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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
• Prior episode of postpartum depression
• Prior diagnosis of depression
• Family history of depression
• Significant life stressors
• Lack of support (eg, from partner or family members)
• Perimenstrual mood disorders
• Poor obstetric outcomes

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.

Unlike the baby blues, which typically lasts 2 to 3 days (up to 2 wk) and is relatively mild, postpartum depression lasts > 2 wk and is disabling, interfering with activities of daily living.

Symptoms and Signs

Symptoms may include

• Extreme sadness
• Uncontrollable crying
• Insomnia or increased sleep
• Loss of appetite or overeating
• Irritability
• Headaches and body aches and pains
• Extreme fatigue
• Unrealistic worries about or disinterest in the baby
• Fear of harming the baby
• Suicidal ideation
• Anxiety

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 they should be asked about such symptoms before and after delivery. They also 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.

Last full review/revision November 2008 by Julie S. Moldenhauer, MD

Content last modified November 2008