The most recent data on mental health conditions during pregnancy indicate a depression prevalence of approximately 25% (Delanerolle et al., 2023). Although these data may be confounded by its collection during the COVID-19 pandemic, it is clear to nurses and physicians working in obstetrics that the mental health of childbearing women and all those who give birth is not currently being adequately addressed. Although extreme examples are often portrayed in the media, perinatal mental health conditions generally respond well to treatment and are manageable by most patients with these diagnoses.

Screening for mental health conditions (including but not limited to depression, anxiety, bipolar disorder, and the symptom of suicidality) should be included during the initial prenatal visit, at some point during the third trimester, and at postpartum visits, whether in-person or virtual (American College of Obstetricians and Gynecologists [ACOG], 2023a). Screening should be accomplished using validated instruments, such as the Edinburgh Postpartum Depression Screening (which screens for symptoms of both depression and anxiety) or the Patient Health Questionnaire-9 (PHQ-9), which screens for depressive symptoms (ACOG, 2023a). Both instruments include a question about self-harm. Screening for bipolar disorder can be through either the Mood Disorder Questionnaire (MDQ) or the Composite International Diagnostic Interview (CIDI). If a patient screens positive for either anxiety or depression, screening for bipolar disorder should occur prior to initiating treatment with medication (ACOG, 2023a). Risk for bipolar disorder onset is at the highest level in the perinatal period than during any other life phase (ACOG, 2023a). Positive screens for any mental health disorder should be complemented by evaluation to rule out other causes of symptoms, including thyroid storm, severe anemia, and substance use disorders, including current intoxication (ACOG, 2023a).

Diagnosis with a mental health condition may cause added distress for patients and families due to the stigma around these diagnoses. Cultural experiences of stigma may be stronger for patients of color, who may especially benefit from the support of patients with similar cultural backgrounds (Beck, 2023). During discussions with patients about these diagnoses, nurses should take care to validate concerns about stigma and reduce stigma wherever possible.

Treatment for perinatal mental health conditions may include both psychotherapy and pharmacotherapy. Selective serotonin uptake inhibitors are appropriate first-line pharmacologic options, with a preference for sertraline or escitalopram (ACOG, 2023b). Although pregnancy and lactation status should be considered in choosing appropriate interventions, neither status should be the sole reason for not initiating pharmacotherapy. A patient's prior experience and response to medications should also be considered. In cases of moderate-to-severe postpartum depression, brexanolone may be used with special attention to the specific challenges of its use, including high cost, inpatient administration, monitoring, and lack of evidence of efficacy past 30 days. If a patient begins their pregnancy while taking a mood stabilizer, the medication should be continued through the pregnancy (with the exception of valproate) as there are considerable risks of symptom return and exacerbation without appropriate medication treatment.

Nurses play a significant role in supporting patients with perinatal mood disorders. We should ensure that our understanding of these disorders is sufficient to appropriately counsel patients and their families on the signs and symptoms of these diagnoses, as well as being able to discuss treatment options. We must work with families to reduce stigma to promote accurate symptom reporting and adherence with treatment plans.

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