Postnatal Depression

Postnatal depression is characterised by low mood in the postnatal period.

There is a spectrum of postnatal mental health illness:

  • Baby blues is seen in the majority of women in the first week or so after birth
  • Postnatal depression is seen in about one in ten women, with a peak around three months after birth
  • Puerperal psychosis is seen in about one in a thousand women, starting a few weeks after birth

 

Baby Blues

Baby blues affect more than 50% of women in the first week or so after birth, particularly first-time mothers. It presents with symptoms such as:

  • Mood swings
  • Low mood
  • Anxiety
  • Irritability
  • Tearfulness

 

Baby blues may be the result of a combination of:

  • Significant hormonal changes
  • Recovery from birth
  • Fatigue and sleep deprivation
  • The responsibility of caring for the neonate
  • Establishing feeding
  • All the other changes and events around this time

 

Symptoms are usually mild, only last a few days and resolve within two weeks of delivery. No treatment is required.

 

Postnatal Depression

Postnatal depression is similar to depression that occurs outside of pregnancy, with the classic triad of:

  • Low mood
  • Anhedonia (lack of pleasure in activities)
  • Low energy

 

Typically, women are affected around three months after birth. Symptoms should last at least two weeks before postnatal depression is diagnosed.

Treatment is similar to depression at other times:

  • Mild cases may be managed with additional support, self-help and follow up with their GP
  • Moderate cases may be managed with antidepressant medications (e.g. SSRIs) and cognitive behavioural therapy
  • Severe cases may need input from specialist psychiatry services, and rarely inpatient care on the mother and baby unit

 

Edinburgh Postnatal Depression Scale

The Edinburgh postnatal depression scale can be used to assess how the mother has felt over the past week, as a screening tool for postnatal depression.

There are ten questions, with a total score out of 30 points. A score of 10 or more suggests postnatal depression.

 

Puerperal Psychosis

Puerperal psychosis is a rare but severe illness that typically has an onset between two to three weeks after delivery. Women experience full psychotic symptoms, such as:

  • Delusions
  • Hallucinations
  • Depression
  • Mania
  • Confusion
  • Thought disorder

 

Women with puerperal psychosis need urgent assessment and input from specialist mental health services.

Treatment is directed by specialist services, and may involve:

  • Admission to the mother and baby unit
  • Cognitive behavioural therapy
  • Medications (antidepressantsantipsychotics or mood stabilisers)
  • Electroconvulsive therapy (ECT)

 

Mother and Baby Unit

The mother and baby unit is a specialist unit for pregnant women and women that have given birth in the past 12 months. They are designed so that the mother and baby can remain together and continue to bond. Mothers are supported to continue caring for their baby while they get specialist treatment.

 

Preparation During Pregnancy

Women that have existing mental health concerns before or during pregnancy are referred to perinatal mental health services for advice and specialist input. This includes decisions and ongoing management of psychiatric medications, such as SSRIs, antipsychotics and lithium. A plan is put in place for after delivery to ensure they are followed up closely with help from midwives, health visitors, GPs, family and friends, so that treatment and additional support can be put in place early if required.

SSRI antidepressants taken during pregnancy can lead to neonatal abstinence syndrome (also known as neonatal adaptation syndrome). It presents in the first few days after birth with symptoms such as irritability and poor feeding. Neonates are monitored for this after delivery. Supportive management is usually all that is required.

 

Last updated September 2020
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