Perinatal depression

Most parents experience a degree of worry with ups and downs in their mood when expecting a baby or coping with a newborn. Postnatal or maternity ‘blues’ are very common and involve a brief period of the mother feeling down and tearful in the week after her baby is born. This feeling passes after a few days.

However, some women develop a more pronounced anxiety or depressed mood that affects their daily life and functioning. This is known as perinatal depression or perinatal anxiety. These are much more serious conditions, and you can become seriously depressed or anxious. This can start during pregnancy but is more common in the months following childbirth.

Postnatal psychosis (sometimes called postpartum psychosis) is rare and involves symptoms of psychosis (being out of touch with reality) associated with significant changes in mood – either a depressed or an extremely high mood. It usually begins in the first 2 weeks after your child is born. Read more about postnatal psychosis(external link)(external link) (Mental Health Foundation, NZ).

Perinatal obsessive-compulsive disorder (OCD) affects about 2–3% of mothers. This often involves intrusive thoughts around their baby being harmed in some way and ritualised behaviours to control the resulting anxiety. Read more about perinatal OCD(external link)(external link) (Perinatal Anxiety and Depression NZ).

About 10 to 15% of women will develop anxiety or depression in the months after the birth of a baby. It may also start during pregnancy, and, if untreated, continue and perhaps get worse after the baby is born.

Perinatal depression or anxiety is likely to be associated with several factors, such as your previous history of anxiety and depression and factors in your environment, such as how much other stress there is in your life and how much support you have.

In terms of life stress, pregnancy, childbirth and parenting all rate highly, with many adjustments to be made and stressful situations to be coped with. It’s not surprising then that those with the following extra factors in their life are at risk of developing perinatal depression or anxiety. 

The hormonal changes your body goes through may also play a small role in the development of perinatal anxiety and depression.

General risk factors include:

• past history of anxiety, depression or other mental health problems
• relationship difficulties, especially with the father of the baby or with your own mother
• having little social support
• life stresses or difficulties such as money or housing problems.

Risk factors related to pregnancy and birth include:

• previous loss, including infertility, IVF, miscarriage, termination, stillbirth or death of baby
• birth complications, such as Caesarean delivery
• the birth not going as planned (eg, birth in hospital or with intervention when a home or natural birth was hoped for)
• birth of a brain-damaged, disabled or ill baby.

Risk factors after birth include:

• persisting postnatal blues
• having a baby in neonatal intensive care (NICU)
• relationship difficulties
• competing demands (from other children, your partner, family, etc)
• sleep problems
• underlying medical problems (like diabetes, high blood pressure, etc)
• a baby that is fussy, has problems feeding or has colic or reflux
• isolation and lack of social connections.

Getting help early can reduce how severe your symptoms get and improve your chances of a faster recovery.

The signs or symptoms of perinatal depression are similar to those for depression. Symptoms can vary from person to person and over time. Not everyone with depression will complain of sadness or a persistent low mood. They may have other signs of depression such as sleep problems. Others will complain of vague physical symptoms.

The symptoms of depression include those related to :

• your feelings (mood)
• your body (physical) 
• your thoughts and beliefs (cognitive).

Some women also have anxiety symptoms. For a diagnosis of depression to be made, mood symptoms and some or all of the other signs must have been present for at least 2 weeks. 

Mood symptoms of perinatal depression

• Persistent low, sad or depressed mood. People have different ways of describing this, especially if you are from non-European cultures. Some women describe feeling sad, empty, having no feelings, or may complain of pain which is hard to locate. Others may cry for no apparent reason. Some may feel sad or low in mood all of the time, while others have periods where their mood is more normal but the periods of feeling good do not last more than a day or two.
• Loss of interest and pleasure in usual activities. This is a reduced ability to enjoy things which you would usually find pleasurable, and can be quite distressing. It includes loss of interest in sex, although this often lessens for a period after childbirth as a result of hormonal changes.
• Irritable mood. This may be the main mood change for some. You may feel angry, short-tempered and irritable. If it continues, it can make dealing with the frustrations of caring for a baby very difficult, and may also be very damaging to other relationships.

Physical symptoms of perinatal depression

• 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. For a few women, sleep is increased. Most people with depression wake feeling unrefreshed from their sleep. While it is usual for mothers to have their sleep interrupted by a waking baby, women with perinatal depression often find they cannot sleep even when the baby is settled. For example, you may lie awake worrying about the next feed or the next day.
• Change in appetite, often not feeling like eating and, as a result, losing weight. Some women will have increased appetite, often without taking any pleasure in eating. This is often seen in those who also sleep more.
• Decreased energy, tiredness and fatigue may be so severe that even the smallest task seems too difficult to complete, causing great difficulty in caring for the baby. Women with postnatal depression need a lot of assistance with caring for the baby and any other children.
• Physical slowing or agitation often comes with severe depression. The person may sit in one place for periods and move, respond and talk very slowly; or they may be unable to sit still, pace and wring their hands. The same person may experience alternating slowing and agitation.
• Bodily symptoms such as generalised aches and pains, headaches and generally feeling unwell.

Cognitive symptoms of perinatal depression

• Thoughts of worthlessness or guilt involve loss of self-confidence and excessive guilt about past minor wrongs. As a result of feeling bad about themselves, women may withdraw from doing things and from contact with others. They may also feel they are a bad mother.
• Thoughts of hopelessness and death and feeling there is no hope in life. The woman may wish she were dead or have thoughts of suicide. While many women with postnatal depression have thoughts of harming themselves (and sometimes their baby), often it is not that they want to die or hurt the baby, but rather they want the situation to change.
• Difficulty thinking clearly. Some women may have difficulty in concentrating. They may not feel able to read the paper or watch television. They may also have great difficulty making even simple everyday decisions.
• Anxiety symptoms of various kinds are also very common as part of depression (80 to 90% of people with depression) but as the depression resolves, these symptoms stop. They may include:
  • Excessive worry or fear, with associated physical symptoms such as muscle tension, pounding heart or dry mouth. The focus of worry will often be the baby.
  • Panic symptoms or even panic attacks, with sudden episodes of extreme anxiety and panic and physical symptoms of fear. Again, the focus is often to do with the baby,
  • Phobias. Specific fears about situations, fear of open spaces, confined spaces, heights, objects, animals or creatures such as spiders.
  • Excessive concern about physical health. The woman may worry she is physically ill in some way, or that her baby is ill or has something terribly wrong with him/her. 

Symptoms of perinatal anxiety

These include:

• anxiety or fear that interrupts thoughts and interferes with daily tasks
• panic symptoms or attacks – outbursts of extreme fear and panic that are overwhelming and feel difficult to bring under control
• anxiety and worries that keep coming into your mind and are difficult to stop or control
• constantly feeling irritable, restless or on edge
• having tense muscles, a tight chest and heart palpitations
• finding it difficult to relax and/or taking a long time to fall asleep at night
• anxiety or fear that stops you going out with your baby
• anxiety or fear that leads you to check on your baby constantly.

If you have some of these symptoms, talk to your doctor, midwife or Well Child Tamariki Ora provider. 

Self-tests

The Edinburgh Postnatal Depression Scale (EPDS)

This is one of the most well-known screening tools for perinatal depression or anxiety. It consists of a set of 10 screening questions that can help assess symptoms that are common in women with depression and anxiety during pregnancy and in the first year after having a baby (Questions 3, 4 and 5 address anxiety specifically). This is not intended to provide a diagnosis – only trained health professionals should do this. 

You can take the test here

Other self-tests

Self-test(external link) from the National Depression Initiative 

If you are concerned and think you (or someone you care about) may have perinatal depression or anxiety, talk to your midwife, doctor, Plunket nurse or Well Child Tamariki Ora provider.

There is no medical test that can diagnose depression. To make a diagnosis, your health professional needs a full understanding of the difficulties you are experiencing. They will ask whether you are experiencing any of the signs of depression listed above. You may find it helpful for your family/whānau or close friend to be involved in this discussion.

If you are experiencing signs of perinatal depression or postnatal psychosis, seek help as early as possible. These conditions can both be effectively treated, and you are likely to recover.

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. The earlier treatment is started, the better your chances of recovery.

"I don’t think I’m depressed or anxious, but I’m struggling – what can I do?"

Many parents are surprised by how difficult they find adjusting to their new roles as parents or to the birth of another child. It’s common for mums (and dads) to feel overwhelmed and out of their depth.

If you’re finding parenting hard and need extra support, talk to your midwife, doctor or Well Child Tamariki Ora provider. There are many services available that can make all the difference when you’re struggling. The sooner you talk to someone and get some extra supports put in place – be it a parenting group, a meal train or an online forum – the sooner you’ll start to feel better.

See also our self-care and support sections below.

Perinatal depression or anxiety are not only distressing conditions, they can also be disabling, so the earlier you get help the better. If perinatal depression or anxiety 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.

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 GP, midwife, counsellor or complementary practitioner.

Research suggests that the treatment most women prefer for perinatal depression or anxiety is a combination of practical support and advice, talk therapies and support groups. If necessary, antidepressants may be helpful.

Counselling and talking therapies

There are a range of talking treatments that have been shown to work for all types of depression and anxiety. Cognitive behaviour therapy is one of the most well known. Talking therapies are provided through face-to-face, phone, group or online programmes. 

Often you can refer yourself to a private counsellor or psychologist. For funded services, ask your health provider what the options are in your region and for a referral. 

For help and support(external link)(external link) Plunket, NZ

Education and courses

Learning about perinatal depression and anxiety can you understand what you are experience and can be a huge help in your recovery. Your doctor or other health professional will be able to give you information about perinatal depression or anxiety, suggest ways to cope with it and discuss any complications which could occur. There are also online courses you can take or ask your midwife or doctor about courses or groups in your area.

Perinatal depression and anxiety recovery and prevention course(external link)(external link) (sessions available in the Auckland area and online) Mothers Helpers, NZ

Medication

Sometimes medication is helpful or needed. Talk about the pros and cons with your doctor and together find one that works for you and has the least side effects for your baby. 

Once you start taking antidepressant medication, keep taking it every day. It takes several weeks to work and most side effects are mild and go away with time. If you have any concerns about possible side effects, talk with your pharmacist or doctor right away.

Read more about some of the common myths of antidepressants(external link)(external link) Mothers Helpers, NZ

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. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress. When considering taking any supplement, herbal or medicinal preparation talk to your doctor to make sure it is safe and will not harm your health, eg, by interacting with any other medications you are taking.  

If you have depression or anxiety, it can be hard to do the very things you need to do to take care of yourself. Your motivation tends to bottom out, leaving you stuck in a whirlpool of negative thoughts about yourself, your baby and your world.

You might feel quite overwhelmed with a loss of self-confidence and a sense that you are unable to do or change anything. Your thoughts may be full of "have to" and "should" but at the same time you may feel unable to do the things that will help you feel better.

As much as you can, try to put these feelings and thoughts to the side and choose to act. By choosing every day to do one small thing for yourself, you will slowly start to feel better.   

From the following ideas find what works best for you when you feel down or anxious. You may find it helpful to develop a list of things that help you and keep it pinned to the fridge. 

• Track your mood. You may find there are times of the day when you feel better and can get more done. Likewise, you may find triggers or activities you find more draining. Discuss these findings with your doctor or health providers.
• Keep active. Physical activity is very helpful for everyone and an excellent way to help manage anxiety and low mood, reduce stress hormones etc. 
• Establish good sleep routines. While interrupted sleep is normal once you have a baby, there are things you can do to foster good sleep routines. Try to develop a good bedtime routine which gives you time to unwind before bed and keeps bedtime and wake times relatively regular.
• Structured problem-solving. Some people are naturally good problem solvers. Most of us are not when we are tired, stressed or depressed. This is an evidence-based approach and easy to learn. View our structured problem-solving factsheet for 6 easy steps. 
• Plan activities. Plan some specific 'you time' activities a week ahead. Having something to look forward to, someone to catch up with, or some relaxation time while someone cares for baby are all great activities to improve balance and wellbeing. Planning ahead and writing it down also helps with getting the day to day activities done. Set yourself small goals each day you can achieve and feel good about. 
• Develop a good support system. This is so important. Reach out to friends and family, accept their offers of help and build your support network. Join a local mothers' group, playgroup or coffee group. Ask your Plunket Nurse(external link)(external link) or contact Parent's Centre(external link)(external link) for groups near you, or join Mothers Helpers private Facebook group – NZ PND Support and Social Group(external link)(external link). Spend time with people who make you feel good and are emotionally supportive. 
• WRAP: Wellness recovery action plan. This is another proven strategy anyone can set up and benefit from. Write a list of things that help you when you're having a bad day or feeling down eg, ring a friend, take the baby for a walk, play some music, dance, do something creative, put some nice clothes on and do your hair, journaling, join a class and learn something new.
• Find ways to give and help others. There is always someone worse off and better off than yourself. Look for little ways to help brighten someone else's day and in doing so it often brightens yours.

See more Tips to cope(external link)(external link) Little Shadows, NZ 

Apps reviewed by Healthify

You may find it useful to look at some Anxiety apps, Depression apps and Mental health and wellbeing apps for pregnancy and postpartum depression.

The length of time women are affected by perinatal depression or anxiety varies. Without treatment, it may continue for 6 months or more. With treatment, 70–80% of women will recover much sooner. Most women make a complete recovery.

Roughly 20–30% of women will improve but still have some symptoms of depression persisting for months or even years later. For a minority (5–10%) there is no improvement, with symptoms continuing for 2 or more years.

Early access to treatment increases the chance of full recovery. Some women have a single episode and remain well following the birth of future children. However, some will have postnatal depression or anxiety following any future births, particularly if you still have the same risk factors in your life. Others will go on to have other episodes of depression outside of the specific perinatal period.

Only mothers can formally be diagnosed with perinatal depression or anxiety. However, research suggests that between about 10% of men experience depression during the first year after the birth of a child.

Some new fathers appear to be more vulnerable to depression than others. Being young, unemployed and/or poor when the child is born increases the risk of depression after becoming a dad. It may be that young fathers are more at risk because being young might mean that it is less likely that the child was planned. A young dad might therefore not feel ready to take on the new responsibilities that come with fatherhood.

If the new mother is depressed, this might make the role as a father more stressful, which in turn can add to the risk of experiencing depression. Other possible causes include increased responsibility, the expense of having children and the change in lifestyle that it brings, the changed relationship with your partner, as well as lack of sleep and the increased workload at home. Few services exist for men, although awareness and understanding of this problem is improving slowly. Talk to your doctor if you are a new dad and feel anxious or depressed. 

What is it like to have perinatal anxiety or depression?

Emily Writes(external link) | Parents Editor

Emily Writes shares a group post on The Spinoff that outlines the many ways perinatal anxiety, depression and psychosis have affected New Zealand parents. We hope that anyone who sees themselves or their loved ones in these stories will seek help.

Read Emily's story here(external link) 

Video: More than baby blues

Emily had no idea what was happening to her when overwhelming feelings kicked in during her second pregnancy. At around 5–7 weeks her mood suddenly dropped: she couldn’t sleep, couldn’t keep her food down and found herself physically and emotionally exhausted. She was “utterly, utterly terrified because [I thought] they were going to take my children from me”. This video may take a few moments to load.

(RNZ, NZ, 2015)

Video: Mental health and motherhood

"Modern motherhood: we’re supposed to have it all, the career, the family and the life. But how do we make it work? When motherhood is nothing new, why do we have mothers on a path of despair and suffering from post natal depression?" Attitude Live explores the contributing factors and modern pressures on contemporary mothers. This video may take a few moments to load.

(Attitude Live, NZ, 2017)

Video: 60 minutes – Postnatal depression

An in-depth look at postnatal depression in New Zealand. This video may take a few moments to load.

(60 Minutes, NZ, 2015)

Sometimes people can’t tell you’re not okay from the outside. Talking with a trusted friend or family member, combined with professional counselling and other resources, provides broad support.

If you need to talk to someone immediately – call or text 1737 to reach a trained counsellor.

Low-cost counselling (Wellington region)(external link)(external link) Little Shadows NZ
Parent’s groups(external link) Mothers Helpers NZ
Support and services for mothers at-risk of or have developed postnatal depression(external link)(external link) Mothers Helpers NZ
Holistic recovery programme – perinatal depression and anxiety recovery and prevention course(external link)(external link) Mothers Helpers NZ
Support for partners(external link) Mothers Helpers NZ
The Journal(external link)(external link) Free personalised online programme to help you to stay positive, create lifestyle changes and learn steps for problem-solving
Support and education for women with experience of depression(external link)(external link) ThroughBlue, NZ
Perinatal Anxiety and Depression Aotearoa (PADA)(external link)(external link) 
Small Steps(external link)(external link) NZ

To find a maternal mental health service within your area, use the location filter under the map (mobile view) or at the bottom of the search results (computer view).

Source: HealthPoint services directory used with permission.