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Postnatal depression — RACGP Fellowship MCQ

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ModerateMental healthPostnatal depressionRACGP Fellowship

A 31‑year‑old woman presents six weeks after delivery with persistent low mood, tearfulness and guilt. She is bonding with her baby but sleeping poorly and has no psychotic symptoms or thoughts of harm. Edinburgh Postnatal Depression Scale is 17. What is the most appropriate management?

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Correct answer: B — Assess risk, offer psychological therapy, and consider an SSRI compatible with breastfeeding

Option B is correct. In moderate postnatal depression (EPDS ≥13), prompt active management is required. Australian guidance affirms SSRIs as first‑line pharmacological treatment in the postnatal period, with most SSRIs having low breast‑milk transfer and being acceptable in breastfeeding (except lithium, clozapine) ([racgp.org.au](https://www.racgp.org.au/afp/2014/april/perinatal-mental-health?utm_source=openai)). Psychological interventions (e.g., CBT) are first‑line for mild‑to‑moderate cases and can be combined with pharmacotherapy when needed ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/22217978/?utm_source=openai)). Option E inappropriately delays treatment; B incorrectly halts breastfeeding; D misinterprets depression as psychosis; E wrongly uses antipsychotics when no psychotic features are present.

Reference: RACGP AFP 'Perinatal mental health – identifying problems and managing medications' (2014) and RACGP mental‑health unit 'SSRI as first‑line treatment for moderate‑to‑severe postnatal depression' (2020) – both provided above, https://www.racgp.org.au/afp/2014/april/perinatal-mental-health