May 30, 2025 • 21 mins
⚕️ FREE MSRA PODCAST – Postnatal Depression (PPD): Key Features & Fast Management Guide
🎧 Get a rapid, practical breakdown of postnatal depression—how to recognise it, manage it, and remember the essentials for the MSRA and clinical practice.
🧠 Key Learning Points
📌 Definition
• PPD is a depressive disorder in women after childbirth (first year).
• More severe and persistent than baby blues; impacts daily function.
• Peak onset ~3 months, but can develop anytime within 12 months.
📌 Causes & Risk Factors
• Hormonal changes, history of depression/PPD, family history, stressful events, lack of support, sleep deprivation, financial/relationship problems.
• Mnemonic: HELPSS—History, Events (stress), Lack of support, Previous PPD, Sleep, Social factors.
📌 Pathophysiology
• Rapid drop in oestrogen/progesterone, disrupted neurotransmitters (serotonin, dopamine, noradrenaline), genetics, altered stress response.
📌 Differential Diagnosis
• Baby blues (mild, <2wks), major depression, bipolar disorder, anxiety, adjustment disorder, postpartum psychosis (rare but serious).
📌 Epidemiology
• 10–15% of women (up to 20% in first year).
• Often under-recognised (screening in only ~13% of UK records).
📌 Clinical Features
• Persistent low mood, anhedonia, fatigue, sleep/appetite changes, poor concentration, guilt, irritability, anxiety, trouble bonding, thoughts of self-harm or harm to baby (urgent red flag).
• Must last ≥2 weeks, significantly impact functioning.
📌 Diagnosis
• Clinical history + screening (EPDS, PHQ-9, GAD-7, MDQ if needed).
• Rule out thyroid dysfunction, anaemia, substance misuse.
• No confirmatory lab test.
📌 Management
• Mild–moderate: Psychological therapies (CBT, IPT), support groups, education, social support.
• Moderate–severe: SSRIs (sertraline/paroxetine safest if breastfeeding; nortriptyline as TCA), consider urgent referral for risk or psychosis.
• Multidisciplinary team approach—midwives, health visitors, GPs, mental health specialists.
• Always involve patient in decisions, consider culture/family needs.
📌 Prognosis & Complications
• Good with prompt treatment—most improve in months.
• Untreated: risk of persistent depression, poor mother–baby bonding, impaired child development, recurrence, relationship breakdown, postpartum psychosis.
📎 More MSRA Resources for Postnatal Depression:
📝 Revision Notes: https://www.passthemsra.com/topic/postnatal-depression-revision-notes/
🧠 Flashcards: https://www.passthemsra.com/topic/postnatal-depression-flashcards/
💬 Accordion Q&A: https://www.passthemsra.com/topic/postnatal-depression-accordion-qa-notes/
🚀 Rapid Quiz: https://www.passthemsra.com/topic/postnatal-depression-rapid-quiz/
🎓 Full Course: https://www.passthemsra.com/courses/psychiatry-for-the-msra/
#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAAccordions #PostnatalDepression #Psychiatry #PerinatalMentalHealth #MotherandBaby
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
OK, so let's dive in the time after having a baby.
It's often pictured as, you know, pure bliss.
Right. Yeah, that's the common image.
But the reality for, well, quitea lot of women involves some
pretty significant mental healthchallenges, and we're not just
talking about feeling a bit overwhelmed for a day or two.
No, absolutely not. We're looking at something much
(00:22):
more serious, more persistent than the the common baby Blues.
And understanding that difference, especially when
you're revising, yeah, is just crucial, isn't it?
It really is, both for clinical practise and yeah for getting
these key topics straight for your exams.
Right, so that's exactly what this deep dive is about.
We're here to help you get to grips with your own revision
(00:42):
notes on Post Natal depression or PPD.
Yeah, our mission is to unpack this material you've got, pull
out the absolute core stuff, thefacts you really need to
remember, and maybe, you know, find ways to make it all stick a
bit better. Think of us as kind of walking
through these notes alongside you.
Yeah, pointing out the high yield bits.
PPD is a big deal, effects a lotof women, so getting a solid
(01:03):
handle on it is, well, it's essential.
Couldn't agree more, it's so important.
So let's start right at the beginning.
What is post Natal depression? According to these notes, they
call it a mood disorder affecting women after
childbirth. Sometimes called postpartum
depression, and the key things your notes highlight are that
persistent sadness, the low mood, things that really get in
(01:26):
the way of functioning day-to-day.
And the timing seems really key here too, doesn't it?
The notes say it typically pops up within the first year after
birth. Yeah, often within weeks or
months. But, and this is important, it
can actually develop later too, even like 6 to 12 months down
the line. It's definitely on a spectrum of
things that can happen around pregnancy and birth.
OK, so it's not just the immediate aftermath.
(01:48):
And crucially, it's more severe,last longer than those baby
Blues. Exactly, the baby Blues are
usually quite mild self limiting.
PPD is different. Your notes say it affects around
around 10% of women, and interestingly there seems to be
a peak around three months afterbirth.
That peak at three months, that's a good specific detail to
lock in for revision. So for the definition timing
(02:11):
within the first year, often weeks, months peaks at three
months and the big difference ispersistence and impact on
function. That's the key takeaway compared
to baby Blues. You got it.
That distinction is absolutely fundamental.
OK. So if that's what it is and when
it tends to happen, the big question is why?
Why does it develop? The notes admit the exact cause
(02:34):
isn't really known. It's complex.
Right, it's not just one thing they talk about a mix.
Hormonal factors, biological stuff, psychological aspects,
and social influences all playing a part.
Hormones often get mentioned, right That big drop after birth?
Yes, the rapid decline in oestrogen and progesterone is
mentioned as a potential factor,but the notes are careful to add
a caveat. Yeah, they say the hormonal link
(02:56):
isn't actually conclusively proven, so it's likely part of
the picture, but maybe not the whole story.
The scientific uncertainty is quite interesting.
Yeah, it really is. So it's not like a simple cause
and effect. So if the cause is complicated,
what makes some women more, well, at risk?
What are the risk factors your notes list out?
OK, this is really important foridentification.
Several clear risk factors are listed.
(03:18):
Having a personal history of depression or other mental
illness, or a family history of it.
OK, so past experience matters. Hugely, and having had PPD
before makes you much more likely to get it again.
Then there are stressors. What kind of stressors?
Stressful life events, maybe during the pregnancy or after
the baby arrives, a difficult ortraumatic birth experience
(03:38):
itself and really importantly, alack of social support, feeling
isolated. That makes sense.
Anything else on the list? Yeah, financial worries,
relationship problems are mentioned too.
And linking back to the potential causes, those hormonal
factors and of course major changes in sleep patterns, which
let's be honest, is almost universal with a newborn, they
(04:00):
also contribute to the risk. OK that gives us a good
framework maybe for remembering you could group them like
history, personal, family, previous PPD, then stressors,
life events, birth trauma, money, relationships and maybe
biosport, hormones, sleep, lack of support.
That's a great way to think about it.
It really emphasises that it's usually a combination of factors
(04:22):
that tips the balance. Right, it's rarely just one
single thing. Exactly.
It's that accumulation of vulnerability.
OK. Moving on to the sort of the
mechanics, what's actually goingon inside the body, the
pathophysiology? The notes are pretty upfront
that this isn't fully mapped outeither.
No, it's definitely described asa complex interplay.
While they can't point to one single trigger, the notes do
(04:43):
suggest potential biological mechanisms.
Those hormonal changes we mentioned, they come up again.
Right, that rapid drop in oestrogen and progesterone post
delivery. Exactly.
It's likely involved, but also there's mention of disruption in
mood regulating neurotransmitters.
Like serotonin? Serotonin yes, and dopamine and
norepiphrine are the ones specifically listed in your
(05:05):
notes. They also mentioned genetic
vulnerability. Some people might just be more
predisposed and an altered stress response system.
Plus those psychosocial factors interacting with all of this.
So it's biological and environmental.
Yeah, the notes even mentioned genetic and maybe epigenetic
factors interacting with stressors like of sleep, the
(05:26):
general huge adjustment to motherhood, all influencing the
symptoms. I guess so.
Key terms from the notes for pathophysiology would be things
like complex interplay hormones,those specific
neurotransmitters, serotonin, dopamine or apinephrine,
genetics and the stress response.
It's like the whole system is under pressure.
That's a good summary of the picture of the notes.
(05:47):
Paint a system under significantstrain from multiple directions.
So if someone presents with symptoms that sound like this,
what else might be going on? What are the main things to
consider in the differential diagnosis according to your
notes? Yes, differential diagnosis
crucial for assessment. The notes list several key
things to rule out or distinguish from PPD.
(06:08):
We've mentioned it already, but the big one is the baby Blues.
Right, need to tell that apart first.
Definitely remember baby Blues are milder shorter lived.
Then you need to think about other psychiatric conditions
that could present in this period.
Major depressive disorder because PPD is essentially MDD.
Just with a post of this Natal onset.
Are also bipolar disorder, generalised anxiety disorder,
(06:30):
perhaps an adjustment disorder, And the nodes just generally
mention other perinatal mental health conditions too.
So for revision, the absolute must do is separating it from
baby Blues based on severity andduration and then being aware of
other major conditions like bipolar or significant anxiety
that could look similar initially.
Precisely, you need a really thorough assessment to make
(06:52):
those distinctions accurately. Let's talk numbers.
How common is PPD? What are these UK based notes
say about the epidemiology? OK.
The estimated prevalence is generally given as around 10 to
15% of women, which is, you know, 1.
In 10-1 In seven, maybe. Roughly, yeah.
But interestingly, the notes also mentioned prevalence might
actually be higher during pregnancy, maybe 1213%.
(07:14):
And in that first year after birth, some estimates go up to
1520%. Wow, OK.
And the notes pointed out a really big challenge with this.
Yes, under recognition they state that PPD is often missed
and the statistic they give is quite stark.
Screening for mental health issues is apparently recorded in
only about 13% of patient records.
Only 13%? Seriously.
(07:35):
That's what the notes say. It strongly suggests many cases
are slipping through the net. The notes specifically mentioned
potential gaps in general practise and possibly among
women from minority ethnic backgrounds whose needs might
get overlooked. That 13% figure really makes you
stop and think, doesn't it? It means the actual problem
could be even bigger than those 1015% prevalence figures
(07:56):
suggest, just because we're not identifying it effectively.
Exactly. So key numbers to remember,
1015% general prevalence, maybe up to the 20% in the first year
and that concerningly low 13% recorded screening rate.
Those numbers definitely put theimportance of this topic into
perspective. OK, let's shift from the numbers
to the person. What does PPD actually look
(08:17):
like? What are the clinical features,
the symptoms you'd expect to seeor hear about?
Your notes give a really good comprehensive list and for
revision you can basically thinkof them as the standard symptoms
of depression but happening in that post Natal context.
OK, so things like persistent low mood, feeling sad, maybe
hopeless, losing interest or pleasure in activities.
(08:38):
The notes use the term anhedonia, which is a good one
to know. Changes in appetite, weight
going up or down, Sleep problems, though?
This one's tricky, right? Yeah, because who doesn't have
sleep problems with a new baby? The notes acknowledge that
overlap. Don't.
They they do. It's about the pattern and
severity. What else?
Fatigue, really low energy, feelings of guilt or
(08:59):
worthlessness? Trouble concentrating, Being
more irritable, more anxious. And there's a particularly
concerning symptom mentioned too.
Yes, absolutely crucial to pick up on thoughts of self harm or
even thoughts of harming the baby.
These are serious red flags. Definitely, and the notes stress
that these symptoms are much more severe and longer lasting
than the baby Blues really interfere with daily life and
(09:21):
potentially impacting bonding with the baby.
Right, and they also mentioned why women might not actually
tell anyone they're feeling thisway.
Yeah, the barriers like? Fear of being judged.
Fear of stigma, Worries about, you know, custody implications,
feeling like a bad mother. Sometimes masking symptoms with
substance use. Understanding those reasons for
hiding it is so important when you're actually talking to
(09:42):
someone isn't. It absolutely for remembering
the symptoms. You could perhaps adapt A
mnemonic like Sid CAPS for general depression, but make
sure you're tailoring it to the PPD list in your notes.
Definitely include irritability,anxiety, and those specific
thoughts about harm. That seems practical.
Know the core depression symptoms but recognise how they
show up specifically in this post Natal period, including
(10:06):
those really worrying thoughts. Exactly.
It's about context and severity.So someone comes in, they have
these symptoms. How do we actually make the
diagnosis? How do we confirm it's PPD?
PPD according to the notes. The notes are really clear on
this. Diagnosis is primarily based on
a thorough clinical assessment. That means talking to the woman,
taking a detailed history, really listening, and evaluating
her symptoms against standard diagnostic criteria like from
(10:28):
the DSM 5 or ICD 11. So no magic, blood test or scam.
Correct. The notes explicitly state no
specific laboratory or imaging tests for confirmation of PPD
itself. OK.
But they do mention doing some investigations.
Yes, but that's for a different reason.
Those tests are about ruling outother medical conditions that
(10:49):
could potentially mimic PPD symptoms or be contributing
factors. OK.
Like what sort of tests? The notes list things like
thyroid function tests because thyroid problems can definitely
cause mood changes and fatigue. A full blood count to check for
anaemia, another cause of fatigue.
Maybe a urine drug screen if substance use is a concern.
(11:09):
Brain scans like CT or MRI are mentioned, but only if there's a
specific reason to suspect otherbrain pathology.
Definitely not routine. Right, so diagnosis is clinical
first and foremost. Labs are just to exclude other
stuff. What about screening tools?
They're mentioned aren't. They yes, screening is really
important for picking up potential cases early.
The notes recommend asking specific questions about mood
(11:30):
during antenatal booking appointments and post Natal
cheques. Just asking directly.
Yeah, simple questions like during the past month, have you
often been bothered by feeling down, depressed or hopeless?
And during the past month, have you often been bothered by
having little interest or pleasure in doing things and
then using validated tools if concerns arise?
The Edinburgh Post Natal Depression scale, the EPDS is
(11:52):
the classic one mentioned. OK.
EPDS any others? PHQ 9 for depression, G87 for
anxiety are also listed. And interestingly, they
mentioned the mood disorder questionnaire, the MDQ
specifically for screening for mania or hypomania, reminding us
about that bipolar differential again.
Makes sense and the formal diagnostic criteria.
(12:13):
Requires meeting a threshold, typically 5 or more core
symptoms, one of of which must be low mood or anedonia.
Present most days for at least two weeks.
These symptoms need to cause significant distress or impair
functioning and can't be better explained by substance use or
another medical condition, and this diagnosis applies up to 12
months after delivery. Got it.
(12:33):
So key points for diagnosis. It's clinical labs rule things
OT screening questions and toolslike Epds are vital and know the
basic criteria. 5 plus symptoms,2 weeks impairment within that
first year. Excellent summary that covers
the core of the diagnostic process outlined in the notes.
OK, so we've got the diagnosis. Now what?
(12:55):
How do we help? The notes talk about a
multifaceted approach. Yes, it really needs to be
tailored to the individual womanand how severe her symptoms are.
The main strategies listed fall into a few categories,
psychological therapies, supportsystems, and medication.
What kind of psychological therapies are mentioned
specifically? CBT, cognitive behavioural
therapy and IPT interpersonal therapy are highlighted as
(13:17):
effective options. Support groups are also really
valuable, providing that peer support and sense of community.
And medication. Yes, for moderate to severe PPD
antidepressants, specifically SSRI, selective serotonin
reuptake inhibitors are a key part of treatment, according to
the notes. Are there other types of support
mentioned? Definitely supportive
interventions are key, things like providing education about
(13:38):
PPD, offering general counselling, helping the woman
connect with or strengthen her social support networks and the
notes really emphasise the importance of teamwork.
Midwives, health visitors, GPS, mental health specialists, all
potentially involved in communicating.
Right, A-Team effort And how does the approach change
depending on how severe the PPD is?
The notes layout a kind of stepped care or tiered approach
(14:02):
for mild to moderate symptoms. The first steps might be things
like guided self help, non directive counselling, or maybe
brief CBT or IPT. But if someone has mild symptoms
but also a history of severe depression, the notes suggest
considering antidepressants evenat that stage.
For moderate or severe PPD, the recommendation moves toward high
intensity psychological therapy like full CBT, starting
(14:25):
antidepressants, or often a combination of both.
And the medication choice, especially if the mother is
breastfeeding, that's a huge consideration, right?
The goats must cover that. Absolutely crucial.
Yes, The notes list specific SSRI that are generally
considered compatible with breastfeeding due to lower
levels in breast milk. Sutriline and Paroxetine are the
main ones mentioned from that class.
(14:46):
OK, sertraline, paroxetine, any others?
Nortriptyline is also listed, although that's actually a
tricyclic antidepressant TCA, but the notes specifically say
to avoid fluoxetine and citalopram because they tend to
reach higher concentrations in breast milk.
Good to know the ones to avoid too.
Yes, and generally other TCA's are used cautiously due to
(15:07):
toxicity risks if overdose occurs.
Mirtazapine and venlafaxine are mentioned as having less safety
data in breastfeeding. Whatever is chosen, monitoring
the baby is essential. What about the really severe
cases? Suicidal thoughts?
Thoughts of harming the baby. Urgent psychiatric referral is
needed immediately in those situations.
(15:27):
The notes state that admission to a specialised mother and baby
unit might be necessary to provide intensive care and
support for both mother and safely.
It sounds like there's also an emphasis in the notes on
involving the woman in decisionsabout her care, being culturally
sensitive, and considering the impact on the whole family.
Yes, those are definitely mentioned as important
principles underpinning good management, ensuring the
(15:50):
approach fits the individual, adheres to guidelines and also
considers specific groups like adolescents.
OK. So for a quick management recap
for revision, think multifacetedtailored to severity.
The pillars are psychology, CBTIPT, support groups,
networks, meds, SSRI's. Know the breastfeeding ones like
(16:12):
sertraline, paroxetine and teamwork and remember severe
symptoms mean urgent referral possibly to a mother and baby
unit. That's a solid overview of the
management strategies described.So once someone gets treatment,
what's the outlook? What's the prognosis generally
like for PPD according to the notes?
Generally positive. Actually, the notes suggest that
with the right treatment and support, symptoms often
(16:33):
significantly improve, typicallywithin a few months.
That's good to hear, but what ifit's not treated?
Well, that's where the concern lies.
Untreated PPD can have really significant, potentially long
lasting negative consequences. The notes emphasise the
potential damage to the mother infant relationship and the
possible impact on the child's longer term emotional and
(16:54):
cognitive development. So that really underlines why
spotting it and treating it early is so critical.
Absolutely, it makes a huge difference.
And what about stopping it before it even starts?
Can we prevent PPD? What do the notes say about
prevention? The main focus for prevention in
these notes seems to be through proactive identification and
screening, especially identifying women who are at
(17:16):
higher risk. Like those with a history we
talked about. Exactly women with a history of
severe mental illness or a strong family history of serious
perinatal mental illness. The note suggests referring
these high risk individuals early on to secondary care,
mental health services for assessment and potential
preventative support. And for everyone else?
Routine screening The notes highlight the role of all the
(17:36):
different healthcare professionals involved,
midwives, obstetricians, health visitors, GPS in asking those
screening questions about depression and anxiety at key
points like the booking visit and post Natal cheques.
Asking specifically about any past or present mental health
issues and treatment is vital. OK so prognosis generally good
(17:57):
with treatment but untreated thenotes warn of serious long term
effects and prevention accordingto this material is heavily
reliant on screening and early referral for those identified as
high risk. That captures the core messages
on outcomes and prevention from the notes, yes.
Right, let's just circle back slightly then and talk
specifically about the complications if PPD isn't
(18:17):
managed well or isn't treated atall.
What are the specific negative outcomes listed in the notes?
It builds on what you just said about prognosis.
It does, and the list of complications really hammers
home why addressing PPD is so vital.
They affect both the mother and the child significantly.
What kind of impact on the mother?
The notes mentioned difficulty bonding with the baby, which is
(18:38):
heartbreaking, Impaired maternalinfant attachment.
An increased risk of relationship problems like
marital conflict and justice. A generally reduced quality of
life for the mother herself. And for the child, what are the
potential ripple effects? The notes list potential
impairments in the child's cognitive and emotional
development. There's also an increased risk
(18:58):
of future mental health disorders for the child and for
the mother later on. So it can cast a long shadow.
It really can. The notes mentioned seeing
changes in behaviour in childrenwhose mothers had PPD and even a
higher risk of them developing depression themselves earlier in
life. They also mentioned postpartum
psychosis. Yes.
Is that considered a complication of PPD?
(19:18):
It's mentioned as a potential severe outcome in the post Natal
period, but it's generally considered a distinct, though
sometimes related condition. It's it's much rarer and often
linked to underlying conditions like bipolar disorder or
schizophrenia, but it's definitely something to be aware
of in this context. OK, so the complications are
widespread mother's well-being, relationships, bonding, and
(19:42):
profound, potentially lasting effects on the child's
development in future mental health and postpartum psychosis
is a separate severe condition to keep.
In mind, precisely understandingthose potential outcomes really
underscores the importance of effective, timely identification
and management. Maybe a memory prompt?
Think impacts mother plus impacts child plus related
(20:05):
severe conditions, psychosis. Wow.
OK. We have definitely covered a lot
of ground. They're working through your
notes section by section. We've hit the definition, the
why and who's at risk, the complex biology, what else it
could be, how common it is, the symptoms to look for, including
those crucial red flags. How it's diagnosed clinically,
the different ways to manage it depending on severity, thinking
about breastfeeding safety, the likely outcomes, the focus on
(20:27):
screening for prevention. And finishing with those really
serious complications if it getsmissed.
Yeah. But hopefully breaking it down
like that, piece by piece, directly following your
material, makes those key pointsfeel a bit clearer, a bit more
manageable for your revision. Definitely remembering those key
differentiators, the risk factorgroups, the management pillars,
psychology support, meds team, and just why acting early is so
(20:51):
critical. That seems key.
Absolutely. Those are the high yield
takeaways. So stepping back from the
specific details for a moment, what does thinking about PPD in
this depth make you consider? For me, it highlights just how
interconnected everything is. Physical health after birth,
Mental well-being, social support, all crucial for both
the parent and the baby during such a vulnerable time.
(21:14):
That's a great point. It really underscores the need
for holistic care, doesn't it? It does.
And maybe it raises a bigger question for you to Mull over as
you continue studying beyond theclinical guidelines and the
facts in these notes. How can we as a healthcare
system, as communities, build better support structures?
How can we be more proactive in preventing this kind of distress
and actually catching PPD even earlier?
(21:35):
Something to think about. That's a really important
question. Definitely food for thought.
Well, we really hope that this deep dive through your revision
notes has been genuinely useful for you.
Yeah, hope it helps it all sink in.
And just a reminder, you can find more resources for this
kind of revision material over at pessimusray.com.
And also at freemesray.com. So thank you for joining us for
(21:56):
this deep dive into post Natal depression.
OK, so let's dive in the time after having a baby.
It's often pictured as, you know, pure bliss.
Right. Yeah, that's the common image.
But the reality for, well, quitea lot of women involves some
pretty significant mental healthchallenges, and we're not just
talking about feeling a bit overwhelmed for a day or two.
No, absolutely not. We're looking at something much
(00:22):
more serious, more persistent than the the common baby Blues.
And understanding that difference, especially when
you're revising, yeah, is just crucial, isn't it?
It really is, both for clinical practise and yeah for getting
these key topics straight for your exams.
Right, so that's exactly what this deep dive is about.
We're here to help you get to grips with your own revision
(00:42):
notes on Post Natal depression or PPD.
Yeah, our mission is to unpack this material you've got, pull
out the absolute core stuff, thefacts you really need to
remember, and maybe, you know, find ways to make it all stick a
bit better. Think of us as kind of walking
through these notes alongside you.
Yeah, pointing out the high yield bits.
PPD is a big deal, effects a lotof women, so getting a solid
(01:03):
handle on it is, well, it's essential.
Couldn't agree more, it's so important.
So let's start right at the beginning.
What is post Natal depression? According to these notes, they
call it a mood disorder affecting women after
childbirth. Sometimes called postpartum
depression, and the key things your notes highlight are that
persistent sadness, the low mood, things that really get in
(01:26):
the way of functioning day-to-day.
And the timing seems really key here too, doesn't it?
The notes say it typically pops up within the first year after
birth. Yeah, often within weeks or
months. But, and this is important, it
can actually develop later too, even like 6 to 12 months down
the line. It's definitely on a spectrum of
things that can happen around pregnancy and birth.
OK, so it's not just the immediate aftermath.
(01:48):
And crucially, it's more severe,last longer than those baby
Blues. Exactly, the baby Blues are
usually quite mild self limiting.
PPD is different. Your notes say it affects around
around 10% of women, and interestingly there seems to be
a peak around three months afterbirth.
That peak at three months, that's a good specific detail to
lock in for revision. So for the definition timing
(02:11):
within the first year, often weeks, months peaks at three
months and the big difference ispersistence and impact on
function. That's the key takeaway compared
to baby Blues. You got it.
That distinction is absolutely fundamental.
OK. So if that's what it is and when
it tends to happen, the big question is why?
Why does it develop? The notes admit the exact cause
(02:34):
isn't really known. It's complex.
Right, it's not just one thing they talk about a mix.
Hormonal factors, biological stuff, psychological aspects,
and social influences all playing a part.
Hormones often get mentioned, right That big drop after birth?
Yes, the rapid decline in oestrogen and progesterone is
mentioned as a potential factor,but the notes are careful to add
a caveat. Yeah, they say the hormonal link
(02:56):
isn't actually conclusively proven, so it's likely part of
the picture, but maybe not the whole story.
The scientific uncertainty is quite interesting.
Yeah, it really is. So it's not like a simple cause
and effect. So if the cause is complicated,
what makes some women more, well, at risk?
What are the risk factors your notes list out?
OK, this is really important foridentification.
Several clear risk factors are listed.
(03:18):
Having a personal history of depression or other mental
illness, or a family history of it.
OK, so past experience matters. Hugely, and having had PPD
before makes you much more likely to get it again.
Then there are stressors. What kind of stressors?
Stressful life events, maybe during the pregnancy or after
the baby arrives, a difficult ortraumatic birth experience
(03:38):
itself and really importantly, alack of social support, feeling
isolated. That makes sense.
Anything else on the list? Yeah, financial worries,
relationship problems are mentioned too.
And linking back to the potential causes, those hormonal
factors and of course major changes in sleep patterns, which
let's be honest, is almost universal with a newborn, they
(04:00):
also contribute to the risk. OK that gives us a good
framework maybe for remembering you could group them like
history, personal, family, previous PPD, then stressors,
life events, birth trauma, money, relationships and maybe
biosport, hormones, sleep, lack of support.
That's a great way to think about it.
It really emphasises that it's usually a combination of factors
(04:22):
that tips the balance. Right, it's rarely just one
single thing. Exactly.
It's that accumulation of vulnerability.
OK. Moving on to the sort of the
mechanics, what's actually goingon inside the body, the
pathophysiology? The notes are pretty upfront
that this isn't fully mapped outeither.
No, it's definitely described asa complex interplay.
While they can't point to one single trigger, the notes do
(04:43):
suggest potential biological mechanisms.
Those hormonal changes we mentioned, they come up again.
Right, that rapid drop in oestrogen and progesterone post
delivery. Exactly.
It's likely involved, but also there's mention of disruption in
mood regulating neurotransmitters.
Like serotonin? Serotonin yes, and dopamine and
norepiphrine are the ones specifically listed in your
(05:05):
notes. They also mentioned genetic
vulnerability. Some people might just be more
predisposed and an altered stress response system.
Plus those psychosocial factors interacting with all of this.
So it's biological and environmental.
Yeah, the notes even mentioned genetic and maybe epigenetic
factors interacting with stressors like of sleep, the
(05:26):
general huge adjustment to motherhood, all influencing the
symptoms. I guess so.
Key terms from the notes for pathophysiology would be things
like complex interplay hormones,those specific
neurotransmitters, serotonin, dopamine or apinephrine,
genetics and the stress response.
It's like the whole system is under pressure.
That's a good summary of the picture of the notes.
(05:47):
Paint a system under significantstrain from multiple directions.
So if someone presents with symptoms that sound like this,
what else might be going on? What are the main things to
consider in the differential diagnosis according to your
notes? Yes, differential diagnosis
crucial for assessment. The notes list several key
things to rule out or distinguish from PPD.
(06:08):
We've mentioned it already, but the big one is the baby Blues.
Right, need to tell that apart first.
Definitely remember baby Blues are milder shorter lived.
Then you need to think about other psychiatric conditions
that could present in this period.
Major depressive disorder because PPD is essentially MDD.
Just with a post of this Natal onset.
Are also bipolar disorder, generalised anxiety disorder,
(06:30):
perhaps an adjustment disorder, And the nodes just generally
mention other perinatal mental health conditions too.
So for revision, the absolute must do is separating it from
baby Blues based on severity andduration and then being aware of
other major conditions like bipolar or significant anxiety
that could look similar initially.
Precisely, you need a really thorough assessment to make
(06:52):
those distinctions accurately. Let's talk numbers.
How common is PPD? What are these UK based notes
say about the epidemiology? OK.
The estimated prevalence is generally given as around 10 to
15% of women, which is, you know, 1.
In 10-1 In seven, maybe. Roughly, yeah.
But interestingly, the notes also mentioned prevalence might
actually be higher during pregnancy, maybe 1213%.
(07:14):
And in that first year after birth, some estimates go up to
1520%. Wow, OK.
And the notes pointed out a really big challenge with this.
Yes, under recognition they state that PPD is often missed
and the statistic they give is quite stark.
Screening for mental health issues is apparently recorded in
only about 13% of patient records.
Only 13%? Seriously.
(07:35):
That's what the notes say. It strongly suggests many cases
are slipping through the net. The notes specifically mentioned
potential gaps in general practise and possibly among
women from minority ethnic backgrounds whose needs might
get overlooked. That 13% figure really makes you
stop and think, doesn't it? It means the actual problem
could be even bigger than those 1015% prevalence figures
(07:56):
suggest, just because we're not identifying it effectively.
Exactly. So key numbers to remember,
1015% general prevalence, maybe up to the 20% in the first year
and that concerningly low 13% recorded screening rate.
Those numbers definitely put theimportance of this topic into
perspective. OK, let's shift from the numbers
to the person. What does PPD actually look
(08:17):
like? What are the clinical features,
the symptoms you'd expect to seeor hear about?
Your notes give a really good comprehensive list and for
revision you can basically thinkof them as the standard symptoms
of depression but happening in that post Natal context.
OK, so things like persistent low mood, feeling sad, maybe
hopeless, losing interest or pleasure in activities.
(08:38):
The notes use the term anhedonia, which is a good one
to know. Changes in appetite, weight
going up or down, Sleep problems, though?
This one's tricky, right? Yeah, because who doesn't have
sleep problems with a new baby? The notes acknowledge that
overlap. Don't.
They they do. It's about the pattern and
severity. What else?
Fatigue, really low energy, feelings of guilt or
(08:59):
worthlessness? Trouble concentrating, Being
more irritable, more anxious. And there's a particularly
concerning symptom mentioned too.
Yes, absolutely crucial to pick up on thoughts of self harm or
even thoughts of harming the baby.
These are serious red flags. Definitely, and the notes stress
that these symptoms are much more severe and longer lasting
than the baby Blues really interfere with daily life and
(09:21):
potentially impacting bonding with the baby.
Right, and they also mentioned why women might not actually
tell anyone they're feeling thisway.
Yeah, the barriers like? Fear of being judged.
Fear of stigma, Worries about, you know, custody implications,
feeling like a bad mother. Sometimes masking symptoms with
substance use. Understanding those reasons for
hiding it is so important when you're actually talking to
(09:42):
someone isn't. It absolutely for remembering
the symptoms. You could perhaps adapt A
mnemonic like Sid CAPS for general depression, but make
sure you're tailoring it to the PPD list in your notes.
Definitely include irritability,anxiety, and those specific
thoughts about harm. That seems practical.
Know the core depression symptoms but recognise how they
show up specifically in this post Natal period, including
(10:06):
those really worrying thoughts. Exactly.
It's about context and severity.So someone comes in, they have
these symptoms. How do we actually make the
diagnosis? How do we confirm it's PPD?
PPD according to the notes. The notes are really clear on
this. Diagnosis is primarily based on
a thorough clinical assessment. That means talking to the woman,
taking a detailed history, really listening, and evaluating
her symptoms against standard diagnostic criteria like from
(10:28):
the DSM 5 or ICD 11. So no magic, blood test or scam.
Correct. The notes explicitly state no
specific laboratory or imaging tests for confirmation of PPD
itself. OK.
But they do mention doing some investigations.
Yes, but that's for a different reason.
Those tests are about ruling outother medical conditions that
(10:49):
could potentially mimic PPD symptoms or be contributing
factors. OK.
Like what sort of tests? The notes list things like
thyroid function tests because thyroid problems can definitely
cause mood changes and fatigue. A full blood count to check for
anaemia, another cause of fatigue.
Maybe a urine drug screen if substance use is a concern.
(11:09):
Brain scans like CT or MRI are mentioned, but only if there's a
specific reason to suspect otherbrain pathology.
Definitely not routine. Right, so diagnosis is clinical
first and foremost. Labs are just to exclude other
stuff. What about screening tools?
They're mentioned aren't. They yes, screening is really
important for picking up potential cases early.
The notes recommend asking specific questions about mood
(11:30):
during antenatal booking appointments and post Natal
cheques. Just asking directly.
Yeah, simple questions like during the past month, have you
often been bothered by feeling down, depressed or hopeless?
And during the past month, have you often been bothered by
having little interest or pleasure in doing things and
then using validated tools if concerns arise?
The Edinburgh Post Natal Depression scale, the EPDS is
(11:52):
the classic one mentioned. OK.
EPDS any others? PHQ 9 for depression, G87 for
anxiety are also listed. And interestingly, they
mentioned the mood disorder questionnaire, the MDQ
specifically for screening for mania or hypomania, reminding us
about that bipolar differential again.
Makes sense and the formal diagnostic criteria.
(12:13):
Requires meeting a threshold, typically 5 or more core
symptoms, one of of which must be low mood or anedonia.
Present most days for at least two weeks.
These symptoms need to cause significant distress or impair
functioning and can't be better explained by substance use or
another medical condition, and this diagnosis applies up to 12
months after delivery. Got it.
(12:33):
So key points for diagnosis. It's clinical labs rule things
OT screening questions and toolslike Epds are vital and know the
basic criteria. 5 plus symptoms,2 weeks impairment within that
first year. Excellent summary that covers
the core of the diagnostic process outlined in the notes.
OK, so we've got the diagnosis. Now what?
(12:55):
How do we help? The notes talk about a
multifaceted approach. Yes, it really needs to be
tailored to the individual womanand how severe her symptoms are.
The main strategies listed fall into a few categories,
psychological therapies, supportsystems, and medication.
What kind of psychological therapies are mentioned
specifically? CBT, cognitive behavioural
therapy and IPT interpersonal therapy are highlighted as
(13:17):
effective options. Support groups are also really
valuable, providing that peer support and sense of community.
And medication. Yes, for moderate to severe PPD
antidepressants, specifically SSRI, selective serotonin
reuptake inhibitors are a key part of treatment, according to
the notes. Are there other types of support
mentioned? Definitely supportive
interventions are key, things like providing education about
(13:38):
PPD, offering general counselling, helping the woman
connect with or strengthen her social support networks and the
notes really emphasise the importance of teamwork.
Midwives, health visitors, GPS, mental health specialists, all
potentially involved in communicating.
Right, A-Team effort And how does the approach change
depending on how severe the PPD is?
The notes layout a kind of stepped care or tiered approach
(14:02):
for mild to moderate symptoms. The first steps might be things
like guided self help, non directive counselling, or maybe
brief CBT or IPT. But if someone has mild symptoms
but also a history of severe depression, the notes suggest
considering antidepressants evenat that stage.
For moderate or severe PPD, the recommendation moves toward high
intensity psychological therapy like full CBT, starting
(14:25):
antidepressants, or often a combination of both.
And the medication choice, especially if the mother is
breastfeeding, that's a huge consideration, right?
The goats must cover that. Absolutely crucial.
Yes, The notes list specific SSRI that are generally
considered compatible with breastfeeding due to lower
levels in breast milk. Sutriline and Paroxetine are the
main ones mentioned from that class.
(14:46):
OK, sertraline, paroxetine, any others?
Nortriptyline is also listed, although that's actually a
tricyclic antidepressant TCA, but the notes specifically say
to avoid fluoxetine and citalopram because they tend to
reach higher concentrations in breast milk.
Good to know the ones to avoid too.
Yes, and generally other TCA's are used cautiously due to
(15:07):
toxicity risks if overdose occurs.
Mirtazapine and venlafaxine are mentioned as having less safety
data in breastfeeding. Whatever is chosen, monitoring
the baby is essential. What about the really severe
cases? Suicidal thoughts?
Thoughts of harming the baby. Urgent psychiatric referral is
needed immediately in those situations.
(15:27):
The notes state that admission to a specialised mother and baby
unit might be necessary to provide intensive care and
support for both mother and safely.
It sounds like there's also an emphasis in the notes on
involving the woman in decisionsabout her care, being culturally
sensitive, and considering the impact on the whole family.
Yes, those are definitely mentioned as important
principles underpinning good management, ensuring the
(15:50):
approach fits the individual, adheres to guidelines and also
considers specific groups like adolescents.
OK. So for a quick management recap
for revision, think multifacetedtailored to severity.
The pillars are psychology, CBTIPT, support groups,
networks, meds, SSRI's. Know the breastfeeding ones like
(16:12):
sertraline, paroxetine and teamwork and remember severe
symptoms mean urgent referral possibly to a mother and baby
unit. That's a solid overview of the
management strategies described.So once someone gets treatment,
what's the outlook? What's the prognosis generally
like for PPD according to the notes?
Generally positive. Actually, the notes suggest that
with the right treatment and support, symptoms often
(16:33):
significantly improve, typicallywithin a few months.
That's good to hear, but what ifit's not treated?
Well, that's where the concern lies.
Untreated PPD can have really significant, potentially long
lasting negative consequences. The notes emphasise the
potential damage to the mother infant relationship and the
possible impact on the child's longer term emotional and
(16:54):
cognitive development. So that really underlines why
spotting it and treating it early is so critical.
Absolutely, it makes a huge difference.
And what about stopping it before it even starts?
Can we prevent PPD? What do the notes say about
prevention? The main focus for prevention in
these notes seems to be through proactive identification and
screening, especially identifying women who are at
(17:16):
higher risk. Like those with a history we
talked about. Exactly women with a history of
severe mental illness or a strong family history of serious
perinatal mental illness. The note suggests referring
these high risk individuals early on to secondary care,
mental health services for assessment and potential
preventative support. And for everyone else?
Routine screening The notes highlight the role of all the
(17:36):
different healthcare professionals involved,
midwives, obstetricians, health visitors, GPS in asking those
screening questions about depression and anxiety at key
points like the booking visit and post Natal cheques.
Asking specifically about any past or present mental health
issues and treatment is vital. OK so prognosis generally good
(17:57):
with treatment but untreated thenotes warn of serious long term
effects and prevention accordingto this material is heavily
reliant on screening and early referral for those identified as
high risk. That captures the core messages
on outcomes and prevention from the notes, yes.
Right, let's just circle back slightly then and talk
specifically about the complications if PPD isn't
(18:17):
managed well or isn't treated atall.
What are the specific negative outcomes listed in the notes?
It builds on what you just said about prognosis.
It does, and the list of complications really hammers
home why addressing PPD is so vital.
They affect both the mother and the child significantly.
What kind of impact on the mother?
The notes mentioned difficulty bonding with the baby, which is
(18:38):
heartbreaking, Impaired maternalinfant attachment.
An increased risk of relationship problems like
marital conflict and justice. A generally reduced quality of
life for the mother herself. And for the child, what are the
potential ripple effects? The notes list potential
impairments in the child's cognitive and emotional
development. There's also an increased risk
(18:58):
of future mental health disorders for the child and for
the mother later on. So it can cast a long shadow.
It really can. The notes mentioned seeing
changes in behaviour in childrenwhose mothers had PPD and even a
higher risk of them developing depression themselves earlier in
life. They also mentioned postpartum
psychosis. Yes.
Is that considered a complication of PPD?
(19:18):
It's mentioned as a potential severe outcome in the post Natal
period, but it's generally considered a distinct, though
sometimes related condition. It's it's much rarer and often
linked to underlying conditions like bipolar disorder or
schizophrenia, but it's definitely something to be aware
of in this context. OK, so the complications are
widespread mother's well-being, relationships, bonding, and
(19:42):
profound, potentially lasting effects on the child's
development in future mental health and postpartum psychosis
is a separate severe condition to keep.
In mind, precisely understandingthose potential outcomes really
underscores the importance of effective, timely identification
and management. Maybe a memory prompt?
Think impacts mother plus impacts child plus related
(20:05):
severe conditions, psychosis. Wow.
OK. We have definitely covered a lot
of ground. They're working through your
notes section by section. We've hit the definition, the
why and who's at risk, the complex biology, what else it
could be, how common it is, the symptoms to look for, including
those crucial red flags. How it's diagnosed clinically,
the different ways to manage it depending on severity, thinking
about breastfeeding safety, the likely outcomes, the focus on
(20:27):
screening for prevention. And finishing with those really
serious complications if it getsmissed.
Yeah. But hopefully breaking it down
like that, piece by piece, directly following your
material, makes those key pointsfeel a bit clearer, a bit more
manageable for your revision. Definitely remembering those key
differentiators, the risk factorgroups, the management pillars,
psychology support, meds team, and just why acting early is so
(20:51):
critical. That seems key.
Absolutely. Those are the high yield
takeaways. So stepping back from the
specific details for a moment, what does thinking about PPD in
this depth make you consider? For me, it highlights just how
interconnected everything is. Physical health after birth,
Mental well-being, social support, all crucial for both
the parent and the baby during such a vulnerable time.
(21:14):
That's a great point. It really underscores the need
for holistic care, doesn't it? It does.
And maybe it raises a bigger question for you to Mull over as
you continue studying beyond theclinical guidelines and the
facts in these notes. How can we as a healthcare
system, as communities, build better support structures?
How can we be more proactive in preventing this kind of distress
and actually catching PPD even earlier?
(21:35):
Something to think about. That's a really important
question. Definitely food for thought.
Well, we really hope that this deep dive through your revision
notes has been genuinely useful for you.
Yeah, hope it helps it all sink in.
And just a reminder, you can find more resources for this
kind of revision material over at pessimusray.com.
And also at freemesray.com. So thank you for joining us for
(21:56):
this deep dive into post Natal depression.
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