Postpartum depression
Postpartum depression is a major depressive episode with onset during pregnancy or within 4 weeks of delivery (the DSM 'with peripartum onset' specifier), clinically recognized throughout the first 12 months after birth. Diagnosis requires five or more DSM depressive symptoms for at least 2 weeks with functional impairment; first-line treatment is cognitive behavioral therapy (CBT) or an SSRI such as sertraline, both compatible with breastfeeding.
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What this article covers
- Overview
Peripartum-onset major depressive episode: postpartum depression is a major depressive disorder (MDD) with onset during pregnancy or within 4 weeks of delivery, the DSM specifier "with peripartum…
- Epidemiology
Incidence: postpartum depression affects an estimated 10% to 15% of postpartum women when full major depressive episode criteria are applied; broader case definitions that include minor depressive…
- Risk factors
Prior mood illness: a personal history of major depressive disorder or a prior postpartum depression episode, or a family history of perinatal depression and anxiety, is the strongest identified risk factor.
- Pathophysiology
Rapid hormonal withdrawal: the abrupt decline in estrogen and progesterone after delivery is thought to trigger the episode; the downstream mechanism is not further characterized.
- Clinical features
Same diagnostic threshold as MDD: 5 or more of 9 symptoms present during the same 2-week period, representing a change from previous functioning, with depressed mood and/or anhedonia required as at least one of the five.
- Differential diagnosis
Postpartum blues: overlapping tearfulness and low mood, but blues start 2 to 3 days after delivery, resolve within 2 weeks without treatment, and never reach the 5-symptom, 2-week threshold of a major depressive episode.
- Diagnosis
Diagnosis is clinical: confirmed when a patient meets full MDD criteria (5 or more of 9 symptoms, including depressed mood or anhedonia, over the same 2-week period, causing functional impairment)…
- Management
First, stratify safety: assess suicidal and homicidal ideation and screen for psychotic features; if the patient is actively suicidal, psychotic, or unable to safely care for the infant, hospitalize and stabilize before outpatient treatment.
- Complications
Impaired mother-infant bonding: untreated postpartum depression can adversely affect parent-child bonding, a primary reason for aggressive screening and treatment.
- Prognosis
Favorable with treatment: postpartum depression responds to the same treatments as MDD outside the peripartum period, cognitive behavioral therapy, interpersonal therapy, and SSRIs, with most treated patients reaching response or remission.
- Prevention
Universal perinatal screening: screen all pregnant and postpartum women for depression and anxiety at least once during the perinatal period, using the PHQ-9 or the Edinburgh Postnatal Depression…
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