At 13:47 09/06/2010, you wrote:
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>an HV has asked me to prescribe prophylactically=2C starting 4 weeks before=
> birth=2C an ssri to a pregnant lady who has recurrent postnatal depression=
>. she claims that this has been recomended by psychiatrists at a meeting ab=
>out PND she attended. i cannot find any evidence to suport and the idea fra=
>nkly appalls me=2C may even be risky.
>
>thoughts.
So.... non evidence based thoughts.....
What does the patient think or want?
If the patient currently or recently has had consultant involvement
then could seek advice there if you feel comfortable with this.
Ask the HV to pursue the evidence and put the onus on them.
If patient not currently depressed, one option is just don't do it.
You could consider starting immediately post-delivery if you consider
the risk of moderate to severe post-natal depression high enough.
Prophylactic CBT and some counselling in advance might be worth
considering also.
Julian
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