Intended for healthcare professionals

Practice Practice Pointer

Assessing low mood during pregnancy

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4584 (Published 29 July 2019) Cite this as: BMJ 2019;366:l4584
  1. Natalie Kirby, specialist trainee year 3 psychiatry1,
  2. Anna Kilsby, consultant perinatal psychiatrist1,
  3. Ruth Walker, general practitioner2
  1. 1Tees Esk and Wear Valley Foundation Trust, West Park Hospital, Darlington DL2 2TS, UK
  2. 2Scott Road Medical Centre, Selby YO8 4BL, UK
  1. Correspondence to: N Kirby natalie.kirby{at}nhs.net

What you need to know

  • Untreated antenatal depression is associated with poorer pregnancy outcomes, adverse child development outcomes, and postnatal depression

  • Women with antenatal depression who require psychological therapy should be fast-tracked for psychological assessment and treatment

  • Discuss the option of antidepressants with women experiencing moderate to severe antenatal depression—the risks of untreated illness often outweigh the risks of antidepressant use in pregnancy in these cases

A woman who is 16 weeks pregnant with her second child presents to her general practitioner feeling tired. She is initially reluctant to discuss her mental health but, on further exploration, describes feeling irritable, tearful, and anxious for the past few weeks.

Depression in the perinatal period is common. It affects some 12% of women antenatally and up to 20% of women during the first postnatal year.123 Reluctance to disclose symptoms, perceived stigma, and diagnostic uncertainty are among the challenges facing healthcare professional trying to identify and help women with antenatal depression. As a result, pregnant women are less likely than non-pregnant women to be diagnosed with depression, and less than half of those diagnosed receive appropriate treatment.45

In this article we outline an initial assessment of a woman presenting with low mood in pregnancy, based on current guidelines, evidence, and our own clinical experience.

Initial assessment

Consider any symptom as part of the broader clinical picture. Symptoms that are more pervasive, have lasted longer than two weeks, and are significantly affecting a woman’s ability to function and carry out her usual activities are more suggestive of depression.

Symptoms of depression—Minor or transient fluctuations in mood are common during pregnancy and do not necessarily indicate depression. However, significant experiences of mood fluctuations, fatigue, changes in appetite, and sleep disturbance should be carefully explored and not immediately minimised as normal experiences of pregnancy. Many of the …

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