"Postnatal depression affects between 10 and 20 per cent of women who have had babies, causing distress at a time of life when there is every reason for happiness. For some, symptoms can be relatively mild, but other women suffer from very serious, continuing bouts of depression.

In this book, Dr Sandra L. Wheatley offers sympathetic advice and support to those who have postnatal depression, and their families.

The topics covered include:

symptoms

causes

treatment, including drugs and therapies

staying well, including emotional support, relaxation and complementary therapies

work worries, relationship issues and other worries, including the ways in which depression may affect the baby and other children

further resources

The message is, don't despair — with support and treatment, postnatal depression will pass and leave you free to enjoy your baby and your life".

You've recently had a baby and this is probably the last way you expected to feel — weepy, vulnerable, isolated, and perhaps scared to talk to anybody. Now is supposed to be a time for celebration and new life. What could have gone wrong? If you're not feeling as happy as you expected, don't worry — you are not alone. Some one in ten women develop postnatal depression or feelings of sadness and despair after the birth of a baby.

Meet Helen. She took part in the research that formed part of my PhD, and I interviewed her twice, once three months after her son was born and again when he was one year old. Her account of having her son and how her life was changed during this time is in the book Nine Women, Nine Months, Nine Lives, the details of which can be found in Further Reading at the back of this book.

Helen was 30 years old when she accidentally became pregnant. She and her husband Richard had been married for six months and had known each other since they were at school. She experienced a great deal of internal conflict about her decision to go ahead with having the baby, having seriously considered a termination well into the first few months of pregnancy, as she had never really seen herself having children. Her husband had always thought he would be a father.

It wasn't until her son was a year old that she confided in me that she thought she had been depressed after Will was born. She described how she had felt trapped at home with the baby and couldn't wait to get back to work. The unrewarding (to her), repetitive tasks involved in caring for a young baby frustrated, irritated and ground her down so much that her confidence in her ability to hold even a simple conversation with other adults took a nosedive. She told me that she had been horrified to realize that she would frequently not speak to her son from the moment he woke up in the morning until well into the afternoon — she just hadn't felt it necessary to interact with him at all. She had to make a conscious effort to speak to him and take an interest in his development.

Before she had Will she thought she was incapable of being a mother. When he was born all the evidence of her own behavior confirmed to her that that was the case. She did want to be a good mother but felt she didn't even know how to be a good enough mother. From the conversation I had with her three months after Will was born I knew that she wanted to return to work as soon as she could. She emphasized that this was for financial reasons. But underneath what she felt it was acceptable to say even to me, as a psychologist, was the real reason: she really felt it would be for Will's and her own benefit to be apart.

The good news was that this allowed her to retain as much of her sense of self as she could and to be the best mother she could be. Going back to work had helped her to recover from her depression. Naturally I encouraged her to continue getting support from the people she felt she could turn to and soon she was well on the way to feeling better.

The most important thing you can do at the moment, and throughout this very difficult time, is to believe that you will get better. Just like Helen, you really must seek and accept help. Don't delay. Helen regretted not getting help sooner, and felt that she had missed out on an important part of her son's life, one that could never be repeated or replaced.

Many people find it difficult to ask others for help, but it is very important that you do. It is unlikely that your depression will just get better on its own, no matter how much you wish that it would. Please don't feel ashamed of how you are feeling. You are not alone. Always remember that one in ten women who have had a baby feel the way you do. The sooner you get help, the sooner you will be well again. Let that thought give you courage.

Having a baby and becoming a parent is a major event in the lives of women and men. Becoming a parent is usually accompanied by changes to your home life, social life and relationships. Whether this is your first, second or third baby, the first few weeks of parenthood are daunting and demanding, both physically and emotionally.

Popular images of motherhood are often misleading. They suggest that mothers are radiant and energetic, living in perfect homes with supportive partners and happy well-behaved babies and children. Mothering is often believed to be a natural ability that all 'good' women have. You may have expected to love your baby immediately, but this can take a while and it is not always instinctive. Not loving your baby straight away does not mean that you are not a 'good woman' or a 'natural mother'. Becoming a mother can feel like an overwhelming responsibility and it is very easy to feel inadequate when other mothers around you seem to be coping well.

In reality, becoming and being a mother means constantly experiencing new events and carrying out tasks we are not sure we can manage. A new set of skills to cope with these situations have to be learnt, so don't be too hard on yourself. We all learn to be a mother when we actually have a baby, not before. Women do not automatically know how to be a mother. Men do not automatically know how to be a father.

Each woman's experience of having a baby and being a mother is unique. It is likely that during the first few weeks and months of motherhood you will feel a mixture of emotions. Some women feel sad more often than they feel happy. Sometimes this sadness can develop into depression. Women who find the weeks and months after childbirth difficult often imagine that they are the only ones who are not coping. This is simply not true.

If you think you are depressed after your baby is born, please do not despair. In all the years I have been helping women through this difficult time I have never yet met a woman who, after having sought and accepted help, did not recover.

By reading this book you are seeking and accepting help, so I would say that means that you will recover. It will take time and effort, but you will recover. Please believe me.

Postnatal mood changes

Before I go any further I will outline some facts about the mood changes a woman can experience at this time. There are three mood changes that can develop after the birth of a baby: the baby blues, postnatal depression and puerperal psychosis.

The baby blues

The baby blues tend to occur in the first week after delivery and affect as many as eight out of ten of all new mothers. In fact, it is considered usual to experience the blues, even if only for a short while. A woman may burst into tears for no obvious reason, or feel on top of the world one minute and miserable the next. It is quite usual to feel anxious or tense, be lacking in confidence or feel worried.

Postnatal depression

Postnatal depression affects one in ten women following the birth of a baby. This illness usually begins in the first six months after childbirth, although for some women the depression begins in pregnancy. It is important to know that postnatal depression can occur at any time within the first year after the birth of a baby, and can last for longer than a year if help is not sought and received. Untreated postnatal depression can lead to the breakdown of relationships with partners and children.

On an optimistic note, early diagnosis and treatment of postnatal depression will result in a faster recovery. Quite often a close family friend or perhaps the partner of the woman recognizes that she is unwell before the mother realizes it herself.

Puerperal psychosis

Puerperal psychosis is a much rarer and serious mood change, affecting about one in 500 new mothers. The symptoms will appear suddenly, often within the first two weeks following the birth of the baby. Women with a family history of mental illness or who have suffered from puerperal psychosis in the past are at a higher risk of developing this illness.

Symptoms include hallucinations (seeing or hearing things that others cannot), delusions (incredible beliefs such as thinking she can save the world) and mania (extremely energetic and bizarre activity like cleaning the house in the middle of the night). The symptoms can be severe and sometimes very frightening for the woman, her partner and her family. In fact her partner may be the first to realize that she is unwell. So it is important that her partner, or someone close to her, knows the symptoms to look out for.

Medical help should be sought immediately from her GP or from the emergency services. Seeking help quickly will make sure that she is well again quickly. Women with this illness are often treated in hospital and will usually make a full recovery.

• The topics covered include: symptoms, causes

  treatment, including drugs and therapies

  staying well, including emotional support, relaxation and complementary therapies, work worries, relationship issues and other worries, including the ways in which depression may affect the baby and other children

  further resources

  The message is, don't despair — with support and treatment, postnatal depression will pass and leave you free to enjoy your baby and your life".

  Contents Introduction

  How do I know if I am depressed?

  Why me?

  Getting well

  How you can help yourself to get well

  Staying well

  Supporting the depressed mother: how to help