Guides/You, the household, the rest of it

Postnatal depression, anxiety and sleep

It is not just tiredness any more, and you have been telling yourself it is for a while. Sleep deprivation and postnatal depression amplify each other, they are difficult to separate from the inside, and both respond to treatment.

4 min read

Broken sleep is a significant risk factor for postnatal depression and anxiety, and postnatal illness in turn makes sleep worse - you lie awake when you could be asleep, or wake early and cannot get back off. Each makes the other harder to escape, which is why waiting for the baby to sleep before addressing your own state often means waiting a very long time.

Postnatal depression affects somewhere around one in ten women, and it affects fathers and partners too - commonly around one in ten. It can begin any time in the first year, not only in the first weeks.

Tiredness or something more

Tiredness lifts, at least sometimes. A good night, a walk, an hour to yourself makes a difference. Depression does not lift when you rest.

Enjoyment has gone. Not just energy - the things you liked no longer feel like anything.

It has lasted more than two weeks. Most days, most of the day.

You cannot sleep even when you can. Lying awake while the baby sleeps, or waking at four and not getting back off. A strong signal.

Persistent anxiety or intrusive thoughts. Constant checking, catastrophic thoughts, frightening intrusive images. Distressing and much more common than people realise.

Feeling detached from your baby, or that they would be better off without you. Please tell someone today.

Where to go

Your GP or your health visitor is the first step, and both are used to this conversation. They may use a short questionnaire - often the Edinburgh Postnatal Depression Scale - which makes it easier to say what is happening without having to find the words yourself. Treatment usually means talking therapy, medication, or both, and there are antidepressants that are compatible with breastfeeding.

In the UK you can also self-refer to NHS talking therapies without going through your GP. PANDAS runs a free helpline for perinatal mental illness on 0808 1961 776, and Mind’s information line is 0300 123 3393. If you need to talk to someone at any hour, Samaritans are on 116 123, free, day or night.

If you are having thoughts of harming yourself or your baby, contact your GP or NHS 111 today, or go to A&E. This is treated as an emergency and taken seriously, and asking for help does not put your baby at risk of being taken away - that is the fear that stops people, and it is not what happens.

Tiredness lifts when you rest. If resting changes nothing, it is worth telling someone.

And the sleep part

Do not wait for the baby’s sleep to improve before dealing with your own state. Treating the depression or anxiety often improves your sleep independently of what the baby is doing, and it makes the nights that remain far more survivable.

What treatment usually involves

Most commonly talking therapy, medication, or both. In the UK you can self-refer to NHS talking therapies without going through your GP, and waiting times vary considerably by area, so it is worth starting that referral even while you arrange an appointment.

If medication is discussed, there are antidepressants compatible with breastfeeding, and a GP will take that into account without needing to be asked. It is also worth knowing that treatment often improves your sleep independently of what your baby is doing - the early waking and the inability to sleep when you can are symptoms rather than consequences, and they respond.

For partners and other parents

Postnatal depression affects fathers and non-birthing partners too - commonly around one in ten - and it is far less asked about, so it goes unrecognised for longer. It often presents differently: irritability, anger, withdrawal, working late, drinking more, rather than obvious sadness.

The same routes apply. A GP, NHS talking therapies by self-referral, PANDAS on 0808 1961 776. If you recognise this in your partner, saying so directly and offering to make the appointment is more useful than waiting for them to raise it - most people in it do not.