2002 International International Biennial Scientific Meeting

POSTNATAL DEPRESSION AND PUERPERAL PSYCHOSIS: A SIGN NATIONAL CLINICAL GUIDELINE FOR SCOTLAND

Roch Cantwell*, Beth Alder** and Joanne Topalian***

* Department of Psychological Medicine, University of Glasgow, Gartnavel Royal Hospital, Glasgow
** Napier University, Edinburgh
*** SIGN Executive, Royal College of Physicians, Edinburgh

r.cantwell@clinmed.gla.ac.uk

Objectives: To establish evidence-based clinical guidelines for the detection, diagnosis and management of postnatal depression and puerperal psychosis, and for the prescription of psychotropic medication during pregnancy and breastfeeding.

Methods: Using methodology established by the Scottish Intercollegiate Guidelines Network (SIGN), comprehensive literature searches on pre-determined questions were followed by expert independent reviews of evidence. This led to the development of evidence-based recommendations graded according to strength of evidence.

Results: Sufficient evidence was found to recommend the routine antenatal screening of all women for risk factors for puerperal psychosis, and postnatal screening for depression using the Edinburgh Postnatal Depression Scale. With regard to management, there was evidence in favour of the use of antidepressants and psychosocial interventions for treatment of postnatal depression, and that suitable facilities should be available to admit all women with their babies where necessary. Lastly, the guideline makes specific recommendations regarding the use of psychotropics in pregnancy and breastfeeding, seeking to achieve a balance between the need for effective treatment of significant maternal illness and the importance of minimising risk to the fetus or infant.

Conclusions: The level of care for women at risk of, or suffering from, perinatal mental illness is very varied. These guidelines provide specific recommendations that ensure minimum standards of care at a national level but which can be adapted to local needs.