Postnatal depression Jumoke Ojo, CT3, RCH Aberdeen Presentation Rachel is a 36-year-old woman Gave birth to her baby 4 weeks ago This is her first pregnancy Husband mentions she has been very tearful and emotional Worries that she is not
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Presentation Rachel is a 36-year-old woman
Gave birth to her baby 4 weeks ago
This is her first pregnancy
Husband mentions she has been very tearful and emotional
Worries that she is not caring for Brian as she previously was initially
Has seen the GP who has now referred her to mental health services<br>
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What do you want to know from Rachel about her low mood?<br>
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Answers Started about two weeks after having her baby.
She feels very low, couldn’t be bothered to do anything for herself, feels tired all the time, finds it difficult to sleep; she sleeps at midnight and wakes up at about 3am and can't go back to sleep.
Feels very guilty about not being able to care for Brian
Cannot concentrate on tasks, and no appetite
Has no thoughts of ending her life<br>
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What risk factors would you want to ask about in this patient?<br>
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Answers: She had depression when she was 23 years old following the death of her mum. She was managed with SSRIs
Her mother had depression severally and eventually ended her life via an overdose
She has no siblings
Pregnancy was planned, and went smoothly including delivery
Spouse is very supportive
She initially felt bonded to Brian but not anymore
No financial or social problems<br>
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Any other symptoms you would like to ask about? Hint: Symptoms that can also be seen in patients with depression that can help assess severity?<br>
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Answers No delusions,
No hallucinations
No belief that thoughts or actions are being controlled<br>
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Risks!! Consider what questions you would like to ask about risk in this patient<br>
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Answers Risk to self: Took an overdose in the past when she was depressed. Currently has no plans, as she cannot bear the thought of baby Brian being without a mother
Risk to others : Absolutely no thoughts of harming baby Brian or anyone else<br>
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A quick summary on postnatal depression Postnatal depression (PND) is a depressive episode that happens after childbirth and occurs in 10 -15% of women within 6 months of having a baby.
Symptoms are similar to symptoms of depression however; it may also include worries about the baby and difficulties caring of the baby.
Some mothers can also additionally have anxiety symptoms, or psychotic symptoms, and some could have thoughts of ending their life
The Edinburgh Post natal depression scale is a scale that can be used to as a screening tool to identify women who may be depressed and may benefit from follow up care.<br>
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A quick summary on postnatal depression Risk factors include:
Personal or family history of depression
Older age,
Single mother
Unwanted pregnancy
Social or financial stressors
Previous postnatal mental illness<br>
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Management Management is usually Bio-psycho-social:
Medication
Psychological support
Social support if indicated.<br>
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Early identification and management of postnatal depression is key in reducing morbidity and mortality from Postnatal depression<br>
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Further reading: RCPsych documentation on postnatal depression: https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/post-natal-depression
