Postnatal depression

• Overview:

  • Significant depressive episode that occurs within 6 months post-partum
  • Peak onset is 3-4 weeks
  • 90% of cases last less than 1 month
• Risk factors:

  • Personal or family history of depression
  • Older age
  • Single mother
  • Poor relationship with own mother
  • Unwanted pregnancy
  • Poor social support
  • Severe baby blues
  • Previous post-partum psychosis
• Clinical features are similar to other depressive episodes but there also may be worried about the babies health or being able to cope with the baby

  There may be a significant anxiety component
• Post natal depression is identified with the Edinburgh Postnatal Depression Scale (EPDS)

  The PHq-9 and GAD-7 can also be used alongside the EPDS
• Management:

  • Early identification in those at risk with the EPDS in primary care
  • Education and support from wider family
  • Treated in usual way with antidepressants and/or CBT
  • If severe or associated with thoughts of self-harm or harm to baby, may require hospital admission
• Post partum psychosis:

  • Peak occurrence at 2 weeks post-partum
  • May relate to reduction in oestrogen levels, cortisol levels or post-partum thyroiditis
  • prominent affective symptoms (mania or depression with psychotic symptoms)
  • Thoughts of suicide or infanticide
  • Management: early identification, admission to hospital
  • Mood stabilizers - carbamazepine
  • Antidepressants
  • ECT if very severe or other treatment failed
  • CBT for recovery
• Baby blues:

  • Up to 75% of new mothers will experience a short-lived period of tearfulness and emotional lability
  • Starts 2-3 days after birth and lasts 1-2 weeks
  • May relate to post-partum reductions in the levels of oestrogen, progesterone and prolactin (occurs around 72 hours after birth)
  • Only required reassurance and observation