Sign | Management of perinatal mood disorders

This is a useful resource if you have a woman who falls pregnant on medication used for depression. Things that I think are useful to remember are:

Screening perinatal mood disorders

There is no good screening test for problems. Mood should be asked about at booking then at the 6 week and 3 month checks. Postnatally, the Edinburgh Postnatal Depression Scale can be used as can the Whooley Questions (1. During the past month, have you often been bothered by feeling down, depressed, or hopeless? 2. During the past month, have you often been bothered by little interest or pleasure in doing things? A third question should be considered if the woman answers “yes” to either of the initial questions: 3. Is this something you feel you need or want help with?)

High Risk. Women who have a history of bipolar disease, schizophrenia or postnatal psychosis are at high risk. A family history of bipolar of postnatal psychosis also increases risk a bit. Ask for these factors at booking. High risk patients should be under the care of a psychiatrist antenatally and have a care plan in place.

Medications in pregnancy

Remember that CBT and structured exercise advice are alternative options.

SSRIs and TCAs. The evidence base is still a bit conflicting here. It seems overall that if there is an increased risk to the baby, that it is small. Generally paroxetine should be avoided during pregnancy because there is a possible increased risk to the baby of cardiac malformation. Even here the risk is small. They advise looking at pros and cons and generally avoid swapping medications where the evidence base is small.

Mood stabilisers. Beware the antiepileptic medications. If you have a patient involved, check the guideline as to what to do.

Medications in breast-feeding

TCA – doxepin should be avoided.

SSRI – if possible fluoxetine, citalopram and escitalopram should not be initiated during breast-feeding. CKS and advise that they can be used if needed (eg if used antenatally or if the patient has had  a good prior response).

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