Postnatal depression

Question 1

Sx of postnatal depression

Answer 1

Pervasive low mood
Tearfulness
Anhedonia
Loss of appetite
Poor sleep
Anergia
Negative view of self or ability to care for a newborn

At least 2 weeks

Question 2

Risk factors

Answer 2

FH of perinatal psychiatric disorders, social isolation, past history of depression and anxiety, domestic abuse

Question 3

DDx

Answer 3

Baby blues

Postpartum psychosis - usually develops within a few days to weeks of birth, extreme mood changes and psychotic symptoms, can develop very suddenly, potentially life-threatening, urgent psychiatric tx needed

Perinatal OCD - sx may be masked by concurrent anxiety / depression, symptom severity can vary, symptoms generally revolve around baby and their wellbeing (outside of normal maternal anxiety) and lead to compulsions

Question 4

Risk assessment

Answer 4

Risk to self - self harm, suicide, history of these, self neglect

RISK TO BABY - thoughts to harm baby, risk of neglect

Screen for substance misuse, relationship difficulties, financial / housing concerns, domestic abuse

Question 5

Communication

Answer 5

Sensitive, empathetic manner
Normalising phrases

Question 6

Management

Answer 6

Psychological therapy
Antidepressants
Both

If antidepressants discussed - need to discuss re breastfeeding