Common Mental Disorders Depression - New Zealand Doctor

Chapter 7 Special issues: women with mental disorders in the antenatal and postnatal period
Good practice points
continued...
Women in the antenatal and postnatal period
A practitioner should support breastfeeding in a woman with
depression in the postnatal period who opts to take antidepressants,
provided she is well-informed about known risks and benefits
A woman with depression in the postnatal period should be
encouraged to attend a mother and baby support group
Opinion of the Guideline Development Team, or feedback from consultation within New Zealand
where no evidence is available
Much of the evidence on the assessment of common mental disorders and the
management of depression in the general adult population applies equally to women
in the antenatal and postnatal period. However, there are specific issues that differ in
this population 101 and these are outlined in this chapter.
7.1 Mental disorders in the antenatal
and postnatal period
Pregnancy and childbirth are critical times of psychological adjustment for women
and are often accompanied by sleep disturbance, tiredness, loss of libido and
anxious thoughts about the infant. 101 In this context some changes in mental state
and functioning can be regarded as a normal part of the process. 101 However, these
significant and stressful life events may increase the risk of a new mental disorder or
precipitate relapse of a pre-existing disorder, particularly in women with other known
risk factors. 101 There is increasing evidence of the risks of untreated mental disorders
in the antenatal and postnatal period, including potentially enduring harm to the
infant. 427-429 The potential negative impact of a maternal mental disorder favours more
urgent identification and intervention than might otherwise be the case. 101
The characteristics of most mental disorders are similar in pregnancy and the postnatal
period to those experienced at other times. However, psychotic disorders may develop
more rapidly and be more severe in this population 101 and childbirth can trigger a
severe bipolar episode, as either a first presentation or a relapse. 430,431 Although
suicide following childbirth is rare, a UK study found it to be the leading cause of
maternal death. 432 In most cases it was associated with postnatal recurrence of a
severe pre-existing mental disorder.
At 6-months post partum about 12% of women report significant distress related to
birth trauma, and during the first year post partum about 2% of these women meet
the diagnostic criteria for post-traumatic stress disorder (PTSD). 433
Depression is common in the antenatal and postnatal period: the best estimates
suggest that up to 13% of women have an episode of major or minor depression
Identification of Common Mental Disorders and Management of Depression in Primary Care 93