2. Postnatal Depression


 

 

Last month we launched a new series featuring the ‘information for patients and professionals’ section from the latest evidence-based guidelines from SIGN.

This month we reproduce the information section from SIGN guideline number 60, on postnatal depression and puerperal psychosis.

Postnatal depression and puerperal psychosis

The following points were drawn up in consultation with patient representatives on the guideline development group to reflect the issues likely to be of most concern to patients following diagnosis of postnatal depression.

These points may be of use to health professionals when discussing postnatal depression with patients and in guiding the production of locally produced patient information materials.

The advice is divided into sections to highlight the issues that patients might wish to discuss at each stage of their care.

Diagnosis

"Asking for help was the hardest thing to do. Having to admit to not coping made me feel even more inadequate.”

"Being told to pull yourself together is no help at all.”

"I was petrified they would take my baby away. Then everyone would blame me.”

  • Is postnatal depression a common illness?
  • Is postnatal depression different to other forms of depression?
  • What are the causes and common symptoms of postnatal depression?

Key point: PND affects feelings, thoughts and ability to carry out the activities of daily life.

Treatment options

  • Is my illness treatable?
  • What care should I expect?

Key point: a package of care should be negotiated with patients. This may involve the practical and family support provided by family, friends, local and national agencies or groups, informal and formal therapies and antidepressant medication.

Demystifying antidepressants

  • How do antidepressants work?
  • Are they addictive?
  • Will they make me sleepy?
  • How long will I take antidepressants for?
  • Can I use antidepressants if I am pregnant or breastfeeding?
  • Will I experience side-effects?
  • How will my use of antidepressants be monitored?

Key point: patients should normally continue to take antidepressant medication for six months after recovery.

Family and carers

"I knew I felt different and judged myself really harshly and felt so inadequate as a mother.”

  • Is my postnatal depression likely to affect the other members of my family?
  • Who can offer support to my family?

Key point: the overall package of care should encompass the needs of the family. Practical support should be offered to enable the parents to meet the baby’s needs e.g. parenting skills, self-help groups.

Recovery

  • Will I get better?
  • Am I going mad?
  • Do I need to see a psychiatrist?
  • Which health professionals am I likely to see?
  • Am I still able to care for my baby?

Key point: the outcome is very good for the majority of women suffering from postnatal depression provided they are managed appropriately.

Reproduced with permission from: SIGN 60. Postnatal Depression – A national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network, June 2002. The full guideline can be downloaded from the SIGN website: www.sign.ac.uk

Information for patients and carers

The National Childbirth Trust
Provides information and support on all aspects of pregnancy, childbirth and early parenthood. There is individual and group support offered, and local groups around the UK. Alexandra House, Oldham Terrace, London W3 1BE. Enquiry line: 0300 330 0700; website: www.nct.org.uk

Meet-A-Mum Association (MAMA)
Self-help group for antenatal women and mothers with young children with local groups around the UK. National helpline open Monday-Friday 7 pm to 10 pm. Tel: 020 8768 0123

The Association for Postnatal Illness
Can link mothers with others who have recovered from postnatal depression. 145 Dawes Road, Fulham, London SW6 7EB. Tel: 020 7386 0868

Action on Puerperal Psychosis
A patient organisation aimed at building up a pool of women who have experienced puerperal psychosis and are interested in helping with research. Contact: Jackie Benjamin, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Mindlesohn Way, Birmingham B15 2QZ. Tel: 0121 440 2296; website: www.bham.ac.uk/app

Depression Alliance
35 Westminster Bridge Road, London SE1 7JB. Tel: 020 7633 0557; fax: 020 7633 0559; website www.depressionalliance.org

The Scottish Association for Mental Health
Cumbrae House, 15 Carlton Court, Glasgow, G5 9JP. Tel: 0141 568 7000; email: enquire@samh.org.uk; website: www.samh.org.uk

Manic Depression Fellowship
Castle Works, 21 St George’s Road, London SE1 6ES. Tel: 020 7793 2600; fax: 020 7793 2639; email: mdf@mdf.org.uk; website: www.mdf.org.uk

The Samaritans
Offers support to those in distress/despair/suicidal who need someone to talk to. 24 hour service. National Helpline tel: 08457 909090

Homestart
Offers support and friendship in the family home to families with at least one pre-school child. Local groups around the UK. 2 Salisbury Road, Leicester LE1 7QR. Tel: 0116 233 9955; fax: 0116 233 0232; email: info@home-start.org.uk; website: www.home-start.org.uk

Health Development Agency
Trevelyan House, 30 Great Peter Street, London SW1P 2HW. Tel: 020 7222 5300; fax: 020 7413 8900; email: hda.enquirydesk@hda-online.org.uk; website: www.hda-online.org.uk

Health Education Board for Scotland
Talking about Postnatal Depression patient information leaflet available. Woodburn House, Canaan Lane, Edinburgh EH10 4SG. Tel: 0131 536 5500; website: www.hebs.scot.nhs.uk

The Royal College of Psychiatrists
Produce a leaflet Postnatal depression – help is at hand. Downloadable from website. 17 Belgrave Square, London SW1X 8PG. Tel: 020 7235 2351;
website: http://www.rcpsych.ac.uk/

CRY-SIS
Offers support for carers of a crying baby. Tel: 020 7404 5011

NHS Direct (in England and Wales): www.nhsdirect.nhs.uk

NHS24 (in Scotland): www.nhs24.com

NHS Helpline: 0800 22 44 88

Information for health professionals

The Marcé Society
An international society for the understanding, prevention and treatment of mental illness related to childbearing. PO Box 30853, London W12 OXG. Email: info@marcesociety.com

The Royal College of Psychiatrists
17 Belgrave Square, London SW1X 8PG. Tel: 020 7235 2351; fax: 020 7245 1231; website: http://www.rcpsych.ac.uk/

Society for Reproductive and Infant Psychology
Department of Psychology, University of Hull, Hull HU6 7RX. Membership secretary: Ms Sue Weaver, tel: 01482 465010; email: s.m.weaver@psy.hull.ac.uk

Suggested reading

  • Community Practitioners’ and Health Visitors’ Association (CPHVA). Postnatal depression and maternal mental health, a public health priority. Borough Green: McMillan Scott, 2001
  • Singh D, Newburn M, editors. Access to maternity information and support: the experiences of women before and after giving birth. London: National Childbirth Trust, 2000
  • Clark G. Postnatal depression in non-English speaking women and those from diverse cultures: a collection of abstracts. London: Community Practitioners’ and Health Visitors’ Association, 2001
  • Marshall F. Coping with postnatal depression. London: Sheldon, 1993
  • Nicolson P. Postnatal depression: facing the paradox of loss, happiness and motherhood. Chichester: Wiley; 2001
  • Littlewood J, McHugh N. Maternal distress and postnatal depression: the myth of Madonna. Basingstoke: Macmillan, 1997

Adapted from SIGN 60. Postnatal Depression – A national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network, June 2002. The full guideline can be downloaded from the SIGN website: www.sign.ac.uk

Guidelines in Practice, October 2002, Volume 5(10)
© 2002 MGP Ltd
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