Depression in Pregnancy Flashcards
What does perinatal depression mean?
Antenatal and post natal depression
How common is severe and mild-moderate perinatal depressive illness (+Anx)?
Severe: 30/1000
Mild-moderate: 100-150/ 1000
What is maternal suicide?
Death of mother during pregnancy and up to 42 days post natally
What are consistent features of maternal suicide?
80% have previous psych Hx
50% have serious mental illness
BAD or PP common
These people are often undersupported with poor early ID and no active management plans
80% use violent methods
What are the complications of maternal mental illness?
Loss of baby
Pre-eclampsia, hyperemesis
IUGR/ low birth rate/ pre term/ morbidity/ low APGAR
Neglect of infant or abuse
Attachment problems
How do you diagnose perinatal depression?
More than 2 weeks of:
- Anhedonia
- Anergia/ fatigue
- Poor sleep
- Poor concentration
- Low self confidence
- Agitation or slow
- Intrusive thoughts
- Negative cognitions
- Severe guilty feelings
- Psychosis
- Hopelessness/ suicidal
How do you detect perinatal MH problems?
Awareness and eduction of women
Training professionals
Routine detection/ ID by clinicians
Secondary mental health services
How do you assess MH perinatally?
Assess mother and child Full social and psychiatric Welfare Role of family/partner/ carer Potential effect of any mental health problem on the womans relationship Risk
What treatment is available?
Drugs
Psychological support
Social support
Childrens welfare/ social services
Psychoeducation
How should you attempt medical support?
Discussion with patient and risk/ benefits
Risk of relapse/ risk of harm
Treatment options that allow breast feeding
Dose adjustment/ lowest effective dose
Monotherapy
How do you prescribe in pregnancy?
Minimum effective dose
No psychotropics (not licensed)
Risk of placental/ breast milk transfer
Miscarriage risk etc.
How do you prescribe antidepressants?
SSRI’s normally safe (incl. sertraline)
TCAs safe but risk of overdose
Clinical risk of discontinuation vs relapse
Refer to neonatology following delivery (neonatal withdrawal, persistent pulmonary hypertension of the new-born, cardiac malformation in paroxetine)
What perinatal mental health services exist?
GPs
Specialist Health Visitors
Lead Mental Health- Obstetrician, Midwives and safeguarding midwives
Children’s Social Services, Early Support, Children’s centres, Voluntary organisation
Community perinatal MHS- MDT
Mother and Baby unit
Birth Trauma and pregnancy loss services
