Patient discussions

Try to develop a trusting relationship with the patient and her partner in order to explore her thoughts, concerns, and expectations and regularly check her understanding of the issues. It may be appropriate to discuss the involvement of her partner, family members, and carers in supporting her.[5]

It is important to give relevant information to women with an existing mental illness who are planning a pregnancy or are pregnant, as well as to women who develop an episode during pregnancy or the postnatal period.[5] This should include the impact of the disorder and its treatment on both the woman herself and her baby and a full discussion of the risks and benefits of medication.[5]

A shared decision-making approach is likely to be helpful with respect to the decision about whether to start a new medication when a woman is breastfeeding. Factors that might tip the balance in favour of antidepressant therapy during breastfeeding include where the woman has expressed a preference for medication, if she declines psychological interventions, if her symptoms have not responded to psychological interventions, or if she has a history of severe depression.[5]​ Specialist advice may be indicated.[5]​ In the US, this discussion may typically be carried out by the patient’s obstetrician.[82]​ Acknowledge the uncertainty of the degree of risk with specific psychotropic medications and consider the risks of exposure during breastfeeding to the child, including developmental or longer-term effects, but also the risks and impacts of untreated depression on both the mother and child.[91]

Although, in general, breastfeeding is associated with improved maternal mental health outcomes, for some women difficulties with breastfeeding may precipitate or worsen postnatal depression.[174]​ Take an individualised approach, but it may be appropriate in some circumstances to recommend consideration of formula feeding as a healthy alternative to breastfeeding, taking into account the woman’s ability to access clean water.[72]​​

Discuss with the woman the risk of a recurrence following future pregnancies.[5]​ It may also be appropriate to discuss the risk of a recurrence of depression at times unrelated to childbirth.

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