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Postnatal Depression Is Less Frequent, And Emerges As A Deep And Protracted ...


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/hyposomnia, 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:
Limited scope of existing reviews.
Identification of gaps and inconsistencies in the literature
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. Boath et al, 2005), mother-child transmission through breastfeeding (e.g. Kohen, 2005), and effects on depressive symptoms (e.g. Hendrick, 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. Boath 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.
Verification of current claims
The RCP publishes an information guide for the use of antidepressants. Various claims are made regarding safety and efficacy of use during/after pregnancy, consistent with NICE (2004) standards. While most assertions are based on research evidence there is a need for on-going reviews that highlight recent findings and consider their implications for existing guidelines.
Some of the key pronouncements and guidelines are as follows:
People who take antidepressants show a significant improvement over persons administered a placebo.
TCAs and SSRIs are equally effective but the latter (newer drug) is safer because it seems to have fewer side effects.

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