Postnatal: Postnatal depression

Question 1

Define postnatal depression.

Answer 1

Depression arising in months following childbirth.

Question 2

Explain the aetiology/risk factors for postnatal depression.

Answer 2

Psychosocial factors play largest role.

Biological theories on sudden drop of progesterone and oestrogen.

Question 3

Summarise the epidemiology of postnatal depression.

Answer 3

15% mothers, usually within 3 months of birth.

Question 4

What are the signs and symptoms of postnatal depression?

Answer 4

May develop insiduously over weeks or exacerbation of baby blues.

Sleep/energy/enjoyment/libido changes.

Cognitive features: guilt, self loathing, anger.

O/E: Depressive features, obsessional thoughts, harming the baby thoughts.

Question 5

What is the management for postnatal depression?

Answer 5

Assess risk to mother and child. Mild cases do not require intervention.

Moderate depression can be managed at home but can need admission to mom and baby unit.

MDT care, screening for depression inclusion at 6wk baby check. Consider antidepressant.

Question 6

What are the complications of postnatal depression? What is the prognosis for postnatal depression?

Answer 6

Harm to baby and mother

Attachment difficulties for baby.

Marital/relationship problems.

Maternal suicide or infanticide.

Insecure attachment at 18 months.

10% mothers have course for >6 months if untreated.