Synopsis
Distinguish transient early emotional changes from depressive illness and postpartum psychosis, assess safety compassionately, and coordinate timely perinatal treatment with infant care and feeding support.
- Baby blues usually settle within two weeks of birth.
- Persistent low mood or impaired functioning deserves assessment and support.
- Ask directly and calmly about suicide and thoughts involving the infant.
- Postpartum psychosis requires assessment within four hours of referral.
- Bipolar history changes relapse risk and antidepressant decisions.
- Treatment and feeding plans should protect maternal recovery and infant wellbeing.
Key red flags
Suicidal intent, preparation or inability to maintain immediate safety.
Delusional beliefs involving the baby or commands to harm someone.
Markedly reduced need for sleep with agitation, disinhibition or rapidly changing behaviour.
Confusion, fluctuating attention, fever, seizure or neurological signs.
Investigation priorities
Establish symptom pattern severity and immediate care needs.
Management branches
Sudden symptoms suggest postpartum psychosis mania or severe disorganisation.
- Contact secondary mental health services immediately for assessment within four hours, preferably involving the specialist perinatal team.
- Provide a safe supervised setting and arrange a trusted capable adult or appropriate service to care for the baby.
- Assess physical red flags and escalate to emergency services immediately when there is imminent danger, severe agitation or medical instability.
Key medicines
Sertraline for an appropriate depressive episodeThe adult depression SmPC starting dose is 50 mg orally once daily; increase if needed in 50 mg steps no more often than weekly, to a maximum 200 mg daily. Continue effective treatment with regular review, usually for at least six months after remission.Assess bipolar symptoms and suicide risk before and during treatment. Check serotonergic interactions, bleeding risk and hepatic impairment; avoid abrupt stopping. SPS considers sertraline preferred during breastfeeding for a full-term healthy infant, with infant monitoring.