Principles of Antidepressant Prescribing in Pregnancy and Postnatal Period
Perinatal depression (PPD), or postnatal (postpartum) depression (PND), is the onset of depression during pregnancy or postpartum period. Cultural and societal expectations can exacerbate new mothers’ maternal demands to form an immediate and strong bond with their baby.
Epidemiological studies show that up to 85% of mothers in Australia will experience some form of baby blues. Symptoms will generally peak on the fourth or fifth day after delivery and remain for a few days. While the symptoms are mild and transient for the majority, some mothers will have persistent symptoms longer than two weeks.
The prevalence of postpartum depression based on a meta-analysis of 59 studies using both self-report questionnaires and diagnostic interviews, was 13%. [O’Hara and Swain, 1996]
When self-report measures are taken out, the prevalence was found to be 7.1%. A recent review looking at prevalence across cultures found rates varying from 4.0–63.9% with Japan and America recording the lowest and highest rates of PND, respectively. [Arifin S et al., 2018]
If PPD is left untreated, there is a high risk of poor maternal health and alcohol and drug abuse. There is also a significant increase in morbidity rates due to self-inflicted injuries. The infant is also likely to have development problems with lower cognitive functioning and adverse emotional and behavioural issues in later life.
Depression during pregnancy has been associated with:
- increased risk of premature delivery
- low birth weight
- gestational hypertension
- perinatal death
- adverse impact on infant emotional and cognitive development
- adverse effect on the mother-infant relationship that in turn leads to poor infant development and outcomes
Koc DTiemeier H Stricker BH Muetzel RL Hillegers M El Marroun H. Prenatal Antidepressant Exposure and Offspring Brain Morphologic Trajectory. JAMA Psychiatry.