Treating postnatal depression
The principles of treating postnatal depression are similar to those for treating major depression in the general population—see here. It is especially important to optimise psychosocial support during the postnatal period and adjust treatment with the following considerations.
Postnatal depression can affect the parent–infant relationship and this relationship may not fully recover without specific treatment. Options include seeing a parent–infant therapist or accessing a locally-available group or individual therapy program. Information on local services is available from the Perinatal Anxiety and Depression Australia (PANDA) National Helpline (1300 726 306), and may be available from the local maternity hospital, particularly the perinatal mental health team.
If a patient has stable pre-existing depression, a change of treatment approach in the postnatal period is not required. If the patient is breastfeeding and takes a psychotropic, see Psychotropic use while breastfeeding. If pre-existing depression worsens, see advice below.
If a patient develops new-onset mild or moderate postnatal depression, treat with psychological therapies as first-line treatment—cognitive behavioural therapy, interpersonal therapy and group therapy have evidence in this population.
If a patient develops new-onset severe postnatal depression, start a selective serotonin reuptake inhibitor (SSRI) (sertraline is most commonly used). Fluoxetine is avoided in breastfeeding because it has the highest reported concentrations, of all SSRIs, in breastmilk—see Antidepressant use while breastfeeding and Approach to antidepressant therapy for major depression in adults and young people. If the patient is willing and able, also start psychological treatment.
Treating a patient with (new-onset or existing) severe postnatal depression can be complex—if possible, refer to a specialist perinatal mental health service. Often a multidisciplinary team approach is required involving the usual treating clinician, a psychiatrist (preferably with perinatal expertise), and a paediatrician. In some cases, hospitalisation is required, ideally in a parent–infant unit where both parent and infant are co-admitted1 .
For further information and support for clinicians and patients, see the Perinatal Anxiety and Depression Australia (PANDA) website. The PANDA National Helpline (1300 726 306) provides risk assessment, support, counselling and information (including referral advice about local medical, mental health and family services).
The Gidget Foundation Australia provides free telehealth counselling for parents in the perinatal period.