Preventing postnatal depression

Maternal postnatal depression is common and is associated with significant harm including infanticide and suicide; see Assessing postnatal depression for further detail. However, evidence for interventions to prevent postnatal depression is limited.

The Antenatal Risk Questionnaire (ANRQ) helps to identify pregnant patients at high risk of postnatal depression who may particularly benefit from psychosocial interventions and close monitoring in the postnatal period.

Psychosocial interventions (eg groups and home visiting) during the perinatal period, and the identification and treatment of antenatal depression can reduce the risk of postnatal depression. Maximising support and general health and wellbeing (including optimising sleep) are likely to help to prevent postnatal depression and are unlikely to cause harm. Omega-3 fatty acid supplementation does not prevent postnatal depression, despite promising data from early small studies.

Limited preliminary evidence suggests antidepressant use during the perinatal period can prevent postnatal depression. However, the evidence is not sufficiently robust to endorse this practice. Nevertheless, a patient with a history of severe postnatal depression can consider restarting a previously effective antidepressant late in the third trimester or immediately after giving birth—see also Principles of psychotropic use while breastfeeding and Antidepressant use while breastfeeding.