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Treatment of postnatal depression beneficial

Mental health

Mental health

Postnatal depression affects around 10% of mothers in the early weeks postpartum. Their feelings of guilt and inadequacy may be increased by the knowledge that their illness may have a detrimental effect on their child‘s cognitive and emotional development.

Infants of postnatally depressed mothers are more insecurely attached and have more behavioural difficulties. Cognitive development is also affected, particularly in boys, and both this effect and behavioural disturbance are still present at age five.1

A review has now found that treatment of postnatal depression has short-term benefit.

The review identified seven randomised controlled trials and one controlled trial. Only three studies assessed the effect of treatment of mothers with postnatal depression on their child's cognitive development.

One study found that intensive and prolonged psychotherapy initiated at 20 months postpartum did improve cognitive development, but there was no long term follow-up to see if this was sustained.

A UK study of brief (10 week) interventions initiated at eight weeks postpartum, including counselling, CBT and psychodynamic therapy, found short-term benefits on mother-infant interactions but no long-term benefits on behaviour or cognitive development.2 A third small trial also showed no cognitive benefits.

The remaining five studies only looked at the effects of treatment on mother-infant relationships. The interventions varied widely, from infant massage to psychotherapy.

All interventions showed benefits but some of the instruments used to measure outcomes were of doubtful validity.

Many questions remain unanswered. Is the primary problem that should be targeted maternal depression or mother-infant relationship difficulties? Can treatment improve long-term outcomes for the child? Which treatment is most effective? For how long should it be provided and by whom?

41181892NICE recommends that GPs should ask two questions to screen for depression at the postnatal check (see table 1, left).3 A recent audit in our practice found that an assessment of mental health was documented in the records of only 31% of our postnatal women, and we have therefore decided to send out the two-question screen with our postnatal check invitations. Although postnatal depression tends to remit spontaneously at 4-6 months, it leads to considerable distress and disruption, and treatment doubles the recovery rate.2 Screening and treatment is therefore entirely justified.

NICE also recommends that we discuss ‘the need for prompt treatment because of the potential impact of an untreated mental disorder on the infant.'3 However, there is a risk that this may exacerbate the mother's feelings of guilt and, as yet, we have no evidence that treatment can improve long-term outcomes for the child.

Poobalan AS, Aucott LS, Ross L et al. Effects of treating postnatal depression on the mother-infant interaction and child development. Br J Psychiatry 2007;191:378-86

Reviewer

Dr Phillip Bland
GP, Dalton-in-Furness

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