Detection and treatment of postnatal depression (perinatal depression or anxiety)

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Abstract
Purpose of review This article will review the main publications from 2002 to the middle of 2003, on the topic of the detection and treatment of postnatal or antenatal depression or anxiety. Recent findings There are three main areas of interest that have been discussed since 2002. The first is anxiety disorders. Whereas in the past the emphasis has been on postnatal depression, studies show that anxiety disorders can be present in significant numbers, both antenatally and postnatally, even if depression is not present. The term 'perinatal depression or anxiety' is therefore considered preferable, by the reviewer, to 'postnatal depression'. The second area of interest has been routine screening for postnatal depression, both antenatally and postnatally. There continues to be evidence that detection of perinatal depression or anxiety is significantly increased with routine use of the Edinburgh Postnatal Depression Scale (EPDS). However, there is a counter argument that such screening fails to meet all the recommended screening criteria. There has thus been a lively debate in this area with clinicians' dismay at initial recommendations that the EPDS should not be used resulting in these recommendations being somewhat modified. Finally, there has been considerable investigation of the prevention and treatment of perinatal depression or anxiety. Positive effects have been reported for a variety of treatments, and a mix of benefits for different prevention programs. However, there continues to be an emphasis on searching for main effects' for prevention or intervention strategies, whilst in all likelihood different treatments may be optimal for different women or perinatal depression or anxiety presentations. Summary The implications for clinical practice are (1) that women and men should not only be assessed for depression, but also for anxiety; (2) that trained clinicians do not just rely upon their clinical judgement regarding a mother's or father's mood, but also use appropriate measures (e.g. EPDS, anxiety scale); (3) that prevention and treatment research broaden its scope by looking for interaction effects.