Ep 139 – Identification and treatment of perinatal mental health problems

Perinatal mental health (PNMH) problems affect one in five women and one in ten men. They can present in several ways, including depression and anxiety, but also post-traumatic stress disorder, adjustment disorder, obsessive-compulsive disorder and psychosis. In the third episode of the perinatal mental health series, Dr James Waldron and Dr Jenny Barnes (GP and Perinatal Mental Health Champion, Warwickshire) discuss what to do in clinical practice when PNMH issues are suspected. Prevention is better than cure, so it is worth taking steps to identify people at risk and offering support and treatment where necessary.

Key take-home points

• Risk factors for PNMH issues include previous mental health problems.
• Be aware of women of childbearing age who are on antidepressants when doing medication reviews.
• Discussions about medication are best had pre-conception.
• NHS talking therapies are available to provide pre-conception counselling for women who are at risk or worried about PNMH.
• Local referral guidelines will be in place, but pre-conception counselling is especially important for anyone who has had a severe episode of depression or psychosis, and these people should be under the PNMH team.
• Social prescribing is also available as a support option for families.
• The PNMH team can also provide pre-conception advice and give a review of women on medication to help develop a plan.
• Current guidance is that selective serotonin reuptake inhibitors (SSRIs) may be suitable for use in pregnancy following an individualised assessment of the risks and benefits. In cases where an SSRI is continued in pregnancy, the lowest effective dose should be used.
• Where possible, use a single drug rather than combinations.
• Choose a medication with a low-risk profile; the UK Teratology Information Service can provide evidence-based safety information.
• Patient information on drug safety in pregnancy is also available and can help to support women in making their decisions. Resources available on the "Best Use of Medicines in Pregnancy (BUMPS)" website listed in the related references.
• Postnatal adjustment disorder or depression can be treated with psychological therapies and support.
• Patients with PNMH issues will be prioritised by NHS talking therapies.
• Some people with more severe symptoms may need a referral to the PNMH team.
• Concerns of harm should trigger an urgent on-the-day referral.
• Local groups can provide peer support and information.

Related references

1. Royal College of Obstetricians & Gynaecologists. https://www.rcog.org.uk/for-the-public/rcog-engagement-listening-to-patients/maternal-mental-health-womens-voices/.
2. UK Teratology Information Service. https://uktis.org/.
3. Best Use of Medicines in Pregnancy (BUMPS). https://www.medicinesinpregnancy.org/.
4. Hearts and minds. https://www.heartsandmindspartnership.org/.
5. NICE. 2020. https://www.nice.org.uk/guidance/cg192.
6. Royal College of General Practitioners. 2023. https://gpcpc.co.uk/wp-content/uploads/2023/09/Ten-Questions-on-PMH.pdf.
7. NHS. 2022. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/nhs-talking-therapies/.