B. Postnatal depression – Explanation
Postnatal depression is seen commonly among women affecting up to 10% of
women giving birth. Cyring, not bonding, worrying and feeling as if she cannot
cope is a typical presentation of postnatal depression
COMPARISON OF POSTPARTUM BLUES, POSTNATAL DEPRESSION,
POSTPARTUM PSYCHOSIS
| Postpartum Blues |
Postnatal Depression |
Postpartum Psychosis |
|
|---|---|---|---|
| Onset | Starts two or three days after birth and lasts 1-2 days |
Peaks at 3 to 4 weeks postpartum |
Peaks at 2 weeks postpartum |
| Mother cares for baby |
Yes | Yes | Thoughts of harming baby |
| Symptoms | Mostly crying | Symptoms of depression:Feels that she is not capabable of looking after her childFeels as if she will not be a good motherTearful, anxietyWorries about baby’s health |
Psychotic Insomnia Disorientation Thoughts of |
| Treatment | Reassurance and explanation |
Antidepressants or CBT |
In PLAB, answer would be ECT |
POSTNATAL DEPRESSION
A significant depressive episode, temporally related to childbirth, within 6 months
usually peaking at 3 to 4 weeks
Clinical features
- Similar to other depressive episodes
- Tearful and anxious
- Worries about her ability to cope adequately with the newborn
- Worries about the newborn
- Struggles to look after herself and the newborn.
Management
Treated like any other depressive illness
- CBT
- Antidepressants
o If breastfeeding, a popular choice of selective serotonin reuptake
inhibitors (SSRIs) is sertraline as it has a good safety profile and is found
at very low levels in breast milk.
o Mnemonic: bREASt. Reduce Excessive Amounts of Sertraline Depressive
episode treated in usual way with antidepressants and/or brief CBT, if severe or
associated with thoughts of self-harm or harm to baby, may require hospital
admission.
