Perinatal Depression — MRCPsych Paper B MCQ

Correct answer: E — Arrange specialist perinatal mental health assessment and a written care plan covering pregnancy, childbirth and postnatal monitoring

The correct answer is E. Severe, incapacitating depression falls within NICE's definition of severe mental illness. A pregnant woman with any history of severe mental illness should be referred to secondary mental health services, preferably a specialist perinatal mental health service. A collaborative written plan should cover pregnancy, childbirth and the postnatal period, including treatment goals, symptom monitoring, increased contact and named professionals. Remaining asymptomatic does not remove the need for anticipatory planning, so reassurance alone or waiting for recurrence is inappropriate. NICE does not recommend routinely starting sertraline at a fixed gestation solely because of previous postnatal depression; medication decisions should be individualised according to previous response and maternal–fetal risks. Lithium is not routine prophylaxis for unipolar postnatal depression and would require a different indication, such as bipolar disorder.

Reference: National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance (CG192), recommendations 1.5.10 and 1.6.6. Published 2014; updated 2020. https://www.nice.org.uk/guidance/cg192/chapter/Recommendations