Postpartum psychiatric disorders - Guidelines for management

Psychiatric disorders, in particular depression, are common postpartum and have potential long term implications for the woman and her family. Critical to management is identification and early intervention. Management needs to be multifaceted, including hospitalisation in severe cases, psychotherapy (supportive at least) and organisation of community support. A number of factors need to be considered with respect to medication, in particular if the woman is breastfeeding. Women with puerperal psychosis may require antipsychotics, antidepressants and mood stabilisers; ECT achieves good results when available and acceptable. Women with postpartum depression can generally be managed with antidepressants alone. Management needs to take into account that these disorders may be long lasting, with risk of recurrence after subsequent childbirth, and may have significant effects on child development.