asking for them. Say: “it would be really helpful if you helped me fold the laundry/washed the dishes/hold the baby while I shower/take the other kids out for a bit.”

Remember it may be difficult and distressing for family/whānau and friends to see you feeling so low, and they may need to:

  • Seek support for themselves from friends, family/whānau and/or counsellors.
  • Educate themselves on postnatal depression.
  • Get help with understanding what is happening to you.
  • Learn to set clear boundaries about behaviour.
  • Learn to manage their own stress.

Family/whānau can learn to use words that may help you feel supported:

  • “You are not alone in this. I'm here for you”.
  • “You may not believe it now, but the way you're feelings will change”.
  • “I may not be able to understand exactly how you feel, but I care about you and want to help”.
  • “You are important to me. Your life is important to me”.

Support for fathers/partners

Fathers /partners can also feel overwhelmed post birth. Ensure your partner gets his/her own support. Plunket has a great podcast on paternal mental health.

Myths about postnatal depression

Postnatal or any depression is a sign of a weak character.

Postnatal depression can strike any person after the birth of a baby. While some particular personality types may be more likely to develop depression, the vast majority of people who develop the condition have been previously healthy and led normal lives.

People with postnatal depression can 'snap out of it' or just choose to 'pull their socks up'.

NOT TRUE One of the most disabling symptoms of depression is the fact that it saps the will and makes doing anything an enormous effort. Depression is an unpleasant experience, and most people with this condition would (and do) do anything to get well. ‘Snapping out of it’ is not an option.

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