Post Natal Depression

(PND)

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Definition

-  Depresson which develops between 1/12 (Puerperium) & 1yr post labour & delivery

-  New onset or recurrent

 

Features

-  Incidence 16% in Australia

-  10% fathers effected

-  50-70% untreated women still depressed 6/12 later

-  25% develop chronic illness

-  25% develop recurrent depression

-  Universal antenatal & postnatal screening

 

Risk Factors

-  Personal or family Hx of depression, anxiety, abuse

-  Recent bereavement, trauma or relationship difficulties

-  Early D/C from hospital post delivery

-  Lack of social support

-  Drug or EtOH abuse

 

DDx

-  Baby blues: 80% women, day 3-10 (hormone changes)

-  Peurperal psychosis

-  Bipolar disorder

 

Associated S/S

-  S/S may be difficult to distinguish from normal postnatal reactions

-  Poor sleep, fatigue, change in appetite

-  Angry, irritable, resentful, fearful, anxious

-  Loss of interest in normal activities, anhedonia

-  Withdrawing from social contact

-  Lack of concentration, poor memory

-  Thought of self harm or of harming baby

-  Impairment of enganging in usual activities

 

Ix

-  Edinburgh Postnatal Depression Scale (EPDS)

 

Mx

-  Mild S/S or social factors

-  Lifestyle advice, peer support psychoeducation/counselling

-  Mild to moderate

-  Above plus refer (mental health nurse, psychologist) for psychological therapy (CBT, IPT)

-  Severe

-  Above plus medication +/- mother infant psychotherapy

-  Involve psychiatrist/psychologist if available

-  GP Care Plan

-  EPDS

-  >12: repeat in 2/52

-  >13: investigate further as may indicate crisis, mental health assessment

-  Item 10 not 0 then assess for risk + refer for mental health assessment

-  Mental health assessment

-  Psychologist: CBT, IPT (Interpersonal psychotherapy)

-  Psychiatrist: Rx

-  ECT rarely indicated

-  Medication

-  Monotherapy, low dose & titrate

-  SSRIs & SNRIs safe in breast feeding (low levels in breast milk) but limited evidence

-  May take up to 3/52 for effect, do not cease abruptly

-  Usually taken for 6-24months

-  Indiciated if severe depression

-  SSRIs: Fluoxetine 10-60mg/day

-  Ass w prematurity, low birth weight, first trimester M/C, neonatal withdrawal syndrome

-  SNRIs: Venlafaxine 75-300mg/day

-  Ass w neonatal withdrawal syndrome

-  +/- TCAs: Nortryptiline 50-150mg/day

-  Less known about effects

-  +/- BZDs may be used until antidepressants take effect (+/- 3/52)

-  Ass w cleft palatte & floppy baby syndrome

-  Admission to hospital/Mother & Baby Unit if

-  If severe S/S, medical comorbidities, danger to self or others or requies more intense Rx & monitoring

-  Keep mother & baby together

 

 

 

References

 

Beyond Blue

RANZCOG College Statement C-Gen 11: Perinatal Depression, July 2010