Common Mental Disorders Depression - New Zealand Doctor

Advice for women
It may be helpful to advise women that the ‘postpartum blues’ are
a different entity from depression. The ‘blues’, with characteristic
tearfulness, anxiety and low mood, are relatively common but are
transient, peaking at 3–5 days after birth and resolving by 10–14 days. 452
7.5 Management of antenatal
and postnatal depression
Approach to intervention
The evidence relating to specific interventions for depression in women in the antenatal
and postnatal period is presented in detail in later sections of this chapter (see 7.6:
Specific Interventions: Evidence review). However, the relevant evidence is very limited
in this population, and practice must be guided largely by patient preference and by
the practitioner’s clinical experience. 453
At the primary care level, there should be close collaboration and sharing of
information between the midwife, general practitioner and other practitioners
involved in the care of a woman with depression in the antenatal or postnatal period.
All relevant information should be available to the Lead Maternity Carer (with the
woman’s consent). Every effort should be made to foster mutual trust and respect
between the woman and all practitioners involved in her care, and to maintain a high
level of support for other children/family/whänau members involved. The therapeutic
relationship may be even more important than the specific treatments offered. 101
The GDT notes that a woman with depression in the antenatal or postnatal period is
likely to experience increased distress arising from concern about her ability to care for
the child. There is no evidence to suggest that a good response to treatment is less likely
than at other life stages, and it may be helpful to provide this reassurance to the woman.
A woman will require thorough discussion of the likely benefits and possible risks of
treatment and also the potential risks of untreated depression. Advising in this area
can be very challenging and time-consuming. It is important to avoid an instructive
prescriptive approach and to fully acknowledge the uncertainty of the evidence. 101
The woman’s partner and/or other family/whänau should be involved in the discussion
if possible. 453 Partners in particular can be a key source of practical and emotional
support and may be able to mediate between the mother and any family members
who find it difficult to understand the nature of postnatal depression. 454 Treatment
98
Identification of Common Mental Disorders and Management of Depression in Primary Care