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:
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
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.
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:
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 March 2013 by Julie S. Moldenhauer, MD
Content last modified September 2013