Treatment of Postnatal Depression

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The treatment of postnatal depression requires an intervention by a multidisciplinary team specialised in the design and application of an individualised plan, based on the scientific evidence and on the needs of the mother. In order to carry out these treatments, specific tools have been developed that enable this intensive and multidisciplinary plan to be applied in a place where the mother and her baby goes in order to carry out the treatment plan.

Mother-Baby Day Hospital

Our country has the CLINIC-BCN Mother-Baby Day Hospital from Hospital Clínic de Barcelona, inaugurated in 2018. It is a partial hospitalisation service where the mothers with moderate-severe postnatal depression go with their baby. They receive a multidisciplinary and intensive treatment, specific interventions to promote bonding, maternal care, and breastfeeding, together with psycho-pharmacological treatment. Furthermore, psycho-educational actions are carried out about the illness and the prevention of future episodes.

Mother-Baby Units

International guidelines recommend the creation of Mother-Baby Hospital Units for cases of more serious episodes, especially those with psychotic symptoms or a suicide risk, and that the mother is admitted with her baby, whenever possible. Currently, there are no other Mother-Baby Hospital Units in Spain.

Non-pharmacological treatment

The psychological therapy techniques that have been shown to be effective for the treatment of PND are cognitive-behavioural therapy (CBT) and interpersonal therapy.

The psychological cognitive-behavioural therapy is the one most used for the treatment of PND. It can be carried out individually as well as in group. This type of therapy is focused on the present, on the current problems that the mother has, in the establishment of specific objectives, and is based on learning techniques that are practiced routinely, and that help to achieve the treatment objectives. This includes:

Woman

Increase social activities and self-care, as well as the time dedicated to oneself.

Woman seated in Yoga position

Implement relaxation or emotional regulation techniques in times of stress.

Emotional support between two women

Train assertivity, that is to say, the interpersonal ability that helps to defend the wishes and opinions and respect those of others.

Negative sign

Do something about negative thoughts about yourself, motherhood, or relationships with the newborn baby.

Interpersonal therapy is based on action on the interpersonal situation of the patient in four possible areas: interpersonal conflicts, which could be with relatives, with the partner, in the workplace; the role transition, which refers to the changes in personal situations, like those in the case of motherhood; the grief situation; and interpersonal deficiencies.

Therapies have also been designed that include acting on mother-baby bonding.

Pharmacological treatment

Correct blue and green pharmaceuticals

The management and treatment of mental illnesses during pregnancy and lactation can be a complex clinical situation. There are data accumulated during the last 30 years that suggest the antidepressants in general and the Serotonin Reuptake Inhibitors (SSRIs), which are of first choice in postnatal depression, can be used safely during breastfeeding. For starting or maintaining any treatment during pregnancy and lactation, a risk and benefit assessment must be made both on the taking of the psychotic drug and of the effects of the untreated maternal illness, in this case the depression.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy electrode patient

Electroconvulsive therapy is an effective and safe treatment in those cases of severe depression (high inhibition, life threatening, melancholy, psychotic symptoms) or resistance to the pharmacological treatment. ECT can be carried out during the postnatal period with anaesthetics compatible with breastfeeding. It is also a treatment that should be taken into account in some cases of severe depression during pregnancy.

ECT can be carried out during the postnatal period with anaesthetics compatible with breastfeeding. Although less frequently, it is also a valuable treatment in some cases of severe depression during pregnancy.

New therapies: brexanolone

Injection

Brexanolone is a new drug with a specific indication for the treatment of Postnatal Depression awaiting approval by the US drug regulatory agency (FDA).

Brexanolone, an intravenous formula of allopregnanolone, rapidly decreases the symptoms of moderate-severe postnatal depression in comparison with placebo.

One of the main characteristics of this treatment is the speed of action, since an improvement is seen from 48-60 hours after administration. The treatment, which is applied intravenously and in hospitalization regime, could be a future therapeutic option that significantly reduces the duration of postnatal depression. The disadvantages are the cost, the administration intravenously and in hospitalization and that has not yet been approved or commercialized in Spain.

Treatment complications

The treatment of PND tends to be protracted over time. Delays are primarily produced in the detection, afterwards in the treatment proposals, and finally in the compliance by the patient. There are barriers to accessing the treatment that involve the institutions, the professionals and the patients.

Barriers by the mother Barriers due to the professionals

Lack of information:

  • Lack of printed information on perinatal mental disorders.
  • Attributing the symptoms to external causes or the childbirth.
  • Lack of knowledge about where and to whom request help.
  • Lack of knowledge on the possibility of combining the pharmacological treatments with lactation.

Operating system:

  • Lack of time and resources for the evaluation of the perinatal depressive symptoms.
  • Difficulty in access to external expert advice in perinatal mental health.
  • Lack of time to contact and coordinate with adequate referral services.
  • Limited access for referral to the mental health services.

Erroneous beliefs and attitudes:

  • Reticence to accept and reveal emotional problems after the birth of their child.
  • Put the care of the infant before the mental health of the mother.
  • Fear of being stigmatised as “a bad mother” or the possibility of withdrawal of the children.

Lack of specialised information:

  • Lack of training and support.
  • Lack of knowledge of screening tools for the detection of the depressive symptoms.
  • Uncertainty about how to decipher the relationship between external social stress factors and puerperal depressive symptoms.
  • Incomplete knowledge about the treatments for the depression.

Problems in the interaction with the health professionals:

  • Perception of little usefulness of the professional response.
  • Previous negative experiences.
  • Concerns about privacy and confidentiality.
  • Reticence to take psychiatric drugs.
 

Difficulties of accessibility:

  • Lack of time.
  • To give priority to the care of the child.
  • Cost of the treatment.
  • Transport problems.
  • Waiting time for the consultation.
 

 

Substantiated information by:

Alba Roca
Anna Torres Giménez
Lluïsa García Esteve
Susana Andrés Perpiñá

Published: 7 May 2019
Updated: 7 May 2019

The donations that can be done through this webpage are exclusively for the benefit of Hospital Clínic of Barcelona through Fundació Clínic per a la Recerca Biomèdica and not for BBVA Foundation, entity that collaborates with the project of PortalClínic.

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