Postnatal depression (PND) is a type of depression
some women experience after having a baby.
Becoming a mother impacts a woman physically,
socially, economically and emotionally. The ways in
which motherhood affects a woman ultimately affects
the lives of her baby, the baby’s father, her family and
friends. When a woman fails to adapt to the role of
mothering an infant, she is identified as having PND
The postnatal period is a time when joy is the
expectation and so women are reluctant to admit to
mood symptoms because they feel embarrassed,
stigmatised or may worry about the child being taken
into care (Boots Family Trust, 2013).
Overview of PND
Symptoms can start soon after giving birth and
last for months or, in severe cases, they can persist
for more than a year.
• A persistent feeling of sadness and low mood
• Feelings of hopelessness
• Feelings of guilt
• Low self-confidence
• Thoughts of self harm or suicide
(Kendall-Tackett & Kantor, 1993; NHS, 2015).
Mothers may be reluctant to address these
issues on their own so the Edinburgh Postnatal
Depression Scale (EPDS; Cox, Holden &
Sagovsky, 1987) is a useful tool in revealing
PND is caused by a combination of physiological,
psychological and social factors.
Physiological factors: women undergo changes in
hormonal levels in the postnatal period. Depression
is likely to occur if oestrogen and progesterone
levels are low and there is a large drop in these
after a woman has given birth
Psychological factors: a woman’s expectations of
motherhood; her self-esteem; and prior vulnerability
factors such as having a dysfunctional family
Social factors: amount of help the mother has
with the baby; amount of emotional support she
receives; demographic characteristics; and her
exposure to stressful life events (Kendall-Tackett &
For mothers, effects of PND can include failure
to bond with their baby, a broken relationship with
the father and suicide attempts (Cantwell, Clutton-
Brock, Cooper et al., 2011). Effects can also
include reduced maternal caregiving activities (e.g.,
breastfeeding, sleep routines vaccinations),
maladaptive parenting behaviour, and behavioural
problems and cognitive and linguistic delays in
children (Field, 2010; Grace, Evindar, & Stewart,
2003; Reck et al., 2004).
Types of treatment available to PND sufferers
considering the types of treatment available
• Directive therapy – cognitive-behavioural therapy (CBT) and
cognitive-analytic therapy (CAT)
These therapies focus on ‘cognitions’ and changing the way a
person thinks about themself and the world around them.
Research identifies resolving past difficulties can resolve PND
(Nicholson 1999; Mauthner 2002). Nicolson (1999) suggested
women gained strength when past difficulties were managed
successfully. Mauthner (2002) stated women who resolved past
issues and conflicts were more satisfied with their role as mothers.
• Non-directive counselling – person-centered counselling
This type of counseling, introduced by Carl Rogers, does not
offer direct advice, but rather allows the patient to hear themselves
discuss their own options out loud to come to a decision. Glavin,
Smith, Sørum & Ellefsen (2010) examined the effect of supportive
counselling by public health nurses on PND and suggested the
non-directive counselling method is an effective treatment method.
• Routine primary care – visits from health nurses
Health nurses visiting the mother know her health history and
are her best resource for making sure she gets the right care.
Wickberg & Hwang (1996) study on the effectiveness of
counselling on Swedish women with PND found 80% of women
with depression in the study group fully recovered after counselling
compared to 25% of women in the control group who did not
receive counselling. They suggested counselling by health nurses
is helpful in managing postnatal depression.
However, Cooper, Murray, Wilson & Romaniuk (2003)
compared different psychotherapeutic approaches for PND and
found little benefit at nine months after birth. In the study, 93
women with PND were randomised to CBT, non-directive
counselling, routine primary care or psychodynamic therapy. Only
the psychodynamic therapy produced significant reduction in
depression in comparison to the control group at 4.5 months, and
by nine months none of the treatments seemed superior to the
control group. The study highlights the importance of further
research comparing alternative treatment approaches for PND.
• Complementary therapies – aromatherapy and exercise
Perrya, Thurstona & Osbornb’s (2008) study on the arts as
therapy in PND found some women become and remained more
confident, but many expressed that after therapy had ended they
returned to their low feelings. Thus longer-term support is needed.
• Antidepressants – pills
Antidepressants balance mood-altering chemicals in the brain,
reducing symptoms and allowing normal functioning. Appleby,
Warner, Whitton & Faragher (1997) evaluated the pharmacological
treatment of PND. The study compared four treatment groups:
fluoxetine plus a single session of CBT; placebo plus a single
session of CBT; fluoxetine plus six sessions of CBT; and placebo
plus six sessions of CBT. After four weeks of treatment, similar
improvements occurred among women receiving either six
sessions of CBT, or fluoxetine plus one session of CBT. The study
shows women's choice of treatment may be guided by their
preference of pharmacological or non-pharmacological
approaches as both seem effective.
However, fluoxetine has been linked with irritability, sleep
disturbance, and poor feeding in some infants exposed to it in
breast milk. Although the data regarding antidepressants during
breast feeding are generally favourable, little is known about the
long term effects of exposure to antidepressants on the child's
developing brain. Many new mothers remain reluctant to take such
medications while nursing (Burt, Suri, Altshuler, Stowe, Hendrick &
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