Scenario

Two months after the birth of her second child a 34 year old woman was admitted to a psychiatric inpatient unit for treatment of depression. She was married and worked as a business manager. She had a history of depression dating back to her late teens, which had been untreated until the birth of her first child three years before. At this point her depression had deteriorated into a psychotic state, but she subsequently responded to a combination of antidepressants and antipsychotic drugs. Her second pregnancy was planned, and her medication was discontinued when she conceived. Although her mental state continued to deteriorate as the pregnancy advanced, she was reassured at antenatal consultations that she had a healthy pregnancy and her baby was developing appropriately. She went into spontaneous labour and delivered a healthy baby girl at 35 weeks.

In the subsequent weeks her mental health deteriorated further. She believed that she was a terrible mother and that her baby was doomed to a life of misery. She experienced derogatory auditory hallucinations confirming these beliefs and in this deluded state attempted suicide. She was discovered by her sister and brought to a general hospital, where she was treated for two weeks in the intensive care unit. After a further 10 week admission in a specialist psychiatric unit, during which she was reunited with her baby, she was discharged fully recovered on venlafaxine 225 mg and olanzapine 5 mg a day.