Perinatal mental health

Separate perinatal syndromes #

Determine whether the presentation is depression, anxiety/OCD, trauma-related illness, bipolar depression, mania or postpartum psychosis. Document pregnancy stage or time since birth and distinguish intrusive unwanted thoughts from delusional conviction or intent. A positive screening score requires diagnostic assessment.

Maternal, infant and treatment history #

Assess prior episodes and treatment response, current sleep, support, substance use, domestic abuse, self-harm thoughts and infant-care concerns. Ask about a personal or family history of bipolar disorder or postpartum psychosis. Establish who can support care and which team coordinates follow-up.

Urgent distinctions #

Medical and prescribing assessment #

Coordinate physical assessment with maternity services when symptoms could reflect medical illness or obstetric complications. Review existing tests, medicines and the proposed treatment’s baseline monitoring. Acute confusion or a rapidly changing mental state requires a medical assessment alongside urgent psychiatric care.

Depression/anxiety versus severe illness #

Offer appropriate psychological care for depression and anxiety, escalating intensity according to disorder and response. Medication choice should consider previous benefit and current illness severity. CANMAT identifies sertraline among first-line antidepressant options in pregnancy; this is guidance on selection, not a guarantee of absence of risk.

Bipolar disorder and postpartum psychosis need a specialist plan that includes relapse prevention, sleep and mother–infant care. A standard antidepressant dose table cannot substitute for that plan.

Doses & prescribing #

Each prescribing record identifies its population and source jurisdiction; international labeling does not establish Indian approval. The clinician selects treatment after assessment.

Reassess the formulation #

Review adherence, actual exposure, tolerability, psychosocial stressors and emerging activation. New decreased need for sleep, elevated mood or psychotic symptoms changes the treatment question and calls for specialist reassessment rather than routine antidepressant escalation.

Birth and postpartum planning #

Agree responsibilities and a written plan spanning pregnancy, birth and the postnatal period. Include warning signs, rapid access to review and feeding intentions. Avoid sudden medication changes without considering relapse and withdrawal consequences.

Breastfeeding and infant vulnerability #

SPS lists sertraline and paroxetine as preferred SSRIs during breastfeeding for full-term healthy infants. An effective medicine used during pregnancy does not automatically need replacing. Prematurity, infant illness or complex combinations require individual specialist advice. Assess the infant for feeding difficulty, weight gain, sleep disturbance, agitation or sedation.

Mother–infant follow-up #

Review symptoms and functioning, medication effects, practical support and the ability to rest. Coordinate infant feeding and growth assessment with the infant’s clinician when a psychotropic is used during breastfeeding. Provide a clear route for urgent review of sudden behavioural or mental-state change.

Avoid misleading risk labels #

Do not use a single numerical pregnancy-safety score. Breast-milk exposure and antenatal exposure are different questions. Sertraline can have low milk transfer while still requiring infant observation; preterm infants may be more vulnerable to accumulation. Balance these considerations with the consequences of untreated maternal illness.

Assessment tools #

Choose the instrument for its intended purpose; interpretation accompanies the linked tool.

Patient discussion #