Postpartum Depression (PND)
- Common, affecting 1 in 10 women postpartum
- Symptoms occur 1-3 months postpartum (useful differentiating factor from baby blues)
- Clinical features are in keeping with classical depression – anhedonia, low mood, fatigue, altered sleep/wake cycle, altered appetite
- Assessment: PHQ-9 OR the Edinburgh Postpartum Depression Scale
- Scored out of 30 – a score of > 13 suggests a depressive state
- Management
- If persistent less severe depression - refer for facilitated self help
- New depression: If moderate or severe PND
- Refer for high-intensity therapy - CBT
- Pharmacological Tx: SSRI / SNRI / TCA (if psychological interventions declined/not effective, or she expresses a preference for medication).
- If breastfeeding, paroxetine and sertraline are the SSRIs of choice – lowest milk ratio
Baby Blues
- Baby blues is very common – it can affects up to 70% of women postpartum
- Clinical Features
- Symptoms occur shortly after birth – 3-7 days postpartum
- Anxiety, irritability, tearfulness, fatigue.
- Management:
- Reassurance, health visitor support
Postpartum Psychosis
- A rare, psychiatric/obstetric emergency (2/1000 women)
- Clinical Features:
- Sudden onset of severe mood swings with psychotic features (delusion and hallucinations) - typically 2-3 weeks post-partum
- Management:
- Admit
- Risk in subsequent pregnancies = up to 50% risk of recurrence