How should I approach the management of a patient with postnatal depression who is hesitant to start pharmacotherapy?

When managing a patient with postnatal depression who is hesitant to start pharmacotherapy, consider offering psychological interventions such as facilitated self-help or high‑intensity psychological interventions like CBT, especially if the depression is mild to moderate or if the woman prefers non-pharmacological options ⁴.

Discuss the risks and benefits of medication openly with the woman, ensuring shared decision-making and person-centred care, and consider her treatment preferences, previous response to treatment, and severity of symptoms ¹.

If the woman has a history of severe depression or has not responded to psychological interventions, pharmacotherapy may be appropriate, but it should be discussed thoroughly, including the safety profile during breastfeeding, and the lowest effective dose should be used ¹.

Ensure close monitoring of symptoms and provide support, with regular follow-up to reassess the need for medication or alternative treatments ⁴.