Postnatal Depression
Understanding PND, breastfeeding safely with antidepressants, and when to seek help
Postnatal depression (PND) is a common and treatable medical condition affecting around 1 in 7 new mothers, usually developing within the first three months after childbirth. It is not a sign of weakness or failure as a parent — it is an illness with effective treatments including psychological therapies and medication that is safe during breastfeeding.
What is postnatal depression?
Postnatal depression is different from the 'baby blues', which is a brief period of emotional upset and tearfulness that commonly occurs around days two to four after birth and resolves on its own within a week or two. PND is a depressive illness that persists beyond two weeks and significantly affects a mother's ability to function and enjoy life. It can also affect fathers and partners. Left untreated, PND can have lasting effects on maternal wellbeing, the mother-infant relationship, and infant development. Early identification and treatment make a significant difference to outcomes.
Recognising the signs
Symptoms of PND include persistent low mood or tearfulness, loss of interest in activities (including in the baby), difficulty bonding with the baby, excessive anxiety about the baby's wellbeing, fatigue, sleep problems, feelings of guilt or worthlessness, and in some cases thoughts of self-harm. The Edinburgh Postnatal Depression Scale (EPDS) is a validated 10-item questionnaire used by midwives, health visitors and GPs to screen for PND at postnatal contacts. If your score suggests possible depression, further assessment will be arranged.
Treatment — psychological therapies
For mild-to-moderate PND, NICE guidelines recommend psychological therapies as first-line treatment. Cognitive Behavioural Therapy (CBT) and Interpersonal Therapy (IPT) have the strongest evidence base for PND. These are available through IAPT (Improving Access to Psychological Therapies) — you can self-refer or be referred by your GP. Guided self-help using CBT-based workbooks or online programmes is also effective for milder presentations. Peer support groups, health visitor enhanced support, and structured exercise have additional benefits.
Antidepressants — what you need to know
For moderate-to-severe PND, or when psychological therapies alone are insufficient, antidepressants are recommended. Sertraline is the first-choice antidepressant in PND and is safe during breastfeeding — it passes into breast milk in only very small amounts and has an excellent safety record in nursing mothers. Antidepressants typically take two to four weeks to reach their full effect. It is important to continue taking them as prescribed and not to stop suddenly. Treatment is usually recommended for at least six months after recovery to prevent relapse. Always discuss any concerns with your doctor or pharmacist.
Breastfeeding and medication
Many mothers worry about taking antidepressants while breastfeeding. The good news is that sertraline and paroxetine pass into breast milk in very small amounts and are considered compatible with breastfeeding by NICE and the BNF. The risk of not treating postnatal depression — to both the mother and infant — generally outweighs the very small risk from medication through breast milk. Your prescriber will discuss the options with you so you can make an informed decision. If you have concerns, a specialist perinatal pharmacist can also provide tailored advice.
Support and recovery
Recovery from postnatal depression is expected with the right support. The PANDAS Foundation (pandasfoundation.org.uk, helpline 0808 1961 776) and APNI (apni.org, helpline 0207 386 0868) provide specialist support and peer networks for mothers with PND. Involving your partner and family in your care is important — they can provide practical help and emotional support. If at any point you feel your mood is rapidly worsening, you are having thoughts of self-harm, or you feel unable to care for yourself or your baby, contact your GP or midwife urgently, or call 999. All information in this article has been prepared following careful evaluation of NICE CG192 and current evidence on postnatal mental health.