Summary
If possible, women at risk of depression should
be identified during pregnancy. They often do
not spontaneously seek help. Early intervention
is important for the health of the woman and
her baby. Psychological interventions such as
support groups are often helpful. Involving the
woman's partner can also assist. Antidepressants
are required in some cases and women with
psychotic symptoms need urgent psychiatric
assessment and treatment.
Introduction
Postnatal depression is better termed perinatal depression as
it often begins antenatally, although it may not be recognised
until the postnatal period. It is a common disorder, with
milder adjustment problems and anxiety affecting some 30%
of women while about 15% of women have more significant
mood disorders, often with anxiety. Women are reluctant to seek
help, but early identification and intervention are essential to
minimise the long-term complications. These include suicide,
chronic depression and marital difficulties, and for the child,
cognitive, emotional and behavioural problems.
Identification
Unless women have previously had depression, they rarely
recognise it in themselves during the perinatal period. For most,
this is their first episode of depression and is unexpected at
a time that is anticipated positively. In the antenatal period it
is all put down to 'the pregnancy' with the presumption that
everything will resolve itself after the baby is born. Historically,
pregnancy was thought to be protective against mental illness
and suicide, however this is not the case. Mental illness is just
less likely to be recognised in pregnancy. Postnatally, there are
many reasons why women do not seek help, or at least not
for themselves. These include the presence of predominant
anxiety rather than depression, a mistaken belief that postnatal
depression is somehow linked to not wanting the baby or being
a bad mother, the stigma of being seen as a bad mother and the
stigma of depression.
Women seek help for the baby, not for themselves. The long
waiting lists in mother and baby units and settling facilities are
testimony to the very real problem perceived by mothers of
their babies having sleeping and feeding difficulties. In some
cases this is the primary problem, but often it is the mother's
reaction, her high unrealistic expectations and her own
depression and anxiety that are the underlying issue.
A key factor in identifying depression is having a suspicion for
the condition particularly in women with risk factors (Box 1).
Ideally, this risk should be detected during pregnancy.
Women with previous perinatal depression or psychosis
are particularly at risk of having another episode with future
pregnancies. Screening for depression with tools such as the
Edinburgh Postnatal Depression Scale can be helpful.1 Many
antenatal clinics and maternal child health nurses do screening
and suggest women with high scores (> 12) see a doctor.
Adjustment disorders have similar symptoms to depression but
fewer, less severe symptoms and with some 'good times' and
an ability to see into the future. These disorders usually resolve
within three months.
Women with depression have symptoms which last longer
than two weeks. They usually have significant anxiety (often
related to the baby and their ability to mother), tearfulness,
and feel easily overwhelmed and unable to cope with even
basic household chores. Biological symptoms (insomnia,
appetite changes) not accounted for by disturbed sleep and
breastfeeding also suggest a more serious disorder. The severity
of symptoms and their impact on the woman's life are the best
guides to the need for intervention.
Risk factors for perinatal depression
High correlation with increased risk
Depression in pregnancy
Past history of affective disorder
Family history of affective disorder
Lack of support – partner, mother
Multiple stressors
Some correlation with increased risk
Perfectionistic personality
Low socioeconomic status
Aboriginal and Torres Strait Islander people
Childhood abuse
Depression should be distinguished from the less common
postpartum psychosis. The latter usually presents in the first few
weeks after birth, with confusion, dramatic mood or psychotic
symptoms, and requires urgent assessment and inpatient
treatment. In all cases if there is a threat to the safety of either
the mother or the infant, referral to specialist care or involving
protective services may be required. For many women with
depression the baby is protective against suicide, but this is not
true for women with postpartum psychosis, and suicide remains
a leading cause of death.
If possible, women at risk of depression should
be identified during pregnancy. They often do
not spontaneously seek help. Early intervention
is important for the health of the woman and
her baby. Psychological interventions such as
support groups are often helpful. Involving the
woman's partner can also assist. Antidepressants
are required in some cases and women with
psychotic symptoms need urgent psychiatric
assessment and treatment.
Introduction
Postnatal depression is better termed perinatal depression as
it often begins antenatally, although it may not be recognised
until the postnatal period. It is a common disorder, with
milder adjustment problems and anxiety affecting some 30%
of women while about 15% of women have more significant
mood disorders, often with anxiety. Women are reluctant to seek
help, but early identification and intervention are essential to
minimise the long-term complications. These include suicide,
chronic depression and marital difficulties, and for the child,
cognitive, emotional and behavioural problems.
Identification
Unless women have previously had depression, they rarely
recognise it in themselves during the perinatal period. For most,
this is their first episode of depression and is unexpected at
a time that is anticipated positively. In the antenatal period it
is all put down to 'the pregnancy' with the presumption that
everything will resolve itself after the baby is born. Historically,
pregnancy was thought to be protective against mental illness
and suicide, however this is not the case. Mental illness is just
less likely to be recognised in pregnancy. Postnatally, there are
many reasons why women do not seek help, or at least not
for themselves. These include the presence of predominant
anxiety rather than depression, a mistaken belief that postnatal
depression is somehow linked to not wanting the baby or being
a bad mother, the stigma of being seen as a bad mother and the
stigma of depression.
Women seek help for the baby, not for themselves. The long
waiting lists in mother and baby units and settling facilities are
testimony to the very real problem perceived by mothers of
their babies having sleeping and feeding difficulties. In some
cases this is the primary problem, but often it is the mother's
reaction, her high unrealistic expectations and her own
depression and anxiety that are the underlying issue.
A key factor in identifying depression is having a suspicion for
the condition particularly in women with risk factors (Box 1).
Ideally, this risk should be detected during pregnancy.
Women with previous perinatal depression or psychosis
are particularly at risk of having another episode with future
pregnancies. Screening for depression with tools such as the
Edinburgh Postnatal Depression Scale can be helpful.1 Many
antenatal clinics and maternal child health nurses do screening
and suggest women with high scores (> 12) see a doctor.
Adjustment disorders have similar symptoms to depression but
fewer, less severe symptoms and with some 'good times' and
an ability to see into the future. These disorders usually resolve
within three months.
Women with depression have symptoms which last longer
than two weeks. They usually have significant anxiety (often
related to the baby and their ability to mother), tearfulness,
and feel easily overwhelmed and unable to cope with even
basic household chores. Biological symptoms (insomnia,
appetite changes) not accounted for by disturbed sleep and
breastfeeding also suggest a more serious disorder. The severity
of symptoms and their impact on the woman's life are the best
guides to the need for intervention.
Risk factors for perinatal depression
High correlation with increased risk
Depression in pregnancy
Past history of affective disorder
Family history of affective disorder
Lack of support – partner, mother
Multiple stressors
Some correlation with increased risk
Perfectionistic personality
Low socioeconomic status
Aboriginal and Torres Strait Islander people
Childhood abuse
Depression should be distinguished from the less common
postpartum psychosis. The latter usually presents in the first few
weeks after birth, with confusion, dramatic mood or psychotic
symptoms, and requires urgent assessment and inpatient
treatment. In all cases if there is a threat to the safety of either
the mother or the infant, referral to specialist care or involving
protective services may be required. For many women with
depression the baby is protective against suicide, but this is not
true for women with postpartum psychosis, and suicide remains
a leading cause of death.
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