Post-natal depression: some information

Post-natal depression is a serious and common disorder that occurs some weeks after delivery and may last for many months. It occurs in at least 15% of women and frequently goes unrecognised because women frequently regard this degree of depression and exhaustion as the normal consequence of looking after a new baby. Surprisingly it does not seem to be influenced by obstetric factors such as length of labour, Caesarean section or even separation of the mother from the baby in the Special Care Baby Unit. It does not occur in one social class more than another and in fact the only environmental factor seems to be the perceived level of support given by the partner to the women.

Traditionally this has been treated by orthodox psychotherapy with antidepressants, discussion groups together with Mother and Baby Units.

It is very likely that the essential cause of post-natal depression is the sudden decrease in hormones, particularly oestradiol that occurs after delivery. In this way it is similar to the depression of pre-menstrual syndrome and the menopause which is also related to decreases in ovarian hormones, particularly oestrogen. In fact later on in life it is clear that women who have the most severe "menopausal" depression around the age of 45 are the women who also had post-natal depression, pre-menstrual depression and significantly felt very well during pregnancy when the hormone levels were high.

Moderately high doses of transdermal oestrogens (200 mcgs twice weekly) have been shown to be effective in post-natal depression even in patients where prolonged anti-depressants have failed. We have a Psychoendocrine Unit at the Chelsea & Westminster Hospital, London dealing with this problem and believe this treatment, shown to be effective, by a scientific study published in the Lancet (1) should be used more often..