Screen at post-natal check up (6 weeks) using Edinburgh Postnatal Depression Scale (EPDS), but still needs careful clinical assessment
Differential: hypothyroidism (more common post-partum), recurrence of previous psychiatric illness, initial presentation of a psychiatric illness (eg schizophrenia or anxiety disorders – postpartum period increases risk), adjustment disorder with depressed mood
Possible aetiological factors:
Stress of delivery, difficult pregnancy
Lack of sleep
Hormonal
Isolation, lack of support
Internal conflicts about role as mother: motherhood idealised or devalued, very difficult adjustment in role, powerless, dependent, alone, may have had unrealistic expectations, etc
May not have wanted to be pregnant, may now feel trapped in unhappy situation (eg relationship)
Cultural factors: cultures vary in support offered (eg by extended family) to new mother, in pressures to return to work (variable maternity leave policies), differing attitudes to female children, etc.
Considerable overlap in the risk factors for major depression, post-partum depression, inadequate parenting and child abuse
Treatment:
Check whether drugs enter breast milk.
Indications for antidepressants similar for those for other mood disorders
If agitated or anxious, more sedating antidepressants are appropriate (eg imipramine) or even small doses of antipsychotics
Long term effect of postnatal depression on child development: disturbances in mother-infant relationships (eg attachment), impaired cognitive and emotional development in later infancy, and risk of longer-term behavioural and social development of the child. These factors compounded by indices of socio-economic adversity, which are risk factors for these outcomes and for depression. So good initial diagnosis and treatment important
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