Perinatal Depression and/or Anxiety

Description

General measures

Medicine treatment

Referral

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O28.8-9/ O90.9 + (F32.0-3/F32.8-9/ F33.0-4/F33.8-9/F34.1/F53.0-1/F53.8-9)

DESCRIPTION

See Depressive disorders and Anxiety disorders, for symptoms of depression and/or anxiety. Note that these conditions may occur together in the same person.

• Depression and /or anxiety may be antenatal or postpartum. Postpartum depression usually begins within a month of delivery but can present up to a year after delivery.
• Anxiety disorders may present as fear of labour and childbirth, or other fears e.g. needle phobia. Such fears may interfere with antenatal and postnatal care if they are not addressed.
• Postpartum blues last less than a week, are characterised by irritability, tearfulness, anxiety beginning by day 3-5 postpartum. Usually resolve with gentle support but may progress to depression.

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CAUTION: Suicide

- Highest risk period is from 6 weeks before to 12 weeks after delivery.
- Adolescent mothers are at particular risk.
- Those with a prior history of self-harm at particular risk.
- See Suicide risk assessment.
- Inform all healthcare providers involved of suicide risk.
- Ensure psychosocial support – partner/ family/ NGO/ welfare support.
- Optimise treatment of mental illness.
- Do not leave unattended if high risk of self-harm.

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GENERAL MEASURES

Antenatal

• Don't stop psychiatric medication if stable on treatment: assess course of illness, severity, and suicide risk. Refer if any or increasing signs of severity.
• Discuss potential benefits/harms of medication to patient and baby as well as alternatives (see Anxiety and obsessive-compulsive disorders and Depressive disorders).
• Antenatal care: provide active adherence support; provide regular, frequent CHW home visits; watch for preterm labour and/or SGA baby; follow-up on any up-referral.

LoE:IIIb⁵¹

• Explore and address psychosocial stressors:
  • Mobilise patient's support system.
  • Stress management/coping skills – refer for counselling e.g. at www.sadag.org
  • Relationship and family issues – refer for counselling, e.g. at www.famsa.org.za
  • Abuse or interpersonal violence - refer to a social worker and for support, e.g. by www.genderjustice.org.za or www.powa.co.za

Postnatal

• Continue close home-based support of mother and baby for at least the first year
• Encourage breastfeeding, if not contraindicated medically (Breastfeeding difficulties may also be associated with depression and anxiety).
• Optimise treatment of mental illness and co-morbid physical health conditions.

LoE:IIIb⁵²

• Optimise psychosocial and parenting support – utilise support groups e.g. at www.sadag.org.
• Refer to Social Welfare if suspect child-care is seriously impaired.

MEDICINE TREATMENT

See Depressive disorders and Anxiety disorders, for treatment of depression and/or anxiety.

• Mild to moderate anxiety – refer for psychotherapy if available (and/or psychosocial support from mothers’ groups, NGOs, counsellors) and monitor response.
• Moderate – severe anxiety and/ or depression - antidepressant (SSRI) treatment for early symptom control and prevention of relapse is generally necessary.

REFERRAL

• All severe depression where functioning is severely impaired.
• Poor response to psychological and supportive medication.
• Poor response to first line SSRI (antidepressant) medication.
• Factors requiring urgent admission, invoke the MHCA if necessary:
  • Suicide risk
  • Any possible psychotic features
  • Risk to infant

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2025-9_Version 1.0_26 March 2026

Chapter 6: Obstetrics and Gynaecology_6.9.1 Perinatal Depression and/or Anxiety