Perinatal psychiatry

postpartum depression, psychosis, and blues and their management

1. Perinatal Psychiatry Dr. Kamal Ghimire

2. Postpartum disorders Postpartum blues Postpartum depression Postpartum psychosis

3. Postpartum blues Occurs in 50% Onset: 2-6 days after delivery Symptoms: transient low mood, crying, irritability and worries about coping with baby. self-limiting,( usually within a few days), but severe blues increase the risk of postpartum depression. No specific intervention is required (apart from reassurance) although, if symptoms do not resolve within two weeks, assess for depression.

4. Postpartum depression Occurs in 10 % in first 6 weeks postpartum. Around 25% of which persists for a year. Risk factors: - Mother: past history or family history of depression, unemployed, uneducated. - Relationships: unmarried, domestic violence, confiding relationships - Baby: premature, multiple births, ill baby. Clinical features are as for other depressive illness but may also include: -guilt and anxiety concerning the baby -feelings of inadequate mothering - unreasonable fears for the baby’s health - a reluctance to hold or feed the baby - (more rarely) thoughts of harming the baby.

5. Management full psycho-social assessment (including possible risk to mother and the baby). First line of treatment for mild to moderate perinatal depression is psychological therapy and not antidepressants because of the potential for adverse effects in the foetus or breastfeeding baby. In severe depression: Antidepressant.

6. Postpartum Psychosis Occurs in 0.5%. Abrupt onset 2-4 weeks post birth. Risk groups: -in those with a previous episode of psychosis - in first time mothers -after instrumental delivery -in those with family history of affective(mood) disorder Symptoms: Usually affective, most depressive but up to one-third manic (postpartum onset of schizophrenia is relatively unusual). Emotional lability and subjective confusion are common.

7. Management Usually requires hospitalization Initially : antipsychotics ECT( electroconvulsive therapy) is reported to be effective and considered if antipsychotics arenot effective

8. Summary

9. Prescribing in pregnancy and breastfeeding

10. In pregnancy Antidepressant : low risk: TCA, Sertraline (avoid paroxetine) Mood stablizers should be avoided where possible. Low dose typical antipsychotics have lowest known risk and are also preferred for bipolar disorders In breastfeeding Antidepressant : imipramine and sertraline are relatively safer Antipsychotics are preferred over mood stablizers for bipolar disorders. Breastfeeding women prescribed psychotropic drugs should be advised how to time feeds to avoid peak drug levels in milk and how to recognise adverse drug reactions in their babies.

11. Thank You