Postnatal depression

Refers to the development of a depressive illness following childbirth and may form part of a unipolar or, less frequently, a bipolar illness.

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) does not recognise postnatal depression as a separate diagnosis; rather, patients must meet the criteria for a major depressive episode and the criteria for the perinatal-onset specifier. The definition according to DSM-5 is, therefore, a major depressive episode with an onset in pregnancy or within 4 weeks of delivery. However there is no established consensus as to the length of postnatal period, and some authorities define postnatal depression as occurring within the first 12 months after delivery.

Aetiology is poorly understood but is likely to involve an interaction between psychological, social, and biological factors.

Patients may present with a history of depressed mood, anhedonia, weight changes, sleep disturbance, psychomotor problems, low energy, excessive guilt, loss of confidence or self-esteem, poor concentration, or suicidal ideation.

The presence of a bipolar disorder must be excluded in all patients.

Treatment is with psychological therapy and/or medication. Antidepressants are recommended for more severe episodes if the patient declines psychological therapy or if psychological therapy is either ineffective or unavailable.

Psychiatric referral may be necessary in patients who do not respond to treatment. However, an urgent psychiatric assessment is warranted if there is a risk of self-harm or harm to the child at any time, or if a postnatal psychosis, or manic or mixed episode, is suspected.

Episodes of postnatal depression last 3-6 months on average, but a few women remain depressed at 1 year.

Postnatal depression refers to the development of a depressive illness following childbirth and may form part of a bipolar or, more usually, a unipolar illness. [1] Musters C, McDonald E, Jones I. Management of postnatal depression. BMJ. 2008 Aug 8;337:a736. http://www.ncbi.nlm.nih.gov/pubmed/18689433?tool=bestpractice.com Postnatal depression is not recognised by current classification systems as a condition in its own right, but the onset of a depressive episode within 4 weeks of childbirth can be recorded via the perinatal-onset specifier in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). [2] American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing; 2013. http://dsm.psychiatryonline.org/book.aspx?bookid=556 There is evidence to suggest that the DSM-5 specifier is too narrow. [3] Forty L, Jones L, Macgregor S, et al. Familiality of postpartum depression in unipolar disorder: results of a family study. Am J Psychiatry. 2006 Sep;163(9):1549-53. http://ajp.psychiatryonline.org/doi/full/10.1176/ajp.2006.163.9.1549 http://www.ncbi.nlm.nih.gov/pubmed/16946179?tool=bestpractice.com Hence, in common usage, depressive episodes occurring within 6-12 months of delivery may be considered to be postnatal depression.