Psychosocial assessment and management of depression and anxiety in pregnancy. Key aspects of antenatal care for general practice.

BACKGROUND: Psychological morbidity, and especially depression and anxiety arising antenatally, are as common as that seen postnatally. Approximately one-third of women will remain depressed postpartum, sometimes for prolonged periods--with the attendant morbidity for mother and infant that this brings. Morbidity is greatest where there is associated drug and alcohol use, domestic violence and personality disorder.
OBJECTIVE: This article aims to provide an overview of psychosocial assessment and the detection and management of depression and anxiety disorders in pregnancy. DISCUSSION: Psychosocial assessment of all pregnant women is an integral part of good antenatal care. The Edinburgh Postnatal Depression Scale is a useful adjunct in the detection and monitoring of anxiety and depression antenatally. Many women will decline medication and thus psychological interventions will often be first line treatments. Where medication is required, prospective controlled studies suggest antidepressants are not associated with increased rates of teratogenicity and are thus relatively 'safe'. Management of more severe and/or complex cases needs to be in association with a psychiatrist and a mental health or drug and alcohol team and may require antenatal notification of an 'at risk' offspring.