Postnatal Depression or PND, is a term used to describe feelings of depression after having a baby. At first, many women are tired, feel unsure and are not able to cope when they come home from the hospital. This normally passes within a couple of weeks. However, for mothers with postnatal depression, things do not improve: Women may feel like: "I was so looking forward to having this baby, and now I feel utterly miserable. What's the matter with me?"

Puerperal Psychosis is the most extreme form of postnatal mood change, it is fairly rare, affecting 1 in 500 new mothers. Symptoms are evident within a short time after the birth and include the mother becoming restless, mildly confused and unable to sleep, the sufferer loses contact with reality. Medical intervention is vital.

Despite extensive and ongoing research into this form of depression, the exact cause is not entirely clear and not usually straightforward.

Some women may feel that their birth experience failed to match up to their expectations. The feeling of being 'let down' can cause depression. A traumatic/difficult birth experience or a premature or unwell baby is sometimes reported by those who develop postnatal depression. 

A small number of women who develop postnatal depression have a temporary thyroid gland defect associated with their mood difficulties. It has been suggested that some women are particularly vulnerable to the drop in sex hormones following birth. 

There is yet, however, no firm scientific evidence in this regard and research into biological factors is still underway. 

Another possible reason for postnatal depression relates to the fact that the birth of a baby brings irrevocable changes to a new mother's life. New babies are hard work, with the constant demands of crying, feeding, bathing and putting to sleep. This usually means a significant loss of uninterrupted sleep. The new mother is suddenly responsible 24 hours a day. There can be a feeling of loss of their old life. This sense of loss can cause depression unless the mother can find ways of adjusting to her profound changes in lifestyle.

A new mother is more likely to be emotionally stressed if she has experienced recent stressful events in her life, for example, a bereavement or a serious illness. In addition, women who are isolated from their families or without a supportive partner can be more likely to suffer depression after birth. 

A previous history of depression can be a significant factor to the development of postnatal depression. 

We as a society, expect too much of mothers. Popular images of motherhood suggest that mothers should be radiant, energetic, and living in perfect homes with supportive partners. Mothering is perceived as instinctive, not something to be learned. Therefore women who find the weeks and months after childbirth difficult often imagine that they are the only ones not coping. This lack of skill and knowledge can lead to overwhelming feelings of inadequacy, a sense of failure and isolation, which can contribute to deep emotional stress.

This is the most common symptom of PND. It means feeling low, unhappy and wretched for much or all of the time. Sometimes the depression is worse at particular times of the day, like mornings or evenings. Sometimes there are good days and bad - which are the more disappointing because the previous good day raised hopes of getting better. 

Sometimes it feels that life is not worth living, at a time when it should be at its most joyous.

Often accompanies the depression. It can be shown towards any other children, and occasionally the baby, but most of all the partner, who may well wonder what on earth is wrong!

All mothers get pretty weary, but the depressed mother is so utterly exhausted that she may think that there is something physically wrong with her.

However, when at last she gets to bed, she may find out that she cannot fall asleep - or if she does, that she wakes early, even if her partner is feeding the baby that night.

Depressed mothers usually have little time or interest to eat, and this contributes to feeling irritable and run down. Some women, though, eat too much, for comfort, but then feel guilty and uncomfortable about getting fat.

What used to be a pleasure is unappealing, what used to be of interest is a bore. This may be especially true of sex. Some women regain interest in sex (if they ever lost it) before the 6 weeks postnatal examination, but PND usually takes any enthusiasm away. The partner who seeks to share the comfort and excitement of intercourse meets reluctance or a rebuff, putting further strain on the relationship.

Anxiety is acute. Often it takes the form of being afraid to be alone with the baby, who might scream the place down or not feed or choke or be dropped or harmed in some other way. Some depressed mothers perceive the baby as 'it', instead of feeling that they have given birth to the loveliest, most adorable baby in the world, they feel detached. The task of a new mother who hasn't yet 'fallen in love' with her baby is extremely difficult. The love comes in the end, but usually when the baby is older.

However, PND may also develop even when love is strong. The mother then worries desperately in case she should lose her precious baby through infection, mishandling, faulty development or a 'cot death'. Snuffles cause her terrible worry, she frets over how much weight has been (or not been) gained, she is alarmed if the baby is crying or if it is too silent - has its breathing stopped? So she wants constant reassurance from her partner, the Health Visitor, the doctor, her family, the woman next door - anyone really! 

If you think you have postnatal depression (PND), see your GP, midwife or health visitor as soon as possible so a diagnosis can be made and an appropriate course of treatment started.

If you do have PND, it is important for you and your family to remember that it can sometimes take a long time to recover fully from the condition.

The most important step in treating PND is recognising the problem and then taking action 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. Bottling everything up can cause tension, particularly with your partner, who may feel they are being shut out.

The support and advice from social workers or counsellors can be very helpful if you have PND. 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.

Ask your health visitor about the services in your area.

Remember, postnatal depression is a temporary illness – you will get better, but you should get some help.

Nurture, NurturePnd.org 01-8430930 

Postnatal Depression Ireland, 021 492 3162

Aware, 1890 30 33 02; aware.ie

Samaritans 24hr listening service, 1850 60 90 90; samaritans.org