At The First Contact They Should Also Ask About: Nice Mental Health

When PND is untreated it is associated with adverse effects on the infant.

It is only seen when the mother is unable to engage actively with the infant. Negative influences of mothers’ depression are seen in their language skills and intelligence quotients. Fact, nICE recommends that women be proactively screened for mental health problems and highrisk patients identified. Then, these effects are both shortterm and longterm poorer cognitive, emotional, social and behavioural development. At the first contact they should also ask about. These effects are not universal. It is advised that when women present for booking and at the postnatal check, health professionals should ask questions to screen for depression and anxiety.

SIGN recommends that enquiry about depressive symptoms should’ve been made on booking and postnatally at ’46’ weeks and ‘3 4’ months. Subcribe to the Patient newsletter for healthcare and news updates.

Mental Health Act.

Further research is required, there should be a modest role for oestrogens in severe treatment postpartum depression. Dedicated mother and baby units offer the ideal environment but are not available in all areas. Care needs to be delivered and monitored by a multidisciplinary team linking closely with social services and family mental health services. There is no place for synthetic progestogens in PND treatment.

Women identified as at high risk of developing severe depression, or with a history of severe mental illness, could be referred to secondary care mental health services. Pre dating the latest Cochrane review which was unable to make any recommendation, these recommendations were based on a 2009 metaanalysis. NICE guidelines make no recommendations except to consult each safety information individual drug. There will be a higher threshold for pharmacological therapy in depression treatment during pregnancy and the postnatal period than at other times, due to the change in risk. Unless they are taking lithium, nICE guidelines recommend women be encouraged to breast feed, sodium valproate, carbamazepine or clozapine. Notice, they further recommend that fluoxetine, citalopram and escitalopram may be avoided if initiating antidepressant medication at this time, due to comparatively higher levels being present in breast milk, and doxepin avoided altogether. They might be supported in whichever method of feeding they decide upon. This is the case. SIGN guidelines suggest that the TCAs imipramine and nortriptyline and the SSRIs sertraline and paroxetine are present in breast milk at relatively low levels. Clinicians should take into account the limited safety data available on each antidepressant when prescribing for ‘breast feeding’ women, fully inform potential woman risks, and monitor the baby for adverse effects.

a quarter of affected women still have symptoms a year later, most cases resolve within 36 months.

NICE guidelines suggest the following strategy. SIGN guidelines advise that treatment choice for postnatal depression could be governed by efficacy, previous response to treatment, incidence of sideeffects, likely compliance, patient preference, in the case of pharmacological therapies, safety during ‘breastfeeding’.

The illness course is widely variable and will depend on predisposing factors and response to treatment. Women who have ideas of either suicide or of harming the baby, should’ve been referred immediately for urgent psychiatric assessment. That said, pND is associated with reduced likelihood of mother baby bonding and impaired cognitive function in the child. Child protection procedures may need to be invoked.

Guidelines are unable to give clear direction, evidence remains unclear about the role and safety of antidepressants in breast feeding women.

Whenever taking into account all risks and benefits and the information available about potential harm to the baby, clinicians and women with PND have to base their decisions on an individual basis. With that said, cochrane review concluded there was not sufficient evidence to make recommendations about antidepressants efficacy in this situation, to compare them to psychological therapies or each other, or to determine which was safest for the baby. Whilst women are at generally low risk of suicide during pregnancy, it is a significant cause of maternal death in the year following birth in the UK. Improving awareness of perinatal mental health problems, in all their diversity, is important.