1. Dr Simon Belderbos Consultant Psychiatrist
Connect Meeting
Dr Simon Belderbos
Consultant Psychiatrist

3. 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

4. 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%)

5. 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

6. 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

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

8. 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

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

10. 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