Management of perinatal depression
Support and early intervention for women experiencing distress or depressive symptoms may help to prevent more serious mental health problems from developing. Depending on the severity of a woman’s symptoms, management 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.
Psychosocial interventions that are used as preventive approaches or as part of the management of depression includes non-directive counselling, psychoeducation (e.g. COPE website) and peer support.
Remember: 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).
Which psychological therapies are effective?
When considering the different forms of psychological therapy for treating depression in the perinatal period including cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT) and psychodynamic therapy have been shown to improve depressive symptoms in the postnatal period. Women may also benefit from participating in group CBT.
Psychological therapies that are effective in the postnatal period (and at times other than in the perinatal period) would be expected to be effective in the antenatal period as the disorders differ little from disorders among non-pregnant women in both their presentation and course.
What medications for depression can be safely used during the perinatal period?
During pregnancy, the 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.
For more detail on the safety and effectiveness of pharmacological treatments see the National Perinatal Mental Health Guideline developed by COPE.
Guidelines for the use of antidepressants and benzodiazepines in the general population should also be consulted.
Things to remember about perinatal depression