(Extract from the Mind Publication "Understanding Post Natal Depression ")

'Everybody kept saying to me, "Oh, how well you're coping." And yet, behind the closed walls, you think, "Why can't I tell them what's going on?" '

'I sat in the park under a big tree, looking at the beautiful clear blue sky. There was no-one else there. Tears just kept coming out of my eyes and rolling down my cheeks, for no particular reason. I didn't feel particularly sad, but I just couldn't stop them.'

'Late one afternoon, I stood washing up at the kitchen sink. The water was hot. The next thing I remember is that the water was cold and it was dark outside. I was glad that we lived near King's Cross Station because ther were lots of trains and I could walk under one.'

Postnatal depression is very common, and yet often not recognised. It is still possible that health professionals with whom a new mother comes into contact (GPs, midwives, health visitors, etc) may not have received adequate training - or may be too hard-pressed - too recognise the condition. Too many women suffer in silence, struggling on alone. This booklet describes the signs and symptoms to look out for and tells you what can be done to help.

What is postnatal depression?

People expect that having a baby is going to be a source of happiness, and of course it is, and should be. But, as a new mother, you may be very far from feeling this straight away, and this can bring with it a huge anxiety. You may well go through a period of depression, which may be brief and manageable (the 'baby blues') or deeper and longer-term (postnatal depression). Very rarely, a new mother may experience an extremely severe form of depression, known as puerperal psychosis.

The baby blues

The baby blues usually arrives two to four days after the birth and is so common that it's regarded as normal. You may feel very emotional and liable to burst into tears, for reasons that may seem quite trivial to other people. You may find it difficult to sleep (even when the baby lets you) and you may not feel like eating. You may also feel anxious, sad, guilty, and afraid that you are not up to being a mother.

Doctors suggest that the baby blues may be down to changes in hormone levels that happen after the birth, but others say it's brough on by the experience of being in hospital. Although having the baby blues is distressing, its important to know that it clears up quickly, usually within a couple of weeks. Medical professionals don't usually take it very seriously. If the depression goes on for longer, however, or gets worse, it may be turning into postnatal depression.

Postnatal depression (PND)

At least one new mother in ten goes through PND, often when the baby is between four and six months old, although it can emerge at any time in the first year. It comes on either gradually or all of a sudden, and can range from being relatively mild to very hard-hitting.

What are the common signs of PND?

You may go through one or more of the following experiences, although it's extremely unlikely that you will go through all of them:

• feeling very low, or despondent, thinking that nothing is any good, that life is a long, grey tunnel, and that there is no hope
• feeling tired and very lethargic, or even quite numb. Not wanting to do anything or take an interest in the outside world
• a sense of inadequacy; feeling unable to cope
• feeling guilty about not coping, or about not loving the baby enough
• wanting to cry
• being unusually irritable, which makes the guilt worse
• losing your appetite, which may go with feeling hungry all the time, but being unable to eat
• difficulty sleeping; either not getting to sleep, waking early, or having vivid nightmares
• being hostile or indifferent to your husband or partner
• losing interest in sex
• having panic attacks, which strike at any time, causing rapid heartbeat, sweaty palms and feelings of sickness or faintness
• an overpowering anxiety, often about things that wouldn't normally bother you, such as being alone in the house
• difficulty in concentrating or making decisions
• physical symptoms, such as stomach pains, headaches and blurred vision
• obsessive fears about the baby's health or wellbeing, or about yourself and other members of the family
• thoughts about death

Thoughts about death can be very frightening, and may make you feel as if you are going mad or completely out of control. You may be afraid to tell anyone about these feelings. It's important to realise that having these thoughts doesn't mean that you are actually going to harm yourself or you children, although this does happen very occasionally. However difficult, the more you can bring these feelings out into the open and talk about them with someone you trust, the less likely it is they will be acted on. The woman quoted on the opening page didn't walk under a train, but lived to tell the tale.

Topics also included in this leaflet are: