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The Courage To Be Disliked: A single book can change your life (Courage To series 1) eBook : Kishimi, Ichiro, Koga, Fumitake: Amazon.co.uk: Kindle Store

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From the woman who created EMDR therapy

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A must for anyone struggling with PTSD

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This is a bit of a chonky book but don't let that put you off. Little and often will work fine and it will probably change your world along the way.

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Practical strategies for using mindfulness to cope in times of mental distress.

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MINDFULNESS reveals a set of simple yet powerful practices that can be incorporated into daily life to help break the cycle of anxiety, stress, unhappiness, and exhaustion. It promotes the kind of happiness and peace that gets into your bones. It seeps into everything you do and helps you meet the worst that life throws at you with new courage. The book is based on Mindfulness-Based Cognitive Therapy (MBCT). MBCT revolves around a straightforward form of mindfulness meditation which takes just a few minutes a day for the full benefits to be revealed. MBCT has been clinically proven to be at least as effective as drugs for depression and is widely recommended by US physicians and the UK’s National Institute for Health and Clinical Excellence - in other words, it works. More importantly it also works for people who are not depressed but who are struggling to keep up with the constant demands of the modern world.MBCT was developed by the book’s author, Oxford professor Mark Williams, and his colleagues at the Universities of Cambridge and Toronto. By investing just 10 to 20 minutes each day, you can learn the simple mindfulness meditations at the heart of MBCT and fully reap their benefits. The book includes links to audio mediations to help guide you through the process. You’ll be surprised by how quickly these techniques will have you enjoying life again.

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Professor Paul Gilbert is the creator of and the world's leading authority on Compassion Focused Therapy. Mindfulness plays a big role in this approach and research has shown it can significantly improve mental health.

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Are you ready to transform your mind and emotions? To cultivate compassion, stability, self-confidence, and well-being? If so, get ready to change the way you experience your life with this highly-anticipated approach using mindfulness and compassion.

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Are you ready to transform your mind and emotions? To cultivate compassion, stability, self-confidence, and well-being? If so, get ready to change the way you experience your life with this highly-anticipated approach using mindfulness and compassion.Therapists have long been aware of mindfulness as a powerful attention skill that can help us live with greater clarity and awareness-but mindfulness alone is not enough to completely change the way a brain works.

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Guided Calming Meditation on Being Present in the Here and Now

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Guided Calming Meditation on Being Present in the Here and Now

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Daily Calm | 10 Minute Mindfulness Meditation | Be Present

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Whether it's sleep deprivation, money worries, new responsibilities, or the relationship dynamic shifting, dads also have a lot to take on board. This is a huge life change for both parents. On top of this, dads and co-parents might feel guilty about what their partner is going through, knowing they aren't the ones breastfeeding at 3am or healing from labour and birth.

Here's what you need to know about postnatal depression in partners. (Most of the research has been conducted in fathers to date, so while we often refer to dads below, we know it can apply to all types of partners.)

1. Dads and partners can experience depression in the first year after birth

The number of men who become depressed in the first year after becoming a dad is double that of the general population (Davé et al, 2010). Twenty five percent of dads experience mild depressive symptoms (Noorullah et al, 2020) and around 10% to 12% have a diagnosis of depression (Paulson et al, 2010; Philpott and Corcoran, 2018).

First time dads are appear to be more vulnerable to postnatal depression than dads welcoming subsequent children (Fatherhood Institute, 2010).

2. Postnatal depression in men and other partners often goes undiagnosed

The peak time for postnatal depression in men is three to six months after the birth (Fatherhood Institute, 2010).

As with postnatal depression in mums, it often goes undiagnosed. The symptoms can look a lot like the everyday stresses of having a newborn (Musser et al, 2013).

If you have concerns about your own or your partner's mental health, do seek help from your GP who can help you to access support services.

3. Hormonal changes may play a role

Just as with mums, changes in hormones might make postnatal depression in dads more likely (Saxbe et al, 2017).

Hormones including testosterone, oestrogen, cortisol, vasopressin, and prolactin may change in dads during the period after their babies arrive (Kim and Swain, 2007).

4. Postnatal depression in dads and partners is more likely if the mum has depression too

If one of you is experiencing emotional or mental health difficulties, it's more likely that the other is too. Of fathers with depressed partners, a quarter to half may experience depression themselves (Fatherhood Institute, 2010).

5. A range of factors can make dads and partners more likely to get postnatal depression

Dads who are under 25 are more likely to experience postnatal depression than their older counterparts (Davé et al, 2010).

Yet age isn't the only risk factor for postnatal depression in men. Other major risk factors include a history of depression and anxiety, financial pressures, and no longer being in a relationship with the child's mother (Huang and Warner, 2005; Wee et al, 2010; Nazareth, 2011).

Other factors that make postnatal depression in men more likely include: sleeping or crying issues with the baby; drug abuse or dependence; and feeling unsupported by their partners (Huang and Warner, 2005; Fatherhood Institute, 2010; Stadtlander, 2015).

However, the relationship between these factors is unclear so they might not necessarily be the direct cause of mental health difficulties.

6. Postnatal depression in dads and partners can show itself in different ways than in mums

Symptoms can include:

fear, confusion, helplessness and uncertainty about the future

withdrawal from family life, work and social situations

indecisiveness

frustration, irritability, cynicism and anger

marital conflict

partner violence

negative parenting behaviours

alcohol and drug use

physical symptoms like indigestion, changes in appetite and weight, diarrhoea, constipation, headaches, toothaches and nausea.

(Musser et al, 2013; Stadtlander, 2015)

7. Postnatal depression in dads and partners can take its toll on their relationships

Postnatal depression in dads can affect their relationship with the baby's mother (Wee et al, 2011; Demontigny et al, 2013). It can also affect the relationship they have with their child. They may play and engage less with their children and talk more negatively about and to them. They may sing and read less to their children, and may discipline them more harshly (Sethna et al, 2015).

8. Postnatal depression in dads and partners can have an impact on the development of their child

Dads' depression is associated with emotional, social and behavioural problems as well as developmental delay in their children (Fatherhood Institute, 2010).

The association is stronger when a father experiences antenatal as well as postnatal depression, and when his symptoms are particularly severe. There is also a stronger association when the mum also has mental health problems (Stadtlander, 2015).

9. Screening is available

You might associate screening with physical illness but mental health diagnoses are catching up. Men who are concerned about their mental health can use this NHS screening tool (NHS, 2020). Alternatively, if you're concerned, see your GP or call NHS 111.

10. Postnatal depression in dads and partners is treated the same as postnatal depression in mums

The treatment of paternal postnatal depression is in its early stages. Currently, the options for treatment are the same as for mothers with psychotropic medication and/or talking therapies (Nazareth, 2011; NHS, 2018).

Relationship counselling may also be useful (Musser et al, 2013).

Most, importantly share how you're feeling. You're not alone and support is available.
This page was last reviewed in February 2022.
We run Partners in Mind, a peer-to-peer support group for dads and partners in the North West. There are lots of videos and online resources to help you manage your mental health, as well as groups so you can meet and talk to other dads. Take a look at their information page here, email parentsinmindnw@nct.org.uk or follow them on Instagram @nctparentsinmindpartners and on Facebook @NCT Parents in Mind.

Our support line offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700. We also offer antenatal courses that are a great way for both parents to find out more about birth, labour and life with a new baby.

For information and support, visit Fathers Reaching Out run by Mark Williams, campaigner, speaker and writer.

The Campaign Against Living Miserably (CALM) is leading a movement against male suicide, the single biggest killer of men under 45 in the UK.

The Hub of Hope is a national mental health database, bringing help and support together in one place, with a focus on grassroots organisation.

ANDYSMANCLUB is a non judgmental, talking group for men.

DadsNet offers support and knowledge through a community of dads on practical parenting and fatherhood.

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Postnatal depression in dads and co-parents: 10 things you should know | Life as a parent articles & support | NCT

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It's understandable that we focus on mums in the postnatal period but let's not forget the dads and co-parents who also need support.

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An incredible charity which supports all mums, including mums who have lost a baby.

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We believe that every baby lost is too many. Tommy’s exists to support, care for and champion people, no matter where they may be on their pregnancy journey.

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Trusted info from the Royal College of Psychiatrists

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This information is for anyone who wants to know more about postnatal depression (PND for short).

We hope it will be helpful to:

women who have, or think they might have postnatal depression

pregnant women who are worried about getting postnatal depression

partners, family and friends.

Disclaimer

This leaflet provides information, not advice.

The content in this leaflet is provided for general information only. It is not intended to, and does not, mount to advice which you should rely on. It is not in any way an alternative to specific advice.

You must therefore obtain the relevant professional or specialist advice before taking, or refraining from, any action based on the information in this leaflet.

If you have questions about any medical matter, you should consult your doctor or other professional healthcare provider without delay.

If you think you are experiencing any medical condition you should seek immediate medical attention from a doctor or other professional healthcare provider.

Although we make reasonable efforts to compile accurate information in our leaflets and to update the information in our leaflets, we make no representations, warranties or guarantees, whether express or implied, that the content in this leaflet is accurate, complete or up to date.

Postnatal depression (PND) is a depressive illness which affects between 10 to 15 in every 100 women having a baby. ¹ The symptoms are similar to those in depression at other times. ² These include low mood and other symptoms lasting at least two weeks. Depending on the severity, you may struggle to look after yourself and your baby. You may find simple tasks difficult to manage.

Sometimes there is an obvious reason for PND, but not always. You may feel distressed, or guilty for feeling like this, as you expected to be happy about having a baby. However, PND can happen to anyone and it is not your fault.

It's never too late to seek help. Even if you have been depressed for a while, you can get better. The help you need depends on how severe your illness is. Mild PND can be helped by increased support from family and friends.

If you are more unwell, you will need help from your GP and health visitor. If your PND is severe, you may need care and treatment from a mental health service.

The timing varies. PND often starts within one or two months of giving birth. It can start several months after having a baby. About a third of women with PND have symptoms which started in pregnancy and continue after birth. ³

You may have some or all of the following symptoms:

Depressed

You feel low, unhappy and tearful for much or all of the time. You may feel worse at certain times of the day, like mornings or evenings.

Irritable

You may get irritable or angry with your partner, baby or other children.

Tired

All new mothers get pretty tired. Depression can make you feel utterly exhausted and lacking in energy.

Sleepless

Even though you are tired, you can't fall asleep. You may lie awake worrying about things. You wake during the night even when your baby is asleep. You may wake very early, before your baby wakes up.

Appetite changes

You may lose your appetite and forget to eat. Some women eat for comfort and then feel bad about gaining weight.

Unable to enjoy anything

You find that you can't enjoy or be interested in anything. You may not enjoy being with your baby.

Loss of interest in sex

There are several reasons why you lose interest in sex after having a baby. It may be painful or you may be too tired. PND can take away any desire. Your partner may not understand this and feel rejected.

Negative and guilty thoughts

Depression changes your thinking:

you may have very negative thoughts

you might think that you are not a good mother or that your baby doesn't love you

you may feel guilty for feeling like this or that this is your fault

you may lose your confidence

you might think you can't cope with things.

Most new mothers worry about their babies' health. If you have PND, the anxiety can be overwhelming. You may worry that:

your baby is very ill

your baby is not putting on enough weight

nowhere is clean or safe enough for your baby

your baby is crying too much and you can't settle him/her

your baby is too quiet and might have stopped breathing

you might harm your baby

you have a physical illness

your PND will never get better.

You may be so worried that you are afraid to be left alone with your baby. You may need re-assurance from your partner, health visitor or GP.

When you feel anxious, you may have some of the following:

racing pulse

thumping heart

breathless

sweating

fear that you may have a heart attack or collapse.

You may avoid situations, such as crowded shops because you are afraid of having panic symptoms.

Avoid other people

You may not want to see friends and family. You might find it hard to go to postnatal support groups. You may agree to go out and then make excuses at short notice.

Hopeless

You may feel that things will never get better. You may think that life is not worth living. You may even wonder whether your family would be better off without you.

Thoughts of suicide and self harm

If you have thoughts about harming yourself, you should ask your doctor for help. If you have a strong urge to harm yourself, seek urgent help (see below).

Psychotic symptoms

A small number of women with very severe depression develop psychotic symptoms. They may hear voices and have unusual beliefs. If this happens, you should seek help urgently (see below).

You may feel guilty that you don't feel the way you expected to.

You may or may not love your baby.

You may not feel close to your baby.

You might find it hard to work out what your baby is feeling, or what your baby needs.

You may resent the baby or blame the baby for the way you feel.

You may feel as if you are missing out on motherhood.

Depressed mothers often worry that they might do this, but it is very rare. Occasionally, through utter tiredness and desperation, you might feel like hitting or shaking your baby. Many mothers (and fathers) occasionally feel like this, not just those with PND. In spite of having these feelings at times, most mothers never act on them. If you do feel like this, tell someone.

Women often worry that if they tell someone how they feel, their baby may be taken away. Actually your GP, health visitor and midwife will want to help you get better. This will mean that you can enjoy and care for your baby at home. They can provide you with support and information so you can do this.

Having a baby is a time of huge change. It is common to feel many different emotions. Not everyone gets a depressive illness.

Over half of new mothers will experience the 'Baby Blues'. ⁴ This usually starts 3 to 4 days after birth. You may have mood swings. You may burst into tears easily. You can feel irritable, low and anxious at times. You may also over-react to things. It usually stops by the time your baby is about 10 days old. Women with baby blues do not need treatment. If it continues for more than 2 weeks, tell your health visitor or GP. They can check whether you have PND.

Depression and are the most common mental health problems in pregnancy. They affect 10-15 in every 100 women.1,5 Depression in pregnancy can be helped in much the same way as postnatal depression. Women also experience a range of other mental health problems during pregnancy, just like at other times. See our page onmental health in pregnancy.

Postpartum (puerperal) psychosis
This is the most severe type of mental illness that happens after having a baby. It affects around 1 in 1000 women ⁶ and starts within days or weeks of childbirth. It can develop in a few hours and can be life-threatening, so needs urgent treatment.

There are many symptoms that may occur. Your mood may be high or low and there are often rapid mood swings. Women often experience psychotic symptoms. They may believe things that are not true (delusions) or see or hear things that are not there (hallucinations).

This illness always needs medical help and support. You may have to go into hospital. Ideally, this should be to a specialist mother and baby unit where your baby can go with you.

Women who have had previous episodes of severe mental illness, particularly bipolar disorder, are at a high risk of postpartum psychosis. You also have a high risk if you have had Postpartum Psychosis before. Let your doctor or midwife know about this. You can discuss with them ways to increase the chances of you staying well. Although postpartum psychosis is a serious condition, women usually recover completely. For more information see our page onPostpartum Psychosis.

Perinatal Obsessive Compulsive Disorder affects 2-3 in every 100 women after having a baby. ⁷ Women have anxious thoughts or images which keep coming into their mind (obsessions). These thoughts often focus on the possibility of the baby being harmed. The thoughts cause anxiety. Women may also keep repeating thoughts or actions in an attempt to reduce this anxiety (compulsions). Treatment is with Cognitive Behaviour Therapy and/or medication. For more information see our page onPerinatal OCD.

Other mental health problems after childbirth

You may have had a mental illness before pregnancy. Your symptoms may get worse or return after your baby is born. Just as at other times, women can experience many types of mental health problems. If you are worried about any type of mental illness, discuss this with your GP. They can make sure you get the help and support you need.

Many possible causes for PND have been suggested. There is probably no single reason, but a number of different stresses may add up to cause it.

You are more likely to have PND if you have ²:

Previous mental health problems, including depression

Depression or anxiety during pregnancy

Poor support from partner, family or friends - or marital difficulties

A recent stressful event - e.g. death of someone close to you, relationship ending, losing a job.

Experienced domestic violence or previous abuse

Arrived in a developed country as a refugee or to seek asylum

There may be a physical cause for your depression, such as an underactive thyroid or low levels of vitamin B12. These can be easily treated.

PND can start for no obvious reason, without any of these causes. Also having these problems does not mean that you will definitely have PND.

Several interventions have been shown to prevent Postnatal Depression. These include:

Telephone support from other women who have had Postnatal Depression⁸

Home visits by health professionals⁸

Interpersonal Psychotherapy⁸

Cognitive Behaviour Therapy⁹

Not enough research has been done to make it clear whether antidepressants prevent depression. ¹⁰

The following are suggestions that may help to keep you well.

Don't try to be 'superwoman'. Try to do less and make sure that you don't get over-tired.

Do make friends with other women who are pregnant or have just had a baby. It may be more difficult to make new friends if you get PND.

Do find someone you can talk to. If you don't have a close friend you can turn to, you can find support through one of the organisations at the end of this page.

Do go to antenatal classes. If you have a partner, take them with you. If not take a friend or relative.

Don't stop antidepressant medication during pregnancy without advice. You are more likely to relapse if you have had severe depression¹¹, several episodes or a recent episode.¹² You need to discuss the risks and benefits of continuing treatment in pregnancy and breastfeeding with your GP or psychiatrist.

Do keep in touch with your GP and your health visitor if you have had depression before. Any signs of depression in pregnancy or PND can be recognised early.

Do make sure that you have treatment for depression in pregnancy. This may be a talking therapy or medication.

Do accept offers of help from friends and family.

Do tell others how you are feeling. You may be surprised how many people feel or have felt the same way.

Do make a Wellbeing Plan - this helps you to start thinking about the support you might need in your pregnancy and after the birth. You can download a Wellbeing Plan template from the Tommy's charity website.

The first thing is to recognise you have had a depressive illness. Don't dismiss it as the 'baby blues'. Don't assume it's normal to feel like this when coping with a baby.

There are lots of reasons why women delay seeking help. You may:

not realise what is wrong

worry about what other people think

feel ashamed to admit that you are not enjoying being a mother.

Some women worry that their baby will be taken away. In fact, you are doing what is best for your baby and for yourself by getting help for your PND. Doctors and health visitors want to get the care you need so you can look after your baby.

People are now more aware of depression in general. This means PND shouldn't be missed so often.

Doctors, midwives and health visitors usually ask new mothers about their mental health. They may ask you to fill in a questionnaire or ask the following questions:

During the last month, have you been bothered by feeling down, depressed or hopeless?

During the last month, have you been bothered by having little interest in pleasure or in doing things?

Is this something you feel you need or want help with?

It is important to answer these questions honestly so that you can be offered help if you need it. If your answers suggest you might have PND, you should see your GP. Your GP will need to ask more questions to confirm the diagnosis.

The help and treatment you need depends on how severe your PND is. Your GP and health visitor can help you decide what kind of help you need. If you don't get the help you think you need straight away, you can ask for a second opinion or you could see a different GP.

Try some of the self-help suggestions below. If this is not enough, you might find a talking therapy helpful. For more severe depression, you may need medication, with or without talking therapy. Your GP can advise you about these treatments.

A small number of women will need help from mental health services. Your GP can refer you to a perinatal mental health service - a specialist service for pregnant women or women with a baby under a year old. Otherwise you can be referred to a Community Mental Health Team. These are usually only needed for women with more severe illnesses.

Only a few women will need to go into hospital for treatment of PND. In that case, you should usually be admitted with your baby to a specialist Mother and Baby Unit.

If you cannot look after yourself or your baby, or if you have plans to harm yourself, you should be seen urgently by:

your GP

a mental health service - your GP can arrange this. You may already have a crisis number to call

your local Emergency Department - open 24 hours.

Don't be frightened by the diagnosis. Many women have postnatal depression and you will get better in time. Your partner, friends or family can be more helpful and understanding if they know what the problem is.

Do tell someone about how you feel. It can be a huge relief to talk to someone understanding. This may be your partner, a relative or friend. If you can't talk to your family or friends, talk to your health visitor or GP. They will know that these feelings are common and will be able to help.

Do take every opportunity to get some sleep or rest during the day or night. If you have a helpful partner, relative or friend, ask them to feed the baby at night sometimes. You can use your own expressed breast milk, or formula milk for this. If you are on your own, try and rest when the baby sleeps. Even if you cannot sleep, take some time to rest and relax.

Do try to eat regularly, even if you don't feel like eating. Eat healthy food.

Do find time to do things you enjoy or help you relax - e.g. go for a walk, read a magazine, listen to music.

If you have a partner, do try to enjoy some time together. If you are a single mother, try to do something enjoyable with a friend or family member.

Do go to local groups for new mothers or postnatal support groups. Your health visitor can tell you about groups in your area. You may not feel like going to these groups if you are depressed. See if someone can go with you. You may find the support of other new mothers helpful. You may find some women who feel the same way as you do.

Do let others help you with housework, shopping and looking after other children.

Do some exercise. Ask your health visitor if there are any mother and baby exercise classes in your area. Walking with your baby in the pram is good exercise. Regular exercise can boost your mood.

Do use self-help books and websites.

Do contact organisations that support women with Postnatal Depression.

Don't blame yourself, your partner or close friends or relatives. Life is tough at this time, and tiredness and irritability can lead to quarrels. 'Having a go' at your partner can weaken your relationship when it needs to be at its strongest. The same can happen with other close family or friends who are trying to support you.

Don't use alcohol or drugs. They may make you feel better for a short time, but it doesn't last. Alcohol and drugs can make depression worse. They are also bad for your physical health.

Don't be shocked or disappointed if your partner, friend or relative says she has postnatal depression. It is common and can be effectively helped.

Make sure that you understand what postnatal depression is. Ask the health visitor or GP if you need more information.

It's helpful just to spend time with someone who is depressed. It is important to listen and to offer encouragement and support. Reassure her that she will get better.

Be mindful of language you use - this is an illness, not something someone can 'snap out of', 'get on with' or cure by 'thinking positively'.

Take your partner, relative or friend seriously if she talks about not wanting to live or about harming herself. Make sure she seeks help urgently (see section above on Urgent Help).

Encourage your partner, relative and friend to get the help and treatment she needs. If you have any worries about treatment, discuss these with the doctor.

Do all you can to help with the practical things. This includes feeding and changing the baby, shopping, cooking or housework.

If you are the mother's partner, make sure that you have some support yourself.

If this is a first baby, you may feel pushed to one side, both by the baby and by your partner's needs. Try not to feel resentful. Your partner needs your help and support.

Ensure you are a good role model and take care of yourself.

Fathers can also get depressed after the birth of a baby. This may be more likely if the mother also has postnatal depression. If you are a father and think you may have depression, talk to your GP. It is important for you and your family that you get the help you need.

Most women will get better without any treatment within 3 to 6 months. 1 in 4 mothers with PND are still depressed when their child is one-year-old. ¹³ However, this can mean a lot of suffering. PND can spoil the experience of new motherhood. It can strain your relationship with your baby and partner. You may not look after your baby, or yourself, as well as you would when you are well. PND can affect your child's development and behaviour even after the depression has ended. ¹⁴ So the shorter it lasts, the better.

The treatment you need depends on how unwell you are. You should be told about all the likely benefits and risks of treatment so you can make the best choice for you.

Treatment includes: ¹⁵

Talking about your feelings can be helpful, however depressed you are. Sometimes, it's hard to express your feeling to someone close to you. Talking to a trained counsellor or therapist can be easier. It can be a relief to tell someone how you feel. It can also help you to understand and make sense of your difficulties.

Trained health visitors can offer counselling at home in some areas. There are also more specialised psychological treatments.

Cognitive Behavioural Therapy can help you to see how some of your ways of thinking and behaving may be making you depressed. You can learn to change these thoughts which has a positive effect on other symptoms. Other psychotherapies can help you to understand the depression in terms of your relationships or what has happened to you in the past.

Improving Access to Psychological Therapies (IAPT) services offers short-term talking therapies. The types of therapy offered will vary depending on your local IAPT service. These may include guided self-help sessions with a therapist, cognitive behaviour therapy, couples therapy and counselling. IAPT services offer individual and group therapies. Women who are pregnant or have recently had a baby are usually given priority. You can often bring your baby to appointments. Some IAPT services also have groups just for women who are pregnant or for new mums. You can self-refer to your local IAPT service. Your GP, midwife or health visitor can also make a referral for you.

Talking treatments are usually very safe, but they can have unwanted effects. Talking about things may bring up bad memories from the past. This can make you low or distressed. Psychotherapy can put a strain on relationships with people close to you.

Make sure that you can trust your therapist and that they have the necessary training.

Another problem with talking therapies is that they are still hard to get in some areas. National guidelines state that women with PND should be seen within a month. Sometimes there are long waiting lists. This means you may not get any treatment for quite a while.

If you have a more severe depression, or it has not improved with support or a talking therapy, an antidepressant will probably help. 15,16

There are several types of antidepressants. They all work equally well, but have different side-effects. They are not addictive. They can all be used in PND, but some are safer than others if you are breastfeeding. 2,16

Antidepressants take at least 2 weeks to start working. You will need to take them for around 6 months after your start to feel better.

Make sure that your doctor knows that you are breastfeeding. For many antidepressants, there is no evidence that they cause problems for breastfed babies, so breastfeeding is usually possible. If your baby is unwell or premature the advice may change. You can talk to the doctor looking after your baby about this.

The decision is an individual one for each woman. Some antidepressants have been used in breastfeeding for many years. There is less information about newer medications. Your doctor can provide up-to-date information and advice and can check with the UK Drugs in Lactation Advisory Service if needed.

To decide whether to breastfeed when taking an antidepressant, you need to think about:

how severe your illness is (or has been in the past)

treatments which have helped you before

side-effects

up-to-date information about the safety of medication in breastfeeding

the benefits of breastfeeding

whether your baby is very premature or has any health problems

the impact of the untreated illness on your baby.

Breastfeeding has many health benefits for mother and baby. However, fully breastfeeding a baby can be very tiring. Some women find it easier to combine breast and bottle feeding. If a partner, friend or family member can do some of the feeds you will be able to get more rest.

Sometimes women feel guilty if they can't breastfeed. If you are unable to breastfeed you should not worry. It is more important for your baby that you are well. You will still develop a close bond with your baby if you bottle feed.

Hormones have been suggested as a treatment for PND. However, there is little evidence that they work, and they have their own dangers ², particularly if you have had thrombosis (blood clots in their veins).

St John's Wort is a herbal remedy available from chemists. There is evidence that it is effective in mild to moderate depression. It seems to work in much the same way as some antidepressants, but some people find that it has fewer side-effects.

One problem is that St John's Wort can interfere with the way other medications work. If you are taking other medication, you should discuss it with your doctor. This is very important if you are taking the oral contraceptive pill. St John's Wort might stop your pill working. This can lead to an unplanned pregnancy.

There is not enough information to say that it is definitely safe in breastfeeding. ¹⁷ Only small amounts get into breast milk, but do not assume that because it is 'herbal', it will be safe. Discuss the risks and benefits of treatment in breastfeeding with your doctor.

Telephone helpline and information leaflets for women with postnatal mental illness. Also a network of volunteers (telephone and postal) who have experienced postnatal mental illness. Email: info@apni.org Tel: 020 7386 0868

Free App with information in the form of video clips about many aspects of pregnancy and parenting, including mental health.

Information and support for women who have had a traumatic birth experience

Information and support about breastfeeding, including information about using medication when breastfeeding. Breastfeeding Helpline: 0300 100 0212

Advice and information on how to cope with a sleepless baby and/or a crying baby. Helpline: 08451 228669.

Support and practical help for families affected by mental health problems and other challenges such as substance misuse and domestic violence. Contact: T: 020 7254 6251. Email: info@family-action.org.uk

Support and practical help for families with at least one child under-5. Help offered to parents finding it hard to cope for many reasons. These include PND or other mental illness, isolation, bereavement, illness of parent or child.

Practical and emotional support in all areas of pregnancy, birth and early parenthood. Antenatal and postnatal courses. Local networks where you can meet other parents. Support line: 0300 330 0700

Help advice and support on a wide range of pregnancy and parenting issues, including mental health.

Support and advice for women with perinatal mental illness and their families. An organisation that helps individuals and their families with pre- and postnatal depression advice and support. Support line: 0843 2898401. Email: info@pandasfoundation.org.uk

Relationship support including couple and family counselling. Face-to-face, telephone or online counselling.

24-hour free helpline 116 123 ; Email: jo@samaritans.org.

Confidential emotional support for those in distress who are experiencing feelings of distress or despair, including suicidal thoughts.

Postnatal Depression Support packs. Mother and baby hampers for women with PND who are in considerable financial difficulty.

Further reading

Overcoming postnatal depression: a five areas approach by Christopher Williams, Roch Cantwell and Karen Robertson, Hodder Arnold (2012)

The Compassionate Mind Approach to Postnatal Depression: Using Compassion Focused therapy to Enhance Mood, Confidence and Bonding, by Michelle Cree, Robinson (2015)

Antenatal and Postnatal Depression by Siobhan Curran, Vermillion (2017)

Coping with postnatal depression by Dr Sandra Wheatley, Sheldon Press (2005)

Surviving postnatal depression by Cara Aitken, Jessica Kingsley Publishers (2000)

Feelings after birth: the NCT book of postnatal depression by Heather Welford, NCT Publishers (2002)

1. Woody CA, Ferrari A, Siskind D, Whiteford H, Harris M. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2017; 219: 86-92.

2. Howard LM, Moylneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. The Lancet. 2014; 384;1775-1788.

3. Wisner K, Sit D, McShea M, Rizzo D, Zoretich R, Hughes C et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 2013; 70: 490-498.

4. Henshaw C. Mood disturbance in the early puerperium: a review. Arch Womens Ment Health. 2003; 6: S33-42.

5. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005; 106:1071-83.

6. VanderKruik R, Barreix M, Chou D, Allen T, Say L, Cohen LS. VanderKruik et al. The global prevalence of postpartum psychosis: a systematic review. BMC Psychiatry. 2017; 17:272.

7. Russell EJ, Fawcett JM, Mazmanian D. Risk of obsessive-compulsive disorder in pregnant and postpartum women: a meta-analysis. J Clin Psychiatry. 2013; 74:377-85.

8. Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database Syst Rev. 2013; 2: CD001134

9. Sockol LE.A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. J Affect Disord. 2015; 15:177:7-21.

10. Molyneaux E, Howard LM, McGeown HR, Karia AM, Trevillion K.Antidepressant treatment for postnatal depression. Cochrane Database Syst Rev. 2014;9:CD002018.

11. Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC et al Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006; 295: 499-507.

12. Yonkers KA, Gotman N, Smith MV, Forray A, Belanger K, Brunetto WL etal. Does antidepressant use attenuate the risk of a major depressive episode in pregnancy? Epidemiology. 2011; 22: 848-854.

13. Goodman JH. Postpartum depression beyond the early postpartum period. J Obstet Gynecol Neonatal Nurs. 2004; 33:410-20.

14. Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M et al. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;15;384:1800-19.

15. National Institute for Health and Clinical Excellence Antenatal and postnatal mental health: clinical management and service guidance. NICE Clinical Guideline 192: London 2014. www.nice.org.uk/ guidance/CG192

16. McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V et al. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum. J Psychopharmacol. 2017; 31: 519-552.

17. Budzynska K, Gardner ZE, Dugoua JJ, Low Dog T, Gardiner P. Systematic review of breastfeeding and herbs. Breastfeed Med. 2012; 7: 489-503.

Credits

Produced by the RCPsych Public Engagement Editorial Board

Author: Dr Lucinda Green

Service user and carer input: Members of Depression Alliance and Cocoon Family Support

Series Editor: Dr Phil Timms

Series Manager: Thomas Kennedy

Published: Nov 2018

Review due: Nov 2021
© Royal College of Psychiatrists

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Information on post-natal depression, its causes and how you can seek help

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What is maternal mental health?

You may have heard the terms "perinatal mental health" and "maternal mental health" used interchangeably. Both refer to mental health during pregnancy and up to two years after giving birth.

The word "peri" comes from Latin and means "around," while "natal" means "birth".

Maternal mental health problems

Most people are aware of postnatal depression, or PND, but depression can also occur during pregnancy. Other perinatal mental illnesses include anxiety, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and eating disorders.

These illnesses can range from mild to severe, and require specialist treatment as soon as possible. Some conditions may have existed before pregnancy and got worse during the perinatal period, or shown up for the first time.

The most serious perinatal mental health problem is considered to be postpartum psychosis, and should be treated as a medical emergency if suspected.

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About maternal mental health | Maternal Mental Health Alliance

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The terms perinatal and maternal are often used interchangeably. 'Peri' is the Latin for "around", and 'natal' is the Latin for "birth". So perinatal mental health refers to a woman's mental health during pregnancy and the first years after birth.

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Perinatal Mental Health Info from the NHS

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Perinatal Mental Health Info from the NHS

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Perinatal mental health (PMH) problems are those which occur during pregnancy or in the first year following the birth of a child. Perinatal mental illness affects up to 27% of new and expectant mums and covers a wide range of conditions.

If left untreated, mental health issues can have significant and long-lasting effects on the woman, the child, and the wider family. Specialist PMH services provide care and treatment for women with complex mental health needs and support the developing relationship between parent and baby. They also offer women with mental health needs advice for planning a pregnancy.

The NHS Long Term Plan builds on the commitments outlined in the Five Year Forward View for Mental Health to transform specialist PMH services across England. We aim to ensure that by 2023/24, at least 66,000 women with moderate/complex to severe PMH difficulties can access care and support in the community.

As part of the £2.3bn investment in mental health identified in the Long Term Plan, additional investment will support further service developments for perinatal mental health. Set out in detail in the Mental Health Implementation Plan, this includes:

Increasing the availability of specialist PMH community care for women who need ongoing support from 12 months after birth to 24 months

Improving access to evidence-based psychological therapies for women and their partners

Mental health checks for partners of those accessing specialist PMH community services and signposting to support as required.

We will also work to make it easier to access psychological support for those who experience mental health difficulties arising from, or related to, the maternity experience through the development of Maternity Outreach Clinics (this work will be delivered in partnership with the Maternity Transformation Programme).

Five years ago, access to specialist PMH services was variable and 40% of the country did not have a specialist community team. There are now specialist PMH community services in all 44 local NHS areas in England, and further developments planned. These enabled over 13,000 additional women to receive support from specialist PMH services in 2018/19 against our target of 9,000.

Our national transformation programme also saw four new Mother and Baby Units open in areas of particular need in 2018/19 (in the North West, South West, South East Coast and East of England). This brought the total number of units in England to 19.

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Perinatal mental health (PMH) problems are those which occur during pregnancy or in the first year following the birth of a child. Perinatal mental illness affects up to 27% of new and expectant mums and covers a wide range of conditions.

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Resources from the Royal College of Psychiatrists

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Resources from the Royal College of Psychiatrists

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This is a site where you can find reliable, trusted information on what you are experiencing.

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If you are in crisis and have hurt yourself or are thinking about hurting yourself:

call 999

go to A&E if you are able to

call your mental health crisis team

If the support you need is less urgent, you can also speak to your GP or mental health team.

You can also contact the following organisations if you need to speak to someone:

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Mental health | Royal College of Psychiatrists

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Mental health information for patients and carers, with a special section for young people and parents.

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This is a fantastic resource which tells you about every mental health condition you can think of

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Find information and support for your mental health.

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111 online will not give you a diagnosis, but we will direct you to the best place to get help for your symptoms.

We cannot:

issue fit notes - you need to contact your GP surgery

make or cancel appointments for you in other parts of the NHS

Read about how 111 online works in detail

NHS 111 online is available in England only.

Get help in:

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111 online will not give you a diagnosis, but we will direct you to the best place to get help for your symptoms. We cannot: issue fit notes - you need to contact your GP surgery make or cancel appointments for you in other parts of the NHS Read about how 111 online works in detail NHS 111 online is available in England only.

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Tools and Resources for Preventing Suicide

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Tools and Resources for Preventing Suicide

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If it feels like things in life are leading you to are dark place - don't give up. The world needs you in it and even if you realise it or not, you absolutely have so much still to do.

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Campaign Against Living Miserably (CALM)

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We're the Campaign Against Living Miserably (CALM) and we're uniting the UK against suicide.

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Take a look at our resources, information and support, find further help or reach out to one of our volunteers.

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Shout - UK's 24/7 Crisis Text Service for Mental Health Support

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Shout 85258 is the UK's first 24/7 text service for anyone in crisis. Get free, confidential mental health support anytime, anywhere. Text 'SHOUT' to 85258.

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If you are experiencing a mental health crisis, the samaritans can help

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