Perinatal depression is a general term for depression experienced while pregnant or after giving birth. It may also be referred to as:

• Antenatal depression – experienced while you are pregnant
• Postnatal depression (PND) – experienced during the first year after giving birth

What are the signs and symptoms of perinatal depression?

You might feel:

• Sad or tearful – this may get worse at certain times of the day
• Restless, agitated or irritable – with your baby and/or your partner
• Guilty – you might think you are a bad mother
• Empty and numb – you may be unable to enjoy the things you usually love or your time with your baby
• Isolated and lonely
• Detached from reality
• A lack of confidence and self-esteem
• A loss of libido – no interest in sex
• Hopeless
• Suicidal

Some of these feelings can be mistaken for a normal part of pregnancy or parenthood, and many people put them down to sleep loss and the demands of having a new baby. It’s important to recognise if something more serious is happening and seek help early. Always speak to your GP if you’re experiencing any of these symptoms.

Is PND different from the ‘baby blues’?

The ‘baby blues’ are experienced by about 60% of women, usually starting on the third day after birth. Symptoms include feeling tearful and/or irritable for little or no reason. These feelings are due to hormonal changes and usually pass within a few days. PND usually starts a few weeks after the birth and lasts longer.

Who is at risk of perinatal depression?

Anyone can experience perinatal depression, but you might be more at risk if you:

• Have previously experienced mental ill-health, either during pregnancy or not.
• Have little support from family or friends.
• Have experienced a recent stressful event such as a bereavement, break-up or job loss.
• Are currently experiencing issues such as relationship or financial trouble.

Partners can experience perinatal mental health problems too. 1 in 10 dads are affected by PND.

Treatment

Mild PND may get better with time and good support, but you should still see your GP or health visitor so that the symptoms can be monitored. They can help you decide if you do need treatment and which option is right for you.

The three main types of help are:

Talking Therapies

Cognitive Behavioural Therapy (CBT) has been proven very effective for mild/moderate depression and in preventing relapse. It works on the basis that if you change your unhelpful thinking patterns and behaviour, it will improve how you feel. Self-help books based on CBT, as well as computerised forms of therapy and counselling, might also help. Ask your GP to tell you about them. Any of these may be used with or without medication.

Medication

Antidepressants are the most commonly prescribed and effective treatments for moderate or severe depression. It is important, however, to take them exactly as prescribed and only to stop taking them as and when advised by your GP.

They are not addictive, but stopping them suddenly or too soon may cause a relapse. They work by boosting certain brain chemicals that affect your mood. Any side effects usually disappear or are tolerable, although you should tell your GP as soon as possible if you experience them.

Self-help strategies

When you feel depressed, you tend to do less and less because of tiredness, difficulty sleeping and/or eating, and negative thinking. You stop doing things you used to enjoy. It can get so bad that you can't go to work, or do day-to-day things at home.

You stay in bed or stay at home doing very little and isolate yourself from friends and family. Increasing your activity levels can have a big impact on your mood, but it's important to get a balance of activities that give you a sense of closeness, achievement and pleasure.

For more self-help information, please see below.

To download our ‘Helping you with Postnatal Depression’ resource, click here.

Perinatal anxiety is a general term for anxiety experienced while pregnant or after giving birth. It may also be referred to as:

• Antenatal anxiety – experienced while you are pregnant
• Postnatal anxiety (PND) – experienced during the first year after giving birth

Perinatal anxiety can often be experienced alongside perinatal depression.

What are the signs and symptoms of perinatal anxiety?

Some of the most common symptoms are:

• Thoughts – premonitions of bad things, uncontrollable overthinking, confusion, lack of concentration etc.
• Feelings – fear, worry, nervousness, agitation, irritability etc.
• Physical – Headaches, muscle/chest pain, sweating, tingling, numbness, shaking, dizziness, changes in appetite, rapid or shallow breathing, rapid heartbeat or palpitations, dry mouth, nausea, vomiting, diarrhoea etc.
• Behaviour – avoidance of places, people or situations, not going out, obsessive or compulsive behaviour, increased use of alcohol or drugs etc.

Always speak to your GP if you’re experiencing any of these symptoms.

Who is at risk of perinatal anxiety?

Anyone can experience perinatal anxiety, but you might be more at risk if you:

• Have previously experienced mental ill-health, either during pregnancy or not.
• Have little support from family or friends.
• Have experienced a recent stressful event such as a bereavement, break-up or job loss.
• Are currently experiencing issues such as relationship or financial trouble.

Partners can experience perinatal mental health problems too.

Treatment

Mild perinatal anxiety may get better with time and good support, but you should still see your GP or health visitor so that the symptoms can be monitored. They can help you decide if you do need treatment and which option is right for you. 

The three main types of help are:

Talking Therapies

Cognitive Behavioural Therapy (CBT) has been proven very effective for mild/moderate depression and in preventing relapse. It works on the basis that if you change your unhelpful thinking patterns and behaviour, it will improve how you feel. Self-help books based on CBT, as well as computerised forms of therapy and counselling, might also help. Ask your GP to tell you about them. Any of these may be used with or without medication.

Medication

Antidepressants are the most commonly prescribed and effective treatments for moderate or severe depression. It is important, however, to take them exactly as prescribed and only to stop taking them as and when advised by your GP.

They are not addictive, but stopping them suddenly or too soon may cause a relapse. They work by boosting certain brain chemicals that affect your mood. Any side effects usually disappear or are tolerable, although you should tell your GP as soon as possible if you experience them.

Self-help strategies

When you feel depressed, you tend to do less and less because of tiredness, difficulty sleeping and/or eating, and negative thinking. You stop doing things you used to enjoy. It can get so bad that you can't go to work, or do day-to-day things at home.

You stay in bed or stay at home doing very little and isolate yourself from friends and family. Increasing your activity levels can have a big impact on your mood, but it's important to get a balance of activities that give you a sense of closeness, achievement and pleasure.

For more self-help information, please see below.

Postpartum psychosis is a rare but serious mental illness which affects about 1 in 1000 women and begins in the days or weeks following childbirth.

Postpartum psychosis can affect any woman, but those with a history of mental health conditions are at a higher risk. It can be an overwhelming and frightening experience. With the right support, most people fully recover.

What are the signs and symptoms of postpartum psychosis?

The symptoms of postpartum psychosis usually start quickly, within a few weeks of giving birth. 'Postpartum' means after childbirth. Symptoms vary and can change rapidly. They can include mania, depression, confusion, hallucinations and delusions. It is a psychiatric emergency, and help should be sought as soon as possible.

You might feel:

• Excited or elated (mania)
• Very low or depressed
• A mix of both the above (mood swings)
• Confused or disorientated

You may be:

• Restless
• Having trouble sleeping
• Having trouble concentrating
• Experiencing psychotic symptoms, like delusions or hallucinations

Causes of postpartum psychosis

There is no known specific cause of postpartum psychosis. However, some contributing factors may be:

• A family history of mental ill-health, particularly with postpartum psychosis.
• A previous experience with postpartum psychosis.
• A diagnosis of bipolar or schizophrenia.
• A traumatic birth or pregnancy.

Treatment

It’s really important to get medical help with postpartum psychosis as soon as possible. There are various treatment options available that a doctor might offer you:

Medication

Antipsychotic drugs are the most commonly prescribed and effective treatments for postpartum psychosis. You might also be offered antidepressants.

Antidepressants are not addictive, but stopping them suddenly or too soon may cause a relapse. They work by boosting certain brain chemicals that affect your mood. Any side effects usually disappear or are tolerable, although you should tell your GP as soon as possible if you experience them.

Self-help strategies

After receiving professional medical treatment for postpartum psychosis, there are some steps you can take to help yourself while you get better. 

For more self-help information, please see below.

Many parents find it difficult to recognise and talk about. They fear judgement from others and may not fully understand the illness or know how to express what they feel or need. Speaking to and listening to how other parents have coped with similar experiences and how they manage their thoughts and feelings can really aid recovery.

Peer support offers a safe, non-judgmental place for parents to talk about their experiences. Just knowing you are not alone on this journey can provide comfort and hope at a difficult time.

AWARE is currently supporting the WRDA in the establishment and setting up perinatal support groups around Northern Ireland for more information and to find your nearest one click here.

Knowledge is power, and at AWARE, we're passionate about education. We offer specific mental health programmes to support you as a new or expectant parent during the perinatal period.

Mood Matters (Parent & Baby)

A 2-hour mental health awareness session for new and expectant parents delivered either face-to-face or online. This course helps participants to look after the mental health of them and their baby. It also teaches them to recognise the signs and symptoms of perinatal mental ill-health and makes them aware of sources of help. Click here to find out more.

Living Life to the Full

A 6-week programme using Cognitive Behavioural Therapy (CBT) concepts. Suitable for people with mild to moderate depression. This course teaches participants to recognise and challenge unhelpful thought patterns to better deal with life’s daily stresses. Click here to find out more.

If you feel like you might need some support, you are not alone. Help is available.

The organisations below offer help and support to mothers, fathers & families who need it. Do not be afraid to reach out to them - that's what they're there for!

• Directory of organisations to help improve mental health and emotional wellbeing in your area
• Family Support Hubs - Provide services for families who are experiencing difficulties
• Sure Start - Family health, early years care and education and wellbeing programmes
• Action for Children - Support for children and young people
• TinyLife - Support for parents of premature babies
• Home-Start - Help for parents who are isolated or facing problems accessing services
• Support2gether - Help for families living with Antenatal and Postnatal Depression (PND)
• Lifeline – Provides services for those in distress or despair. Telephone: 0808 808 8000
• Parentline NI - Helpline for advice, support or guidance. Telephone: 0808 8020 400

• Best Beginnings Baby Buddy App
• Tommys.org
• Birth and Beyond
• Helpline NI
• The Dads Network
• The Every Mum Movement
• Association for Postnatal Illness
• Birth Trauma Association
• PANDAS Foundation
• Action on Postpartum Psychosis