Mood disorders during pregnancy and after the birth of your baby A booklet for women and their families Scottish guidelines © Scottish Intercollegiate Guidelines Network ISBN 978 1 909103 60 3 First published 2012 Revised 2017 This booklet can be photocopied to be used in the NHS in Scotland. Contents Who is this booklet for? 1 What is this booklet about? 2 What are the types of mood disorder during and after pregnancy? 4 How will I know if I have antenatal or postnatal depression? 5 How might I feel after giving birth? 7 Who is at more risk of postpartum psychosis and how will I know if I have it? 10 What if I have a raised risk of postpartum psychosis? 12 Risk factors for mood disorders during pregnancy and after the birth 14 What can I do to help myself? 16 How can the people who are close to me help? 17 Is my medication for treatment of mood disorders safe if I’m planning a pregnancy? 19 What treatment choices are available if I develop a mood disorder? 22 Is it safe to take medication when I’m breastfeeding? 27 What medication choices are available to me? 28 Where can I find out more? 32 How are SIGN guidelines produced? 35 Who is this booklet for? This booklet is for you if: • you are pregnant • you are planning a pregnancy • you have had a baby in the last year • you are concerned about mood disorders. Partners, family, friends and carers may also find it useful. The booklet explains: • who is at risk of developing mood disorders during pregnancy and after the birth • how mood disorders are diagnosed • what treatment choices may be available • the safety of taking medication for an existing mood disorder during pregnancy • what you can expect from treatment. 1 What is this booklet about? This booklet explains the recommendations in a clinical guideline, produced by the Scottish Intercollegiate Guidelines Network (SIGN), about the management of perinatal mood disorders. The clinical guidance is based on what we know from current medical research. It also gives advice based on the opinion of healthcare professionals who are trained on how best to manage your care. Details of support organisations and other places where you can get more information are on page 32–34. On page 35 you can find out how we produce guidelines. 2 There are seven different types of recommendations which can be used in SIGN booklets. Strong Recommendation Recommendation Recommendation recommendation based on the against based against based based on good- research evidence on good-quality on the research quality research research evidence evidence evidence ? Recommendation Recommendation Not enough research based on clinical against based on clinical evidence to tell us if experience experience something is of benefit If you would like to see the clinical guideline, please visit www.sign.ac.uk 3 What are the types of mood disorder during and after pregnancy? Antenatal depression is depression during pregnancy. Postnatal depression is depression within the first 12 months after the birth. Postpartum psychosis is a severe mental illness where you lose touch with reality, which can start suddenly after the birth. Perinatal mood disorders are mental health issues that occur during pregnancy or in the first year after the birth. Some things give you a higher risk of developing a mood disorder. They are shown on page 14. 4 How will I know if I have antenatal or postnatal depression? The symptoms are the same as the depression that anyone can get. Before seeing your doctor, it may help to write down how you are feeling. This will help the doctor to offer you the most suitable treatment options. You may experience some of the following symptoms: • Feeling less interested in day-to-day activities. • Feeling sad and crying regularly. • Feeling anxious and fearful. • Tiredness and lack of energy. • Panic attacks. • Pain for which there is no cause. • Difficulty sleeping. • Reduced concentration. • Obsessive behaviour. • Poor appetite. • Loss of interest in sex. • Feeling less able or unable to cope with the demands of the baby and home. Some of the physical symptoms you may experience include: • headaches • numbness, and • breathing too fast (hyperventilation). 5 You can use this space to write down how you are feeling. Occasionally, some mothers may feel like harming themselves or their baby. If you experience any of these thoughts, let your midwife, health visitor, GP or family know. Don’t feel ashamed or afraid of these thoughts; they are caused by the illness. “I believed she (the baby) was behaving the way she was to get at me and to deliberately annoy me, which she wasn’t of course, she was being a baby.” 6