Postpartum depression is depressive symptoms that last > 2 wk after delivery and that interfere with activities of daily living.

Postpartum depression occurs in 10 to 15% of women after delivery. Although every woman is at risk, women with the following are at higher risk:

• Baby blues (eg, rapid mood swings, irritability, anxiety, decreased concentration, insomnia, crying spells)
• Prior episode of postpartum depression
• Prior diagnosis of depression
• Family history of depression
• Significant life stressors (eg, marital conflict, stressful events in the last year, unemployment of partner, no partner, partner with depression)
• Lack of support from partner or family members (eg, financial or child care support)
• History of mood changes temporally associated with menstrual cycles or oral contraceptive use
• Prior or current poor obstetric outcomes (eg, previous miscarriage, an infant with a congenital malformations)
• Prior or continuing ambivalence about the current pregnancy (eg, because it was unplanned or termination was considered)

The exact etiology is unknown; however, prior depression is the major risk, and hormonal changes during the puerperium, sleep deprivation, and genetic susceptibility may contribute.

Transient depression (baby blues) is very common during the first week after delivery. Baby blues differs from postpartum depression because baby blues typically lasts 2 to 3 days (up to 2 wk) and is relatively mild; in contrast, postpartum depression lasts > 2 wk and is disabling, interfering with activities of daily living.

Symptoms and Signs

Symptoms may be similar to those of major depression and may include

• Extreme sadness
• Guilt
• Uncontrollable crying
• Insomnia or increased sleep
• Loss of appetite or overeating
• Irritability and anger
• Headaches and body aches and pains
• Extreme fatigue
• Unrealistic worries about or disinterest in the baby
• A feeling of being incapable of caring for the baby or of being inadequate as a mother
• Fear of harming the baby
• Suicidal ideation
• Anxiety or panic attacks

Typically, symptoms develop insidiously over 3 mo, but onset can be more sudden. Postpartum depression interferes with women's ability to care for themselves and the baby.

Psychosis rarely develops, but postpartum depression increases the risk of suicide and infanticide, which are the most severe complications.

Women may not bond with their infant, resulting in emotional, social, and cognitive problems in the child later.

Fathers are at increased risk of depression, and marital stress is increased.

Without treatment, postpartum depression can resolve spontaneously or become chronic depression. Risk of recurrence is about 1 in 3 to 4.

Diagnosis

• Clinical evaluation
• Sometimes formal depression scales

Early diagnosis and treatment substantially improve outcomes for women and their infant.

Because of cultural and social factors, women may not volunteer symptoms of depression, so health care providers should ask women about such symptoms before and after delivery. Also, women should be taught to recognize symptoms of depression, which they may mistake for the normal effects of new motherhood (eg, fatigue, difficulty concentrating). Women can be screened at the postpartum visit for postpartum depression using various depression scales (eg, Edinburgh Postnatal Depression Scale, Postpartum Depression Prediction Inventory, Postpartum Depression Screening Scale).

Postpartum depression (or other serious mental disorders) should be suspected if women have the following:

• Symptoms for > 2 wk
• Symptoms that interfere with daily activities
• Suicidal or homicidal thoughts (women should be asked specifically about such thoughts)
• Hallucinations, delusions, or psychotic behavior

Treatment

Treatment includes antidepressants and psychotherapy. Exercise therapy, light therapy, massage therapy, acupuncture, and ω-3 fatty acid supplementation have shown some benefit in small studies.

Key Points

• Baby blues is very common during the first week after delivery, typically lasts 2 to 3 days (up to 2 weeks), and is relatively mild.
• Postpartum depression occurs in 10 to 15% of women, lasts > 2 wk, and is disabling (in contrast to baby blues).
• Symptoms may be similar to those of major depression and can also include worries and fears about being a mother.
• Postpartum depression typically also affects other family members, often resulting in marital stress, depression in the father, and subsequent problems in the child.
• Teach all women to recognize the symptoms of postpartum depression, and ask them about symptoms of depression before and after delivery.
• For the best possible outcomes, identify and treat postpartum depression as early as possible.

Last full review/revision March 2013 by Julie S. Moldenhauer, MD

Content last modified March 2013