Management of postnatal depression in primary care: a window of opportunity

Abstract

The postnatal period is a particularly distressing time to experience mental health problems. Detection and appropriate treatment of psychiatric symptoms at this critical time in family life is perhaps more important than at any other time. Postnatal depression (PND) affects more than one in 10 women;1,2 it significantly impacts on partners;3 is associated with an impaired mother–infant bond;4 and has been linked to poor cognitive and emotional development in the infant,5 thus contributing to the inter-generational transmission of poor health. Suicide is a leading cause of maternal death in the UK; the largest proportion due to PND and puerperal psychosis,6 and completed suicides are thought to be the tip of the iceberg in terms of ‘near miss’ events. However, many women are reluctant to disclose PND symptoms to healthcare professionals.7 Strategies for identifying PND and supporting women and their families are therefore very important and must be timely, holistic, and appropriate to new mothers. The perinatal period provides many opportunistic occasions within which to identify and manage mild, moderate, and severe mental illness. This is due to the increased level of health professional contact through routine antenatal and postnatal contact, which does not occur in the non-postpartum population. Although GPs are often the first port of call for women8 or their families seeking help during pregnancy and postnatally, all healthcare professionals in contact with pregnant or postpartum women should be alert to possible symptoms, either those of new onset or of a more chronic nature. Given the evidence for the effectiveness of both pharmacological and psychological interventions in improving health outcomes when PND is identified, there is much to be gained from early identification and management in primary care. …