Perinatal Mood and Anxiety Disorders: The Role of OB and Pediatric Providers
Introduction
Mood and anxiety disorders from pregnancy through the first year postpartum
(PMADs) affect up to 20% of women and often go undetected and untreated. OB
and pediatric visits provide unique opportunities to screen women using validated
tools such as the EPDS, Edinburgh Postnatal Depression Scale (1). Symptoms
causing significant distress or impairment or that last more than two weeks
postpartum are more than the baby blues and should raise suspicion for PMADs.
Postpartum Psychosis (PPP) is rare (1–2 per 1000 births) but serious condition that
begins days to weeks postpartum and carries significant risk to mother and infant
including suicide, neglect, and infanticide (2). Typical symptoms include rapid onset
of delusions, hallucinations, mood lability, disorganized behavior, and impaired
reality testing with a delirium-like quality. PPP is considered a psychiatric emergency
and any concern warrants urgent psychiatric evaluation and child safety evaluation.
Evidence-based treatments for Pediatric Mood and Anxiety Disorders include
psychotherapy (Cognitive Behavioral Therapy and Interpersonal Therapy) and
pharmacotherapy. Selective serotonin reuptake inhibitors (SSRIs) like sertraline and
escitalopram are first-line treatment due to safety profiles during pregnancy
and lactation (3). Illinois DocAssist offers provider training, patient resources and
referral assistance.
Pediatricians should understand that most antidepressants are compatible with
breastfeeding. Sertraline, paroxetine, and escitalopram show minimal infant serum
levels and no adverse developmental effects (4). Consultation with a perinatal
psychiatrist through Illinois DocAssist and referencing the Illinois DocAssist perinatal
medication charts can support informed decisions.
Proactive screening and knowledge of treatments empower providers to safeguard
both maternal and infant well-being.
Difference between Postpartum Psychosis and Depression
…..
Assessing harm to baby:
Low Risk
- Thoughts unwanted
- Thoughts cause distress
- Woman does not want to act on thoughts
- Lack of psychotic symptoms
- Good insight
High Risk
- Thoughts related to psychotic beliefs
- Psychotic symptoms
- Disorganized thinking and behavior
- Poor Insight
References
- Cox JL, et al. Br J Psychiatry. 1987;150:782-786.
- Sit D, et al. Am J Psychiatry. 2006;163(4):608-616.
- Stewart DE, Vigod SN. J Clin Psychiatry. 2016;77(9):1189-1200.
- Weissman AM, et al. Am J Psychiatry. 2004;161(6):1066-1078.