If you think that you have postnatal depression (PND), you should see your GP, midwife or health visitor as soon as possible so that a diagnosis can be made, and an appropriate course of treatment undertaken. If you do have PND, it is important for you and your family to remember that it can sometimes take a long time to fully recover from the condition.

Common treatment methods for PND are detailed below.

Support and advice

The most important step in treating PND is recognising the problem and then taking steps to deal with it. The support and understanding of your partner, family and friends can play a big part in your recovery. However, to benefit from this, it is important for you to talk to those who are close to you and explain how you feel, rather than keeping everything pent-up inside. This can cause tension, particularly with your partner, who may feel that they are being shut out.

The support and advice from social workers, or counsellors, can also be very helpful if you have PND. Ask your health visitor about what services are available in your area. Self-help groups can also provide you with good advice about how to cope with the effects of PND, and you may find it reassuring to meet other women who feel the same as you.

Medication

Medication is sometimes used to treat PND. Antidepressants are often prescribed to treat moderate or severe cases. They work by balancing the mood-altering chemicals in your brain. Antidepressants can help ease symptoms such as low mood, irritability, lack of concentration and sleeplessness, allowing you to function normally and giving you the ability to cope better with your new baby.

A course of antidepressant medicines usually lasts for four to six months. However, if your symptoms improve, the dose may be steadily reduced by your doctor. Antidepressants take two to four weeks to start working, so it is important to keep taking them even if you do not notice an improvement straight away. It is also important to continue taking your medicine for the full length of time recommended by your doctor because if you stop taking it too early, your depression may return.

You should talk to your GP about the type of medicine that is most suitable for you, and any possible side effects that may be caused. If you do experience any side effects from the medicine that you are prescribed, you should tell your GP so that they can alter your dose or change your medicine.

In severe cases of PND, such as postnatal psychosis, where symptoms can include irrational behaviour, hallucinations and suicidal thoughts, tranquillisers may be prescribed as a possible treatment option. However, they are usually only recommended for short-term use.

Between 50% and 70% of women who have moderate to severe PND improve within a few weeks of starting treatment with antidepressants. However, they are not an effective method for everyone.

Antidepressants and breastfeeding

Not enough is known about the possible long-term risks to babies of antidepressants taken by breastfeeding mothers. This is because the normal method of assessing these risks - that is, running large scale clinical trials involving people who have given their consent - would be unethical for children.

We know that antidepressants can pass into breast milk. Therefore, women who are taking antidepressants may wish to discuss feeding options with their GP so that they can make an informed choice.

Many mothers are keen to continue breastfeeding because they feel that it helps them to bond with their child, and boosts their self-esteem and confidence in their maternal abilities. These are important factors in combating the symptoms of PND.

Your GP will be able to provide advice about the benefits and risks of the different feeding methods, but the final decision will be yours to make.

The limited evidence available suggests that the class of antidepressant known as tricyclic antidepressants (TCA) are probably the safest to take while breastfeeding.

TCAs are not suitable for some people, including:

• people with a history of heart disease,
• people with epilepsy, and
• people with severe depression who have frequent suicidal thoughts (this is because an overdose of TCAs can be fatal).

In these circumstances, another type of antidepressant may be prescribed known as a selective serotonin reuptake inhibitor (SSRI). The preferred SSRIs are paroxetine or sertraline because tests have shown that the amounts of these medicines that is found in breast milk is so small that it is unlikely to be harmful.

Counselling

Counselling, or talking treatments, can be useful in treating PND. If your GP feels it may help you, you will be referred to a psychologist or other mental health specialist. There are various different types of counselling, but their availability on the NHS may vary depending where you live. Types of counselling are discussed below.

Cognitive therapy

Cognitive therapy is based on the idea that certain thoughts can 'trigger' mental health problems, such as depression. The therapist will help you to understand how your thoughts can be unhelpful or harmful to your state of mind. Sessions are usually conducted on a weekly basis over several months, and the aim is to help you to change your thought patterns in a way that is more helpful and positive.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) combines cognitive therapy and behaviour therapy. Behaviour therapy is about changing any behaviour that is harmful or unhelpful. The aim of CBT is to help you change the way that you think, feel and behave for the better.

Other talking therapies

Other talking therapies include interpersonal therapy and problem solving therapy. Also, trained health visitors sometimes give short counselling sessions over several weeks, and these have been shown to help ease PND.

For those who have moderate PND, talking treatments such as cognitive therapy and CBT have about the same success rate as antidepressants (50-70%). However, talking treatments may not be as effective for people with severe depression because they require a certain level of motivation, and those with severe depression often find it difficult to motivate themselves.

Some research has suggested that a combination of antidepressants and counselling is better than either treatment alone.

Treating severe PND

You may be referred to a mental health team if your PND is severe, or does not respond to treatment. These teams are usually made up of psychologists, psychiatrists, specialist nurses and occupational therapists. They often provide intensive specialist talking treatments, such as cognitive therapy or psychotherapy.

If it is felt that your PND is so severe that you are at risk of harming yourself or your baby, you may be admitted to hospital or referred to a mental health clinic.

If you have support available from your partner or family, it may be recommended that they care for your baby until you are well enough to return home.

If you do not have support available to help you care for your baby, or your mental health team feel that separation from your baby would adversely affect your recovery, it may be recommended that you are transferred to a specialised 'mother and baby' mental health clinic.

Your baby may have to sleep in a separate nursery until you are well enough to look after them. Once your symptoms begin to respond to treatment, your baby will be able to sleep in your room.

Electroconvulsive therapy (ECT) may be advised if you have severe PND. ECT works for severe PND, but is only used when antidepressants and other treatments have not worked.

If ECT is recommended, you will be given a general anaesthetic and medication to relax your muscles. Electrodes are then placed on your head and a pulse of electricity is passed through your brain, which will trigger a fit or seizure (which is why you are given muscle relaxants). Most people have either six or twelve sessions of ECT, normally with two sessions a week.

For most people the treatment is effective in relieving severe depression, but the effect may not be permanent. Nobody is entirely sure how ECT works, but the generally agreed view is that the electricity changes the chemical composition of the brain in such a way as to elevate mood.

Some people experience unpleasant side effects, including headaches and both short-term and long-term memory loss. Because of the risk of memory loss, your memory will be assessed at the end of each ECT session. If it looks like memory loss is occurring, or you experience any other adverse side effects then the ECT sessions will be stopped.

St John's wort

St John's wort is a herbal supplement that some people take for depression. Though there is some evidence may be of benefit in treating mild or moderate depression, its use is not recommended. This is because it is not tested as rigorously as a medicine. Also, the quantity of its active ingredients vary among individual brands and batches, so you cannot be certain what effect it will have.

Taking St John's wort with some other medications - such as anticonvulsants, anticoagulants, antidepressants and the contraceptive pill - can cause serious problems.

You should not use St John's wort if you are breastfeeding as there is not enough evidence that it is safe in this case.