Conditions - Depression in pregnancy

Question 1

Define the 3 types of depression in pregnancy

Answer 1

Postpartum mental health problems

• Baby blues
• Postnatal depression
• Puerperal psychosis

Question 2

What is the epidemiology of each of the 3 types of postpartum mental health problems?

Answer 2

Baby blues - 60-70%, more common in primips
Postnatal depression - 10%
Puerperal psychosis - 0.2%

Question 3

What are the presenting symptoms of the 3 types of postpartum mental health problems?

Answer 3

Baby blues – 3-7 days after birth, anxious, tearful, irritable

Postnatal depression – within 1 month after birth and peaks at 3 months, features similar to regular depression

Puerperal psychosis – usually within 2-3 weeks after birth, severe mood swings (similar to bipolar) and disordered perception (e.g. auditory hallucinations

Question 4

What investigation is most appropriate for depression in pregnancy and what are its features/results?

Answer 4

Edinburgh Postnatal Depression Scale

• 10 items, max score 30
• Indicates how mum has felt over last week
• Score >13 = ‘depressive illness of varying severity’
• Sensitivity and specificity >90%
• Includes a question about self-harm

Question 5

What are the management plans for the 3 types of postpartum mental health problem?

Answer 5

Baby blues – reassurance and support
Postnatal depression – reassurance and support + CBT + sertraline/paroxetine (SSRI)
Puerperal psychosis – admission into Mother and Baby Unit + CBT + antidepressants/antipsychotics/mood stabiliser

Question 6

What is the prognosis for patients with postpartum mental health problems?

Answer 6

Most women respond well to treatment within a month.