Postpartum depression is a depressive symptom that lasts > 2 weeks after delivery and meets the criteria for major depression.
Postpartum depression occurs in 10-15% of women after childbirth. Although all women are at risk, women who have the following factors are more so:
- Baby blues (e.g., rapid mood swings, irritability, anxiety, decreased concentration, insomnia, crying fits)
- The previous episode of postpartum depression
- History of diagnosis of depression
- Family history of depression
- Significant stressors (e.g., marital conflict, stressful events in the past year, financial difficulties, parenting without a partner, partner with depression)
- Lack of support from partners or family members (e.g., financial support or child care)
- History of mood changes temporally associated with menstrual cycles or oral contraceptive use
- Adverse current obstetric history or status (e.g., history of miscarriage, preterm delivery, newborn admitted to neonatal intensive care unit, a child with birth defects)
- Previous or current ambivalence about the pregnancy (e.g., because it was not planned or because an interruption was considered)
- Breastfeeding problems.
The exact etiology of postpartum depression is unknown; However, previous depression is a major risk, as well as hormonal changes during the puerperium period, sleep deprivation, and a genetic predisposition, may contribute.
Transient depressive symptoms (“baby blues”) are very common during the first week after childbirth. The baby blues differ from postpartum depression because the baby blues, which usually lasts 2 to 3 days (up to 2 weeks), is relatively moderate; While postpartum depression lasts > 2 weeks and is disabling, disrupting activities of daily living.
Symptomatology of postpartum depression
Symptoms of postpartum depression can be similar to those of major depression and may include:
- Baby blues (e.g., rapid mood swings, irritability, anxiety, decreased concentration, insomnia, crying fits)
- Extreme sadness
- Mood swings
- Uncontrollable crying
- Insomnia or hypersomnia
- Loss of appetite or overeating
- Irritability and anger
- Headache, body aches, and back pain
- Extreme fatigue
- Unrealistic anxieties about the infant or, on the contrary, a lack of interest in him
- A feeling of being unable to care for the child or not being a good mother
- Fear of death
- Guilt about his feelings
- Suicidal ideation
- Anxiety or panic
Typically, symptoms develop insidiously in 3 months, but their appearance may be more sudden. Postpartum depression interferes with women’s ability to care for themselves and their infants.
Women may not bond with their infants, leading to emotional, social, and cognitive problems later in the child.
Partners may also be at increased risk of depression, and depression in one parent can lead to relationship stress.
Without treatment, postpartum depression may disappear spontaneously or become chronic. The risk of recurrence is about 1 in 3 to 4.
Postpartum psychosis is rare; Untreated postpartum depression and psychosis increase the risk of suicide and infanticide, which are the most serious complications.
Diagnosis of postpartum depression
- Clinical assessment
- Criteria for major depression
Early diagnosis and treatment of postpartum depression significantly improve outcomes for women and their infants.
Postpartum depression (or other serious mental disorders) is diagnosed if women have ≥ 5 symptoms for > 2 weeks; symptoms include depressed mood and/or loss of interest or pleasure and:
- Significant weight loss, loss of appetite, or weight gain
- Insomnia or hypersomnia
- Agitation or psychomotor retardation
- Feelings of worthlessness or guilt
- Decreased ability to concentrate
- Suicidal or murderous thoughts (patients should be asked specifically about such thoughts)
Due to cultural and social factors, women may not voluntarily report symptoms of depression, so caregivers should ask women these questions about such symptoms before and after childbirth. They should also be educated to recognize the symptoms of depression, which may be confused with the normal effects of new motherhood (e.g., fatigue, difficulty concentrating).
All women should be screened at the postpartum consultation for postpartum depression using a validated screening tool. These tools include the Edinburgh Postnatal Depression Scale and the Postpartum Depression Screening Scale.
Patients with hallucinations, delusions, or psychotic behavior should be assessed for postpartum psychosis.
Treatment of postpartum depression
- Antidepressants
- Psychotherapy
Treatment for postpartum depression may include antidepressants and psychotherapy. If a woman has significant anxiety, she can be treated with anxiolytics.
Women with postpartum psychosis may require hospitalization, preferably in a monitored unit that allows them to stay with their infant. Antipsychotic medications may be needed, as well as antidepressants.
Key points
- The baby blues are very common during the first week after delivery, usually last 2 to 3 days (up to 2 weeks), and are relatively benign.
- Postpartum depression occurs in 10 to 15% of women, lasts > 2 weeks, and is disabling (unlike the baby blues).
- Symptoms are similar to those of major depression and may also include anxiety.
- Postpartum depression can lead to adverse effects on the child or relationship stress.
- Teach all women to recognize the symptoms of postpartum depression and ask if they have symptoms of depression before and after childbirth.
- Formally screen all women for mood disorders during the postpartum consultation.
- For best results, identify and treat postpartum depression as early as possible.
