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PND appears to progress through several stages (Beckford-Ball, 2000; Green, 2005):

1. Postpartum ‘blues’;

2. Postnatal depression;

3. Puerperal psychosis.

Postpartum ‘blues’ “is usually a transient phase occurring 3-5 days after the birth of the child, with few or no psychiatric symptoms. This stage is characterised by mood swings, tearfulness, fatigue, lack of concentration, confusion, anxiety and hostility” (p.126). This condition is easily treated using hormone replacement therapy.

Postnatal depression is less frequent, and emerges as a deep and protracted ‘sadness’ which “is much more intense and persistent than postpartum blues and its symptoms rarely subside without help” (p.126).Many mothers may feel insecure, incompetent, irritable, guilty (about feeling sad following a happy event), weight changes,  insomnia/hypersomnia, psychomotor retardation/agitation, tiredness, and loss of interest in activities. This condition often results in hospitalisation and treatment with antidepressants and cognitive-behavioural counselling.

Puerperal psychosis is a severe mood disorder typified by delusions and hallucinations. This condition is considered a psychiatric emergency, necessitating admission to a psychiatric institution and treatment with antidepressants and other drugs.

Rationale

Despite clear guidelines regarding the use of antidepressants during pregnancy it is necessary to appraise existing literature on the topic, for several reasons:

1. Limited scope of existing reviews.

2. Identification of gaps and inconsistencies in the literature

3. Verification of current claims and guidelines, for example by the RCP, regarding the management of postnatal depression.

Limited scope

Previous literature reviews are considered in this brief (see Chapter 3). Most reviews are limited in scope mainly because they focus on studies using a particular research methodology(e.g. Booth et al, 2005), mother-child transmission through breastfeeding (e.g. Cohen, 2005), and effects on depressive symptoms(e.g. Hendricks, 2003; Bennett et al, 2004). Thus, there is a need for an all-inclusive review that offers a broader insight into current literature.

Identification of gaps and inconsistencies

Previous reviews on the topic have highlighted problems that need to be addressed in future research. However each review is different and new research findings continually emerge that may have implications for previous reviews. For example, past reviews have found little evidence of malformations resulting from SSRI use (e.g. Booth et al, 2005). However, new concerns are starting to emerge regarding various analytic and methodological constraints that negate conclusive inferences about the safety of SSRIs.

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