GPAtlas🧭 When to suspect
Perinatal mental illness covers a spectrum that any GP must hold in mind at every contact in pregnancy and the first year after birth. At the mild end sit the self-limiting maternity “blues”; in the middle, postnatal depression and the perinatal anxiety disorders (including obsessive–compulsive disorder and post-traumatic stress disorder, PTSD); and at the severe end, postpartum psychosis – a psychiatric emergency. The conditions are common and consistently under-recognised, and women may be reluctant to disclose for fear of stigma or of being judged as a mother.
The two clinical priorities are simple: screen actively and treat by severity, and never miss the emergencies – postpartum psychosis and maternal suicidality. At first contact and in the early postnatal period, screen for depression with the Whooley questions and for anxiety with the 2-item Generalized Anxiety Disorder scale (GAD-2), distinguishing transient “baby blues” from true pathology by the persistence and severity of symptoms.
| Presentation | Typical onset | Key features | Action |
|---|---|---|---|
| Baby blues | Days 3–5, settling by ~day 10 | Tearfulness, lability, irritability; mild and self-limiting | Reassurance and support; no treatment |
| Postnatal depression | Often within 3 months (any time in year 1) | Persistent low mood, anhedonia, fatigue, guilt, poor sleep | Assess severity; self-help / CBT ± SSRI |
| Anxiety / OCD / PTSD | Pregnancy or postnatal | Excessive worry, intrusive thoughts, birth-trauma flashbacks | Psychological therapy ± SSRI |
| Postpartum psychosis | Rapid, usually first 2 weeks | Mania or depression with psychosis, confusion, delusions, hallucinations | Emergency → same-day specialist assessment |
Raise your index of suspicion in women with a personal or family history of mental illness – particularly previous postnatal depression, bipolar disorder, or previous postpartum psychosis – and in those facing poor social support, relationship difficulties, domestic abuse, or substance misuse. Postpartum psychosis occurs in about 1–2 in 1000 births and is strongly linked to bipolar disorder and to severe perinatal mental illness in a first-degree relative.
Source: NICE CG192
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