Merck Manual

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Postpartum Depression

By

Julie S. Moldenhauer

, MD, Children's Hospital of Philadelphia

Last full review/revision Jan 2022| Content last modified Jan 2022
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Postpartum depression is depressive symptoms that last > 2 weeks after delivery and meet criteria for major depression.

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

Transient depressive symptoms (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 weeks) and is relatively mild; in contrast, postpartum depression lasts > 2 weeks and is disabling, interfering with activities of daily living.

Symptoms and Signs of Postpartum Depression

  • Baby blues (eg, rapid mood swings, irritability, anxiety, decreased concentration, insomnia, crying spells)

  • Extreme sadness

  • Mood swings

  • 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

  • Guilt about her feelings

  • Suicidal ideation

  • Anxiety or panic attacks

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

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

Partners may also be at increased risk of depression, and depression in either parent may result in relationship stress.

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

Postpartum psychosis rarely develops; untreated postpartum depression and psychosis increase the risk of suicide and infanticide, which are the most severe complications.

Diagnosis of Postpartum Depression

  • Clinical evaluation

  • Criteria for major depression

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

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

  • Psychomotor agitation or retardation

  • Feeling of worthlessness or guilt

  • Diminished ability to concentrate

  • Suicidal or homicidal thoughts (women should be asked specifically about such thoughts)

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).

All women should be screened at the postpartum visit for postpartum depression using a validated screening tool. Such tools include the Edinburgh Postnatal Depression Scale and the Postpartum Depression Screening Scale ( 1 Diagnosis reference Postpartum depression is depressive symptoms that last > 2 weeks after delivery and meet criteria for major depression. Postpartum depression occurs in 10 to 15% of women after delivery. Although... read more ).

Patients with hallucinations, delusions, or psychotic behavior should be evaluated for postpartum psychosis.

Diagnosis reference

Treatment of Postpartum Depression

  • Antidepressants

  • Psychotherapy

Women who have postpartum psychosis may need to be hospitalized, preferably in a supervised unit that allows the infant to remain with them. Antipsychotic drugs Treatment may be needed as well as antidepressants.

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 weeks, and is disabling (in contrast to baby blues).

  • Symptoms are be similar to those of major depression and can also include anxiety.

  • Postpartum depression may result in adverse effects on the child or in relationship stress.

  • Teach all women to recognize the symptoms of postpartum depression, and ask them about symptoms of depression before and after delivery.

  • Formally screen all women for mood disorders during their postpartum visit.

  • For the best possible outcomes, identify and treat postpartum depression as early as possible.

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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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