On Wed, 2010-06-09 at 12:47 +0000, Paul Caldwell wrote:
> an HV has asked me to prescribe prophylactically, starting 4 weeks
> before birth, an ssri to a pregnant lady who has recurrent postnatal
> depression. she claims that this has been recomended by psychiatrists
> at a meeting about PND she attended. i cannot find any evidence to
> suport and the idea frankly appalls me, may even be risky.
> thoughts.
Given the psychiatrists' names (do they usually hunt in packs?) it would
be possible for a referral to be made to them for them to provide an
opinion on the patient in question.
It isn't a ludicrous idea.
I see no obvious reason for starting so long in advance - 4 weeks is a
typical time for improvement to be expected in someone who is depressed
after starting treatment, but it isn't clear to me why that would be
applicable to someone who is not depressed at inception.
Commencing a treatment expected to be required and which had been shown
to help in previous episodes of illness at the moment at which the
changes in hormones etc that trigger PND begins - IE about the moment of
delivery of the placenta - would not seem silly to me, and since the
patient would usually be in hospital at that time, doing so by
prescription then would seem an easy enough thing to arrange by those
planning her natal care.
What is it that HVs do nowadays? I've not seen one for ages.
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