Dr Simon Belderbos Consultant Psychiatrist Connect Meeting 10.4.08 Dr Simon Belderbos Consultant Psychiatrist

Antenatal and Postnatal Mental Health ‘Baby Blues’ 50% Symptoms peak 3rd – 4th Day Short lived episodes irritability, crying, emotional lability. Postnatal depression 10-15% 2-6 weeks postpartum Past history depression

Puerpural Psychosis 1 in 500 Live births Onset day 3-14 Personal / family history Psychotic Illness High rate of recurrence purpural & non-purpural psychosis (50%)

NICE ‘Antenatal and postnatal mental health’ April 2007 Prediction Past Hx Depression Past Hx Psychotic Illness Family Hx Psychotic illness Detection Depression Low mood, anhedonia, lethergy, hopeless Do they want help? Psychosis- ‘change’, confusion, ununderstandable

Treatment Mild – Moderate depression Moderate- Severe depression Brief psychological treatment Enhanced Primary Care Psychology Service CBT or IPT 4-6 sessions Social support Moderate- Severe depression CMHT Psychology, social support & medication

Treatment Puerperal Psychosis ? Prophylaxis antipsychotics Share information prior to delivery CMHT input, postnatal CATT Mother and Baby unit Thumbswood QEII Welwyn

Antidepressants Lowest risk during pregnancy TCA’s or Fluoxetine PPH in neonates with SSRI > 20 weeks Avoid Paroxetine – fetal heart defects Venlafaxine – High blood pressure Brest feeding – Sertraline, imipramine lower levels in brest milk

Antipsychotics Raised prolactin reduce chances of conception Gestational diabetes especially Olanzapine Avoid Clozapine and depot

Mood Stabilisers Avoid Valproate in women of childbearing age Lamotrigine & Carbamazepine stop and use atypical antipsychotic Lithium Consider stopping unless high risk of relapse or consider stopping and restarting in 2nd trimester