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Quick reference guide


Issue date: February 2007 (reissued April 2007)

Antenatal and postnatal mental health
Clinical management and service guidance




NICE clinical guideline 45
Developed by the National Collaborating Centre for Mental Health

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Antenatal and postnatal mental health




About this booklet
This is a quick reference guide that summarises the recommendations NICE has made to the NHS in
`Antenatal and postnatal mental health: clinical management and service guidance' (NICE clinical
guideline 45).

Who should read this booklet?
This quick reference guide is for…

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Antenatal and postnatal mental health Contents




Contents
Key priorities for implementation 4

Principles of care 6

Prediction, detection and initial management 7

Preventing mental disorders 9

The treatment of pregnant and breastfeeding women: 10
balancing risks and benefits

Psychotropic medication 12

Guidance for specific disorders 14

Service organisation 18

Implementation…

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Antenatal and postnatal mental health Key priorities for implementation




Key priorities for implementation

Prediction and detection
At a woman's first contact with services in both the antenatal and the postnatal periods, healthcare
professionals (including midwives, obstetricians, health visitors and GPs) should ask questions about:
­ past or present severe mental…

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Antenatal and postnatal mental health Key priorities for implementation




Management of depression
When choosing an antidepressant for pregnant or breastfeeding women, prescribers should, while
bearing in mind that the safety of these drugs is not well understood, take into account that:
­ tricyclic antidepressants, such as amitriptyline, imipramine and nortriptyline,…

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Antenatal and postnatal mental health Principles of care




Principles of care
Providing and using information effectively
Give culturally sensitive information to women with an existing mental disorder who are planning a
pregnancy or are pregnant, and to those who develop a mental disorder during pregnancy or the
postnatal period.
­…

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Prediction, detection and
Antenatal and postnatal mental health initial management




Prediction, detection and initial management
Prediction and detection

Prediction
In all communications (including initial referral) with maternity services, include information on

any relevant history of mental disorder.
At the woman's first contact with services during pregnancy and the postnatal period,…

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Prediction, detection and
Antenatal and postnatal mental health initial management




Referral and initial care
After identifying a possible mental disorder, consider further assessment, in consultation with
colleagues if necessary.
If there are significant concerns, the woman should normally be referred to her GP for assessment.
­ If she has, or…

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Antenatal and postnatal mental health Preventing mental disorders




Preventing mental disorders
Treating subthreshold symptoms in pregnant women
For symptoms of depression and/or anxiety that do not meet diagnostic criteria but significantly
interfere with personal and social functioning, consider:
­ brief psychological treatment (four to six sessions), such as interpersonal psychotherapy…

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The treatment of pregnant and
Antenatal and postnatal mental health breastfeeding women: balancing
risks and benefits




The treatment of pregnant and breastfeeding women:
balancing risks and benefits
All pregnancies carry a background risk, although this may be increased by the presence of a mental
disorder. Treatment can reduce the risk,…

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