One in ten mothers get post-natal depression. It can last months or years. Dr Howard Lee explains the symptoms and how to get help

There are three types of post-natal emotional disturbance that can affect women:

1. The most rare and dramatic, which fortunately only affects about 2 in every 1000 new mothers, is Post-Natal Psychosis.

The symptoms are quite disturbing and complicated and you may not realise that you are suffering from them because you are out of touch with reality. They may occur within the first six weeks after delivery and include:

• Marked disturbance in mood, characterised by:
• a very high or elevated mood; or
• a very low, depressed mood; or
• moods that swing from high to low.
• A disturbance in thought processes, with nonsensical conversation
• Auditory or visual hallucinations
• Sleep disturbance

No one really knows what causes this very distressing condition - it seems that there are many 'triggers'.

Psychiatric treatment is certainly necessary, however, and this may even include possible admission to hospital. This fact should not cause you unnecessary distress or worry as the outlook is very favourable for most women, who will go on to make a complete recovery.

2. The very common condition of Post-Natal 'blues', which is a brief period of emotional distress, occurring between the 3rd and the 10th day after you have given birth, is thought to affect 50-80 per cent of all women - in some way - and stretches across all cultures and social groups.

The symptoms are attributed to the sudden change in hormonal balance that occurs following childbirth, and as soon as this manages to sort itself out, the symptoms settle.

Treatment is not usually needed but you may find some helpful advice in our article Beating the baby blues.

3. Post-Natal Depression (PND) means 'becoming depressed after having a baby'.

This condition is not usually related to any 'obvious' cause associated with childbirth - although most of those who do suffer the condition are experiencing what is certainly a common complication of childbirth.

Sometimes this may be easy to explain - the baby is unwanted or is 'abnormal' in some way. Mostly though, the depression makes no obvious sense: 'I was so looking forward to having this baby, and now I feel utterly miserable'.

PND can affect one in every ten women who do suffer an emotional disturbance after childbirth. It can happen to anyone, and is certainly not a sign of 'weakness', as so many people think.

It can vary from a very mild illness to a very severe one. It does not lead to 'madness', again, as so many people think. Many women still suffer in silence, quite unnecessarily, from the symptoms of this most common complication of childbirth.

PND can go on for months, sometimes years, and can appear at any time in the first year after the birth, though usually within the first four months.

The symptoms may resolve themselves spontaneously over this period of time but they will be shortened and rendered less severe if treatment is initiated. Studies have also shown that if treatment is not given, some disturbing symptoms can continue for several years.

There are very recognisable symptoms which are:

• Depression: the most common - feeling low, unhappy, and wretched. Sometimes the depression is stronger at certain times of the day. Some days are good, some are bad - a feature which, itself, can be upsetting.
• Irritability: resentment or anger often accompanies the depression. Sometimes shown to the new baby but more often to the partner, who just 'cannot understand what is happening'.
• Fatigue: this is quite different to the accepted tiredness of a 'new' mother. The depressed mother becomes really exhausted during the day.
• Insomnia: Despite the feeling of exhaustion, the mother finds that she cannot sleep when she does go to bed - or even if she does, there can be early morning waking.
• Loss of Appetite: Often presenting as a 'lack of interest' in food and eating. This feature can, of course, add to the general symptoms of feeling 'low'.
• General features of 'not coping', anxiety and loss of enjoyment: PND can develop even when there is a great maternal love - but then there is the accompanying development of a great unwarranted anxiety towards the baby, and the general handling of the infant. There may even be exaggerated concerns about disease and sudden infant death, in some way.

We really don't know very much about why PND develops. It is probably more likely to be quite a complex condition, with not one single cause - but with many 'casual' associations and stresses which all act together during the post-natal period.

Certain 'risk factors' have, however, been acknowledged and these, acting together, may include:

• A previous history of emotional problems, depression during pregnancy, especially PND (one study showed 50-60 per cent chance of recurrence in theses cases).
• Accumulation of general upsetting incidents like bereavement, housing or financial problems, employment issues, relating to the partner.
• Lack of general support and encouragement from the partner.
• A sick baby (prematurity or developmental abnormality).

However, in many instances, PND can develop when none of these features apply and the condition is unexpected and unavoidable.

It is important that it is recognised. Some mothers are ashamed to admit that they are less than thrilled by new motherhood. The fact is, motherhood, even for those who find it uncomplicated, is a new role and one that has to be learned like all others.

So, don't worry that you don't feel confident about everything. There is a learning process. It may help to talk to other new mothers who are coping with post-natal depression. Meet some on our message board.

A great deal can be done, but the first step towards recovery is an acceptance of the PND as an illness - an illness that does need professional help to be treated promptly and efficiently.

Some mums do find this difficult, I know. However, trying to avoid this available help and 'waiting for the condition to settle' is not a good idea. It must be said, too, that some medical attendants just overlook or even ignore it: 'Oh, that's just the Baby Blues.'

Nowadays, fortunately, there is a general awareness of depression in general and PND should be missed less often.

Doctors don't always dismiss patients who have emotional problems just by giving them a prescription. However, sometimes anti-depressant drugs will help a lot and the medication is certainly appropriate, and necessary.

The specific anti-depressant drugs used for the treatment are extremely successful and can be life saving.

It is important to realise, however, that this form of medication does have a frustratingly slow rate of onset and good effect - up to 2 weeks - and it is necessary to continue with the drugs for many days before any improvement at all is felt.

Side effects to the prescribed medications, like fatigue and drowsiness, may also appear for a short time, and these are added to similar symptoms already present within the illness and can be somewhat frustrating to those who are suffering.

The benefits, however, will eventually far outweigh these added features and a great deal of encouragement, from all of those around is certainly needed. For your reassurances I would add that these drugs:

• are not 'tranquillisers' or 'pep' pills
• are not addictive
• do not stop you breast feeding
• do need to be continued for at least 6 months after the depression has lifted to reduce the risk of a relapse.

It is very sad that we just do not know enough about PND to be able to prevent it in the first place.

It is also so upsetting that this illness can come along, unexpectedly, and prevent you enjoying a most glorious time in your life. So, do remember, we can help, and most importantly: don't try to keep it to yourself.