Scottish Intercollegiate Guidelines Network (SIGN)

SIGN 127 Management of perinatal mood disorders

The SIGN guideline on the management of perinatal mood disorders is available now and an accompanying patient version will be launched at the Annual Conference of the Scottish Perinatal Mental Health Forum in Glasgow on Monday 23rd April 2012.

Background

In 2002, SIGN published a guideline on postnatal depression and puerperal psychosis (SIGN 60). SIGN 127 provides recommendations based on updated evidence and expands the guideline scope to include mood and anxiety disorders in the antenatal period.

Why we need a guideline

Pregnancy does not protect against the initial development
or continuation of mental disorders and there is an
increasing understanding of the effects of antenatal and
postnatal mental illness on pregnancy and the developing child.

Mood disorders have a particular relationship with pregnancy and the postnatal period. Depressive and anxiety disorders are common and are linked to adverse developmental outcomes for infants.

Postpartum psychosis is a much less common condition, affecting one to two per thousand women, and is closely linked with bipolar disorder. This guideline will assist in the development of local evidence based integrated care pathways and networks.

The challenge for healthcare professionals

The identification of women at high risk for mood disorders in the perinatal period is a challenge for healthcare professionals and the guideline provides recommendations to guide identification and risk reduction. in treatment, issues around balancing the potential benefits and harms of medication use are of major concern to clinicians and patients. The guideline outlines general
principles of prescribing during this period and, where evidence is available, makes recommendations around use of specific medications.

Remit

The guideline provides recommendations based on current evidence for best practice in the management of antenatal and postnatal mood and anxiety disorders, including depression, anxiety and postpartum psychosis. The guideline covers prediction, detection and prevention as well as management in both primary and secondary care. It also outlines the evidence in relation to the use of psychotropic medications in pregnancy and during breastfeeding.

Target users of the guideline

Effective detection and management of perinatal mood disorders requires coordination of a wide variety of primary and secondary care services, including midwives, health visitors, clinical psychologists, community mental health services, general practitioners, pharmacists, obstetricians and psychiatrists, with other community agencies, such as voluntary organisations and social services, providing further support. The guideline will be of interest to each of these specialist groups.

Implementing this guideline.

The implementation strategy for this guideline encompasses:
Identification of the key recommendations that should be prioritised for implementation
Description of recommendations likely to have significant resource implications
A series of key points for audit to assist with implementation
Guideline and supporting materials available to download from the SIGN website
Dissemination of a quick reference guide to all appropriate healthcare professionals
Electronic dissemination of the full guideline to all NHS Boards
iPhone, iPad and Android app in development
Patient version of the guideline out now
April 2012 launch event in association with the Scottish Perinatal Health Network Annual Conference.