Text adapted from: "Perinatal mood and anxiety disorders," in Psychiatry in primary care by Ariel K. Dalfen (CAMH, 2019).
When deciding which treatment the patient needs, determine the severity of the symptoms and the level of distress. Explain that many effective and safe treatments are available, and provide psychoeducation about symptoms. Encourage the patient to pursue a range of treatment options to address specific biological, psychological and social issues.
Often, patients are initially frightened or ashamed of accepting treatment, or they may get external pressure from other people in their lives to avoid psychiatric care. Ideally, you can maintain the role of educating patients about the myths and realities of perinatal mental health problems and treatment and provide ongoing support and reassurance to patients and their families, despite their initial decision about treatment. Sometimes patients take time to make decisions around treatment options, and you can offer them help along the decision-making journey.
It is ideal to enlist the patient’s partner, family or friends to provide instrumental support, such as sleep assistance, meal preparation and house cleaning, as well as emotional and informational assistance. Support groups for new mothers or new parents with mental health concerns are also effective. Since it can be particularly challenging for new parents to attend in-person groups, telephone or online peer support are an option. Some community agencies offer individual or group support for perinatal mothers and their families free of charge.
For mild or mild-to-moderate levels of symptomatology, psychotherapy may be effective on its own. CBT and interpersonal therapy (IPT) are brief therapies that are first-line treatments for perinatal populations. Other types of psychotherapy, including supportive therapy, mindfulness-based CBT, psychodynamic therapy and couples therapy, are also effective. There is growing evidence to support the use of therapist-assisted internet-delivered therapies, such as online CBT, which may also be more accessible and cost-effective.