Overview

• Postnatal Depression → low mood in the postnatal period.
  • Baby Blues → seen in majority of women in first week after birth.
  • Postnatal Depression → one in ten women, with peak around three months after birth.
  • Puerperal Psychosis → one in a thousand women, starting few weeks after birth.

Making Diagnosis

Clinical Features

• Baby Blues → mood swings, low mood, anxiety, irritability, tearfulness.
  • Symtpoms are usually mild, only last a few days and resolve within two weeks of delivery.
• Postnatal Depression → triad of low mood + anhedonia + low energy.
  • Symptoms should last at least two weeks before diagnosis.
• Puerperal Psychosis → delusions, hallucinations, depression, mania, confusion, thought disorder.

Investigations

• Edinburgh Postnatal Depression Scale → screening tool for postnatal depression. Total score /30, score >10 suggests postnatal depression.

Management Plan

• Baby Blues → no treatment required.

• Postnatal Depression ⇒

  • Mild → additional support, self-help and follow up with GP.
  • Moderate → SSRIs and CBT.
  • Severe → input from specialist psychiatry services.

• Puerperal Psychosis → urgent assessment and input from specialist mental health services.

  • Admission to mother and baby unit.
  • CBT.
  • Medications → antidepressants, antipsychotics and mood stabolisers.

• SSRIs during 1st Trimester → increased risk of congenital heart defects.

  • Paroxetine has an increased risk of congenital malformations, particularly in the first trimester.

• SSRIs during 3rd Trimester → risk of persistent pulmonary hypertension of the newborn.