psychiatric disease during the puerperium

Last edited 03/2021 and last reviewed 08/2023

Most psychiatrists and the Law would accept that a psychiatric illness is puerperal if it occurs within 12 months of childbirth.

Elation in the first 24 hours after pregnancy can precede one of the following three types of psychiatric disturbance:

• post-partum blues
• depressive illness
• puerperal psychosis

Definition of postnatal depression:

• 11th revision of the International Classification for Diseases, and the 5th revision of the Diagnostic and Statistical Manual of Mental Disorders, recommend the use of generic (non-perinatal) mood disorder diagnostic categories for depression occurring in the postnatal period, in recognition of the absence of clear evidence for a distinct postnatal depressive clinical syndrome (1,2)
  • however, they allow for the use of a secondary perinatal diagnostic category (in ICD-11) or specifier (in DSM-5) for depression during pregnancy or within four to six weeks after childbirth

A systematic review regarding the use of antidepressants in postnatal depression has been undertaken (1)

• remains limited evidence regarding the effectiveness and safety of antidepressants in the management of postnatal depression, particularly for those with more severe depression
  • found low-certainty evidence that SSRI antidepressants may be more effective in treating postnatal depression than placebo as measured by response and remission rates. However, the low certainty of the evidence suggests that further research is very likely to have an important impact on our effect estimate
  • in clinical practice, the findings of this review need to be contextualised by the extensive broader literature on antidepressants in the general population and perinatal clinical guidance, to inform an individualised risk-benefit clinical decision

• advice from the UK National Screening Committee on antenatal screening for psychiatric disease in pregnancy....click here

Reference:

1. World Health Organization. International classification of diseases for mortality and morbidity statistics (11th Revision). 18 June 2018. Available at www.who.int/classifications/icd/en/ (Accessed 9/3/2021)
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). 5th edition. Washington, DC: American Psychiatric Association, 2013.
3. Brown JV et al. Antidepressant treatment for postnatal depression. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD013560.
   DOI: 10.1002/14651858.CD013560.pub2