#ob-gyn see also: [[drugs in pregnancy|drugs safe in pregnancy]] see: [PANDA - perinatal anxiety and depression Australia](https://www.panda.org.au), [RANZCOG - mental health Care in perinatal period](https://ranzcog.edu.au/wp-content/uploads/Mental-Health-Care-Perinatal-Period.pdf) - [devonthink link](x-devonthink-item://0FAB035F-55BF-42BB-93E1-49A644695F40), [RWH - depression and pregnancy](https://www.thewomens.org.au/health-information/pregnancy-and-birth/mental-health-pregnancy/depression-pregnancy), [postpartum psychosis](x-devonthink-item://56BF74A2-93AE-4E67-A34F-C3D080B9814B), [Cope - postnatal depression](https://www.cope.org.au/new-parents/postnatal-mental-health-conditions/postnatal-depression/), [RANZCP - perinatal mental health services](https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/perinatal-mental-health-services), [Pink elepahnts support network](https://www.pinkelephants.org.au/) > - 10-15% of women will be diagnosed with depression during pregnancy or postnatal period > - "baby blues" are very common, affecting up to 80% of new mothers > - most likely time for depression to begin is in first few weeks after the baby's birth > - **post-partum psychosis is a psychiatric emergency** **Features of Baby blues:** may be due to birth itself or hormone levels changing Women often experience symptoms 3-5 days post birth - mood swings - teariness - feeling overwhelmed and/or anxious. Symptoms usually go away after a few days without treatment / with ↑ support and affirmation from support network. If symptoms not improving, may be a sign of developing depression. **Common symptoms of postnatal depression**: - feeling depressed or miserable consistently for most of the day and for most days of the week - feeling irritable, angry or anxious a lot of the time - ↑ crying, sometimes for no apparent reason - ↓ interest in things person would normally enjoy - not able to sleep (even when baby is sleeping) or sleeping more than usual - ↓ appetite or over-eating - excessive fatigue and tiredness - difficulty concentrating and being forgetful - preoccupation with morbid thoughts or being anxious about multiple things, such as bad things happening to to baby or partner - feeling disconnected from baby, that your baby is not really hers or that mum is not bonding with baby - excessive feelings of guilt and/or failure, that mum is a ‘bad mother’ - thoughts of self harm - thoughts that things would be better for you and your baby if mum (+/- baby) were dead, leading to thoughts of suicide **Features of post-partum psychosis** - confusion and disorientation, about the day and time and who people are - concentration can be affected and mum's mind may feel foggy or that it is overloaded with too many thoughts - severe physical anxiety or agitation, such that mum cannot stay still - variable mood, either on a high, irritable or depressed - insomnia, feeling like mum needs less sleep and perhaps going days without sleeping - delusions or thoughts that are not true and that are often paranoid – that the hospital staff are spies, that your partner is an imposter in disguise. - hallucinations or impaired sensations where mum either hears, sees or smells things that are not present - strange sensations that mum is not really herself and there are others controlling your actions and thoughts - thoughts of and/or plans to harm herself and her baby. ## Edinburgh postnatal depression scale ![[Pasted image 20250206030453.png]] ![[Pasted image 20250206030534.png]] QUESTIONS 1, 2, & 4 (without an \*) Are scored 0, 1, 2 or 3 with top box scored as 0 and the bottom box scored as 3. QUESTIONS 3, 5-10 (marked with an \*) Are reverse scored, with the top box scored as a 3 and the bottom box scored as 0. **Scores** - 0-9 : Scores in this range may indicate the presence of some symptoms of distress that may be short-lived and are less likely to interfere with day to day ability to function at home or at work. However if these symptoms have persisted more than a week or two further enquiry is warranted. - 10-12 : Scores within this range indicate presence of symptoms of distress that may be discomforting. Repeat the EDS in 2 weeks time and continue monitoring progress regularly. If the scores increase to above 12 assess further and consider referral as needed. - 13 +: Scores above 12 require further assessment and appropriate management as the likelihood of depression is high. Referral to a psychiatrist/psychologist may be necessary. - **Item 10**: Any woman who scores 1, 2 or 3 on item 10 requires further evaluation before leaving the office to ensure her own safety and that of her baby. ## Treatment (incomplete section) note that olanzapine and quetiapine are considered safe to use during breast feeding if needed with appropriate monitoring (eg in a pregnant woman with acute pyschosis, this would be reasonable). Diazepam would also be considered safe to use if the situation indicated it. ## Disposition high risk patients may need admission to a mother-baby unit