As a mother with severe postnatal depression admits killing her two young children, mental health experts discuss the condition and explain what steps can be taken to help women recover from such extreme baby blues.
By Lisa Salmon
When Felicia Boots was spared jail last month for killing her two children, the judge's decision that a prison sentence was "wholly inappropriate" was applauded by postnatal depression charities.
Like 10-15% of new mums, including celebrities like Gwyneth Paltrow and Courteney Cox, Boots suffered postnatal depression (PND) following the births of her two children.
But while PND typically causes symptoms like low mood and anxiety, in Boots's case it was so severe that it resulted in her suffocating her daughter Lily, 14 months, and nine-week-old son Mason. Describing the tragedy as "indescribably sad", the judge in the subsequent court case ordered that 35-year-old Boots be detained at a psychiatric unit, after she admitted manslaughter on the grounds of diminished responsibility.
While cases like this are, thankfully, very rare, it highlights how crucial it is that PND is taken seriously and mothers suffering from the condition receive the professional support they need.
More than half of new mothers will experience some degree of mood swings, tearfulness and anxiety with the 'baby blues', which normally start about three or four days after childbirth, and only last a week or so. However, PND typically starts later, lasts much longer, and can have far more extreme symptoms.
These can sometimes include thoughts of self-harm and suicide or of harming the child, but such thoughts aren't usually acted upon, explains consultant perinatal psychiatrist Dr Lucinda Green, a spokesperson for the Royal College of Psychiatrists.
"A case where children are harmed is incredibly rare, in contrast to postnatal depression, which is very common," she says.
Other research has shown that new mothers who think about harming their child are more likely to say they have suicidal thoughts, rather than admitting their true thoughts about harming their baby, says Green.
"That's for obvious reasons," she explains. "They're worried about how they'll be judged, or that their baby will be taken away from them. But it's much more common that we see women who are thinking about harming themselves, than women who are thinking of harming their baby."
Boots had been prescribed antidepressants but hadn't been taking them, as she was convinced the children would be taken away from her because of the effects of the drugs on her breast milk.
Green, who works at St Thomas' Hospital, London, says that while this is an understandable concern, many mothers breastfeed successfully while on antidepressants.
"If someone has a very severe depression, it might be more important for her to have treatment so she gets better and can look after her baby. It's something that women should discuss with their GP," she advises.
Green explains that while PND can strike any new mum, it's more likely to affect women who have a past history of depression. The risk is also higher for mothers who've experienced a very stressful event, or who don't have a strong support system around them.
"There are often a lot of different factors that come together," she says. "It's a combination of biological, psychological and social factors. Having a baby is a huge change for women and it doesn't always go as people expect. Some find it difficult to adjust to, even if it's a very much-wanted baby."
Despite its name, in about a third of cases PND starts before the baby's even been born. Onset is variable, and while it can start in the first month or two after giving birth, it can also begin many months later.
Family members may notice that things don't seem right with a new mother, although Green warns: "Some women are quite good at hiding their symptoms, and we hear stories about them being reluctant to seek help, because they're worried they'll be judged as not being a good mother and their baby might be taken away.
"It's really important to stress that women should seek help - it's very, very rare for a baby to be removed from its mother," Green adds. She emphasises that in the unusual cases when a baby is removed, it's normally because there are other problems going on too.
Treatments for PND are similar to those given for other types of depression, and can include psychological help like cognitive behavioural therapy as well as antidepressants.
Evidence suggests that PND can sometimes affect infant development, and there can be long-lasting problems with the mother and child relationship, particularly in the more severe cases.
"Sometimes women recognise they're not giving their baby enough stimulation or looking after them in the way they want to, and they feel guilty, which is one of the symptoms of depression," says Green.
"Unfortunately there's still a lot of stigma around mental illness, but it's very important that women get help if they're ill, so they can get better and look after their baby."
Diane Nehme, secretary of the Association for Post-Natal Illness (APNI), agrees, and says the Boots tragedy highlights the fact that women with PND who do seek help need to be checked frequently.
"It's a depression, it's up and down all the time, and it's very difficult to know what's going on in a woman's mind if contact isn't kept up," she says.
The idea that a child may be taken away from a mother with PND is "a thought from yesteryear", she adds.
"Sometimes the outside help provided by organisations like social services can be really useful - they're not always demons," Nehme stresses. "They're there to help and provide services, and it's incredibly rare that a child would be taken away."
Nehme points out that PND isn't always as severe as its portrayed in the media, and stresses: "Those stories are the exception rather than the rule.
"Many people have uncontrolled thoughts when they've got postnatal depression, but it doesn't mean they're about harming the baby or themselves - it may be about their health or the baby's health.
"It's a very treatable illness - without doubt you will get better and come out the other end."
Recognising postnatal depression
Some of the following symptoms, lasting more than two weeks, may indicate postnatal depression:
:: Feeling low, unhappy and tearful much or all of the time
:: Being more irritable than usual
:: Tiredness and sleeplessness
:: Appetite changes
:: Inability to enjoy anything
:: Loss of interest in sex
:: Negative and guilty thoughts, e.g. that you're not a good mother
:: Anxiety, e.g. that you or your baby is very ill, or you might harm your baby
:: Avoiding other people
:: Suicidal thoughts
:: Psychotic symptoms, such as hearing voices (this is very rare)
:: For more information about postnatal depression, visit the Royal College of Psychiatrists' website on www.rcpsych.ac.uk/expertadvice.aspx, or the Association for Post-Natal Illness website on www.apni.org