Support and early intervention for women experiencing distress or anxiety symptoms may help to prevent more serious mental health problems from developing. Depending on the severity of a woman’s symptoms, management of perinatal anxiety may involve a combination of psychosocial support, psychological therapy and pharmacological treatment. Appropriate responses to assessments and clinical judgement are fundamental to decision-making about management.

Support, therapies and treatments for perinatal anxiety

Psychosocial support

Psychosocial interventions used as preventive approaches or as part of management of anxiety includes non-directive counselling, psychoeducation and peer support.

Women may also benefit from being given information about options for support in their communities (e.g. parent education groups, support groups, playgroups) and suggestions for where to seek practical support with tasks like cooking, cleaning and taking care of the baby, or any older children (e.g. family, friends, neighbours or community services).

Psychological therapies

The range of psychological therapies that are effective in treating anxiety disorders at times other than in the perinatal period would also be expected to be effective in the perinatal period as the disorders differ little from disorders among non-pregnant women in both their presentation and course.

Pharmacological treatments

During pregnancy use of selective serotonin reuptake inhibitors (SSRIs) can be considered as there is no evidence for a consistent pattern of birth defects. Tricyclic antidepressants (TCAs) can also be considered, especially if they have been effective previously, but should be used with caution due to the risk of overdose.

Both SSRIs and TCAs can also be safely used during breastfeeding.

Short-term use of short-acting benzodiazepines may be considered while awaiting onset of action of SSRIs.

More detail on the safety and effectiveness of pharmacological treatments is included in the National Perinatal Mental Health Guideline developed by COPE.

Guidelines for the use of antidepressants and benzodiazepines in the general population should be consulted.

Practice points to remember about perinatal anxiety

• Although the EPDS was specifically developed to detect symptoms of depression, there is evidence to support its use in the detection of symptoms of anxiety, taking into consideration the woman’s scores on questions 3, 4 and 5, her answer to the psychosocial question on “worrying” and applying clinical judgement.

• While the EPDS is a self-report tool, it may be appropriate for it to be administered verbally in situations where there are difficulties relating to language or literacy, cultural issues or disability.

• Before the EPDS is administered, women need clear explanation of the purpose of the assessment (including that it is part of normal care and will remain confidential) so that they can provide informed consent. If a woman does not consent to assessment, this should be documented and assessment offered at subsequent consultations.

• Decision-making about the need for and type of follow-up mental health care is based on the woman’s preferences and clinical judgement.

• Not all women will want or need further monitoring or mental health assessment. Providing information and encouraging continuing contact with an appropriate health professional can support women to seek further assistance.

• Ideally, a woman’s regular GP will provide continuing mental health care in the perinatal period. However, not all women have access to this type of care or choose it when it is available. Assist women to identify a health professional with the skills, knowledge and cultural competence to provide appropriate ongoing care.

• Continuity of care is an important aspect of effective care. It is important to document all assessments and share relevant information with the next health professional providing care to the woman (eg midwife passes information to maternal and child health nurse).

• To access Medicare counselling items, a GP needs to provide a letter of referral for pregnancy support counselling or develop a mental health treatment plan with the woman for more formalised mental health treatment. The GP then refers to a mental health care professional either through the Better Access or perinatal ATAPS Medicare programs.