chronic

Postpartum depression

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

ACOG Clinical Practice Guideline · Paroxetine 20 mg Tablets SmPC section 4.2 (eMC product 537) · LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) · Perinatal Depression - StatPearls - NCBI Bookshelf (NBK519070) - disease-level clinical article

Verified against3 documents

Paroxetine 20 mg Tablets SmPC section 4.2 (eMC product 537)
LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070)
Perinatal Depression - StatPearls - NCBI Bookshelf (NBK519070) - disease-level clinical article

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (12)

Five or more depressive symptoms, running at least 2 weeks, make the diagnosis
The window runs from during pregnancy through to 12 months after the birth
One of the five must be low mood or loss of pleasure [loss of interest · low mood]
Mood is down for most of the day, either as she describes it or as others see it
Nothing gives interest or pleasure any more, most of the day
Sleep is wrong in either direction, too little or too much
Movement and thought are slowed, or the opposite, restless and agitated [irritability]
She feels worthless or guilty, and has no energy left
Thoughts of killing herself, an actual attempt, or death coming to mind again and again
Concentration fails and decisions become impossible
Appetite or weight shifts, for instance by 5% over 1 month
Anxiety often rides along, and psychosis can occur, including voices telling her to harm the baby [anxiety]

Signs — what you find (6)

The picture is the same as depression outside pregnancy, plus a pregnancy or birth in the history [low mood]
Mood is visibly low and both activity and energy have dropped
She tires after the smallest effort, sleeps badly and eats less
Guilt, worthlessness and a collapse of self-esteem and self-confidence are the usual accompaniment [collapse]
Bodily features: no pleasure, waking very early, agitation, weight loss, lost sex drive, poor appetite and markedly slowed movement [irritability · poor appetite · weight loss]
The features shift from day to day and do not lift when circumstances improve

Tests (10)

Every patient should be screened for perinatal depression using the Edinburgh scale
Screen both in pregnancy and again after the birth
The Edinburgh scale is 10 questions the patient fills in herself in a few minutes; PHQ-9 and GAD-7 are alternatives
Ask about drugs, alcohol and smoking, and about every prescribed and over-the-counter medicine
The aims are to settle the diagnosis, weigh the risk of suicide and of harm to others, and exclude other psychiatric illness
Check thyroid-stimulating hormone, since an overactive or underactive thyroid produces the same mood picture
The symptoms must not stem from a substance or another illness, and there must be no psychotic disorder and no past manic or hypomanic episode
DSM-5-TR calls it peripartum onset when the depressive episode begins in pregnancy or within 4 weeks of delivery
Roughly half of episodes labelled postnatal in fact start before the delivery
At every postnatal visit assess for a mood disorder, for suicide risk and for psychosis, both of which are emergencies

If not this — what else fits (12)

Baby blues: begins in the first week, settles around day 10 to 14, affects half to three-quarters of mothers and needs no treatment
The discriminator is function: blues do not stop her running her day or caring for the baby, though severe blues raise the later risk
Blues symptoms overlap closely, crying, low and irritable mood, anxiety, poor sleep and appetite change, but never reach full depressive criteria
An overactive or underactive thyroid can produce the same mood disturbance
Broken sleep on its own can look like this: flat mood, poor concentration and fatigue
Substance use, or being intoxicated, can show up as swinging mood
Postnatal anxiety, where relentless worry is the centre of the picture
Adjustment disorder: an emotional and behavioural reaction to the stress of birth, milder and shorter-lived
Post-traumatic stress disorder after a frightening birth, with trauma symptoms
Weigh peripartum major depression and bipolar I or II when symptoms outlast 2 weeks, above all with marked irritability
Postpartum psychosis: usually starts 3 to 10 days after birth, with hallucinations, agitation, odd behaviour, muddled thinking and delusions
That psychosis is an emergency carrying suicide and infanticide risk; it is rare, at 1 to 2 per 1000 pregnancies

SourceStatPearls "Perinatal Depression" - disease-level clinical article

Presentation findings are traced to the source above.

SERTRALINE

1st line

Strength50 mg

Formoral.solid

Adult dose and duration

50 mg once daily; if the response is inadequate, increase in steps of 50 mg at intervals of at least one week, to a maximum of 200 mg/day - at least 6 months

Paediatric dose

Adult-only condition - paediatric section not applicable

Choice

Sourced preference. This condition's own cited article, Perinatal Depression (NBK519070), makes sertraline a first-line choice for medical therapy; it supports paroxetine only conditionally, for a woman who has previously responded to it.

Dose source

LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070)

Why

Perinatal Depression (StatPearls NBK519070) names sertraline a first-line choice for medical therapy, with extensive and reassuring safety research behind it.

Cautions

There is an initial transient rise in anxiety or agitation during the first 2 weeks.
Do not stop abruptly; taper to avoid discontinuation symptoms.
Monitor a breastfed infant for irritability, poor feeding or sleep disturbance.
Use in nursing mothers is not recommended unless, in the judgment of the physician, the benefit outweighs the risk.
Concomitant intake of pimozide is contraindicated (see section 4.5).

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
OPIRALINE 50 MG 20 F.C. TABS.	EL-OBOUR	29.00 EGP (1.45/unit)
AGRELOCIT 50 MG 20 TAB.	MEMPHIS > ATM PHARMACEUTICAL INDUSTRIES	34.80 EGP (1.74/unit)
DEPR-STAT 50MG 10 CAPS.	MEMPHIS	21.60 EGP (2.16/unit)
SESERINE 50MG 30 TAB.	ADWIA	75.00 EGP (2.50/unit)
SERPASS 50MG 30 F.C.TAB.	GLOBAL NAPI PHARMACEUTICALS	102.00 EGP (3.40/unit)
SIRTO 50MG 10 F.C. TABS.	HI-PHARM	34.00 EGP (3.40/unit)
MOODAPEX 50 MG 30 F.C.TAB.	MULTI-APEX	111.00 EGP (3.70/unit)
LUSTRAL 50 MG 20 F.C.TABS.	VIATRIS	136.00 EGP (6.80/unit)

PAROXETINE

2nd line

Strength20 mg

Formoral.solid

Adult dose and duration

20 mg once daily in the morning, titrate by 10 mg increments up to max 50 mg daily if needed x 6-12 months

Paediatric dose

Adult-only condition - paediatric section not applicable

Dose source

Paroxetine 20 mg Tablets SmPC section 4.2 (eMC product 537)

Why

Alternative SSRI with minimal excretion into breast milk

Cautions

Discontinuation syndrome is pronounced; slow taper required when stopping.
Avoid if planning subsequent immediate pregnancy due to early first-trimester cardiac risk.
Paroxetine is contraindicated in combination with thioridazine or with pimozide (see section 4.5).
Sedation and weight gain are common.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
XANDOL 20MG 20 TAB.	EUROPEAN EGYPTIAN PHARM. IND.	42.00 EGP (2.10/unit)
PAXETIN 20 MG 10 F.C.TABS.	PHAROPHARMA	22.80 EGP (2.28/unit)
DEPANX 20MG 10 F.C. TAB.	GLOBAL NAPI PHARMACEUTICALS	24.00 EGP (2.40/unit)
PAROXETINE 20 MG 30 F.C.TABS.	EVA PHARMA	93.00 EGP (3.10/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.