Postpartum Depression

Introduction

• Description: Postpartum depression is a cluster of symptoms that are characterized by a disturbance of mood; loss of sense of control; intense mental, emotional, and physical anguish; and loss of self-esteem associated with childbirth. There is a spectrum of symptoms and severity from postpartum “blues” that are mild and self-limited (subsyndromal depressive symptoms) to debilitating major depression. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) limits the definition to the first 4 weeks following childbirth, whereas others extend the interval up to a year after delivery.

• Prevalence: 8%–15% of delivering women; true psychosis occurs in 1–2/1000 deliveries. Arguments can be made that this represents the most common complication of pregnancy.

• Predominant Age: Reproductive age (by definition).

• Genetics: No genetic pattern, although there is a proposed family tendency.

Etiology and Pathogenesis

• Causes: Unknown.

• Risk Factors: History of major depression, premenstrual syndrome, prior postpartum depression, perinatal loss, early childhood loss (parent, sibling), physical or sexual abuse, socioeconomic deprivation, family predisposition, lifestyle stress, preterm delivery, unplanned pregnancy, single marital status, young age. There is a 50% recurrence rate for subsequent pregnancies.

Signs and Symptoms

• Five of the following must be present—depressive mood most of the time; diminished interest in normal or pleasurable activities; significant involuntary change in weight; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or guilt; diminished ability to think or concentrate; recurrent thoughts of death

• Begins 2–12 months after delivery; lasts 3–14 months (up to 50% of cases have symptoms before delivery)

Diagnostic Approach