Postpartum mental health problems

Postpartum mental health problems range from the 'baby-blues' to puerperal psychosis.

The Edinburgh Postnatal Depression Scale may be used to screen for depression:

• 10-item questionnaire, with a maximum score of 30
• indicates how the mother has felt over the previous week
• score > 13 indicates a 'depressive illness of varying severity'
• sensitivity and specificity > 90%
• includes a question about self-harm

'Baby-blues'_Postnatal depression_Puerperal psychosis| Seen in around 60-70% of women

Typically seen 3-7 days following birth and is more common in primips

Mothers are characteristically anxious, tearful and irritable_ Affects around 10% of women

Most cases start within a month and typically peaks at 3 months

Features are similar to depression seen in other circumstances

_ Affects approximately 0.2% of women

Onset usually within the first 2-3 weeks following birth

Features include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations)| Reassurance and support, the health visitor has a key role_ As with the baby blues reassurance and support are important

Cognitive behavioural therapy may be beneficial. Certain SSRIs such as sertraline and paroxetine* may be used if symptoms are severe** - whilst they are secreted in breast milk it is not thought to be harmful to the infant_ Admission to hospital is usually required, ideally in a Mother & Baby Unit

There is around a 25-50% risk of recurrence following future pregnancies|

*paroxetine is recommended by SIGN because of the low milk/plasma ratio **fluoxetine is best avoided due to a long half-life