From the Guidelines
The recommended treatment for mothers who screen positive for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS) typically involves a stepped-care approach beginning with psychological interventions and potentially progressing to pharmacotherapy based on severity. For mild to moderate depression, cognitive behavioral therapy (CBT), interpersonal therapy (IPT), or non-directive counseling should be offered first, typically consisting of 6-12 weekly sessions 1.
Key Considerations
- For more severe depression or when psychological interventions are insufficient, antidepressant medication is recommended, with sertraline (50-200 mg daily) or escitalopram (10-20 mg daily) being preferred options for breastfeeding mothers due to minimal transfer into breast milk 1.
- Paroxetine (20-50 mg daily) is also considered safe during breastfeeding but should be avoided during pregnancy 1.
- Treatment should continue for at least 6-12 months after symptom remission to prevent relapse.
- Social support interventions, including peer support groups and partner involvement in treatment, are valuable adjuncts.
- Regular monitoring using the EPDS every 2-4 weeks during treatment helps track progress.
- For mothers with thoughts of self-harm or suicide identified on the EPDS (question 10), immediate psychiatric evaluation is essential, as highlighted in recent guidelines 1.
Rationale
This comprehensive approach addresses the biological, psychological, and social aspects of postnatal depression, recognizing that effective treatment improves both maternal wellbeing and child development outcomes. The use of the EPDS for screening is supported by recent reviews 1, which emphasize the importance of early diagnosis and treatment to minimize disease severity and associated morbidity.
Implementation
In clinical practice, the stepped-care approach should be tailored to the individual needs of each mother, taking into account the severity of symptoms, previous mental health history, and patient treatment preferences 1. By prioritizing a comprehensive and multidisciplinary approach to postnatal depression, healthcare providers can improve outcomes for both mothers and their children.
From the Research
Recommended Treatment for Postnatal Depression
The recommended treatment for mothers screening positive for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS) includes:
- Counselling sessions with a public health nurse, as part of the Edinburgh method 2
- Selective serotonin reuptake inhibitors (SSRIs), which have been shown to be efficacious and well tolerated in the treatment of postpartum depression 3
- Cognitive-behavioural intervention, psychosocial community-based intervention, psychodynamic therapy, and cognitive behavioural therapy, which have been used as comparisons to SSRIs in randomized clinical trials 3
Screening and Diagnosis
The EPDS is a widely used screening tool for postpartum depression, with a recommended cut-off point of 9/10 for possible postpartum depression, 12/13 for probable postpartum depression, and 14/15 for antepartum depression 4
- The EPDS has been validated in several countries, with sensitivity and specificity ranging from 34 to 100% and 44 to 100%, respectively 4
- The predictive power of the EPDS has been assessed using odds ratios and receiver operator characteristic (ROC) curves, with mothers with a 1-week EPDS score >9 being 30.3 times more likely to exhibit postpartum depression symptomatology at 4 weeks and 19.1 times more likely at 8 weeks 5
Future Directions
The development of the Edinburgh Postnatal Depression Scale-United States (EPDS-US) aims to provide an updated perinatal mental health screening tool using a respectful care and trauma-informed approach 6
- The EPDS-US incorporates principles from Trauma-Informed Care and the Cycle to Respectful Care, with the goal of fostering symptom disclosure in an environment of safety and trust 6
- Validation studies are required to assess the effectiveness of the EPDS-US in identifying mothers at risk for postpartum depression 6