Postnatal Depression Flashcards
What is postnatal depression?
It is characterised by low mood in the postnatal period
What are the three types of postnatal depression?
Baby blues
Postnatal depression
Puerperal psychosis
What are the two causes of postnatal depression?
Physical Issues - After childbirth, there is a dramatic drop in oestrogen and progesterone hormones, alongside other hormones produced by the thyroid gland. This can result in individuals feeling tired, sluggish and depressed
Emotional Issues - Due to the neonatal care, patients are often sleep deprived, overwhelmed and feel a loss of control over their life. These issues can also contribute to postpartum depression.
What increases the risk of postnatal depression?
When patients have a personal or family history of depression, or other mental health conditions
What % of women are affected by baby blues?
> 50%
When does baby blues take place?
It occurs in the first week after birth
How long does baby blues tend to last?
A few days
Does baby blues require treatment?
No
What are the five clinical features of baby blues?
Mood Swings
Low Mood
Anxiety
Irritability
Tearfulness
How common is postnatal depression?
It affects one in ten women
When does postnatal depression tend to affect patients?
Three months after birth
However, it can continue on from baby blues
How can we distinguish the difference between baby blues and postnatal depression?
Postnatal depression clinical features are more intense and last longer
They typically interfere with the patient’s ability to care for their baby and handle other daily tasks
What are the triad clinical features of postnatal depression?
Low mood
Anhedonia
Low energy
What is anhendonia?
A lack of pleasure in activities
How long do clinical features ned to persist before a diagnosis of postnatal depression can be obtained?
More than 2 weeks
What scale can be used to help diagnose postnatal depression?
‘Edinburgh Postnatal Depression Scale’
What is the ‘Edinburgh Postnatal Depression Scale’?
It involves patients answering ten questions, with a total score out of 30 point
What ‘Edinburgh Postnatal Depression Scale’ score suggests a diagnosis of postnatal depression?
> 10
In what three ways do we manage mild postnatal depression?
Additional support
Self-help
A follow up with their GP
What is the first line management option for moderate to severe postnatal depression, without previous history of severe depression?
Cognitive behavioural therapy (CBT)
What is the management option for severe postnatal depression, with a history of severe depression?
SSRIs
Name two SSRIs used to manage severe postnatal depression
Sertraline
Paroxetine
Which SSRIs should be avoided when managing severe postnatal depression
Fluoxetine
When does puerperal psychosis tend to develop?
Two to three weeks after birth
What is puerperal psychosis?
It is an extremely severe and rare form of mental illness, which can cause harm to either the mother or baby
What are the three risk factors for puerperal psychosis?
A previous diagnosis of bipolar disorder or a psychotic illness
A history of puerperal psychosis in the patient’s mother or sister also increases the risk
A previous episode of puerperal psychosis
What is the chance of puerperal psychosis recurring in another pregnancy, after a previous episode?
50%
What are the five clinical features of puerperal psychosis?
Delusions
Hallucinations
Depression
Mania
Confusion
How do we treat puerperal psychosis?
We direct patients to specialist mental health services
In most cases, women suffering from puerperal psychosis need to be treated as an inpatient in mother and baby units
What are mother and baby units?
This is a specialist unit for pregnant women and women that have given birth in the past 12 months
What is the purpose of mother and baby units?
They are designed so that the mother and baby can remain together and continue to bond
What are the three treatment options available for puerperal psychosis?
Cognitive behavioural therapy
Electroconvulsive therapy (ECT)
Antipsychotics and/or mood stabilisers
How long do severe symptoms of puerperal psychosis last?
Two to twelve weeks
How long does it take patients to fully recover from puerperal psychosis?
Six to twelve months
Why is an early diagnosis of puerperal psychosis important?
It reduces the likelihood of long term difficulties
How do we prophylactically treat postnatal depression?
We refer women with existing mental health concerns to perinatal mental health services for advice and specialist input
This includes initiation and ongoing management of psychiatric medications
In addition to this, a plan is put in place for after delivery to ensure that these patients are followed up closely, so that treatment and additional support can be put in place early if required
What three medications can be used to treat postnatal depression prophylactically?
SSRIs
Antipsychotics
Lithium
What is the teratogenic effect of prescribing SSRIs during pregnancy?
Neonatal abstinence syndrome
When does neonatal abstinence syndrome present?
In the first few days of birth
How do we manage neonatal abstinence syndrome?
Supportive management
