Postnatal depression may present with symptoms 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.
Recognition and effective treatment is vital; untreated postnatal depression causes substantial impairment for the woman, and may also result in impaired behavioural, emotional, and cognitive outcomes for the baby
Exclude postnatal psychosis and bipolar disorder in all patients.
Treatment is with psychological therapy and/or medication. Antidepressants are recommended for more severe episodes if the woman declines psychological therapy or if psychological therapy is either ineffective or unavailable.
Psychiatric referral may be necessary for patients who do not respond to treatment. 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 to 6 months on average, but may last for months or even years.
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. 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 peripartum-onset specifier in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR). There is evidence that the DSM-5-TR specifier is too narrow. Hence, in common usage, depressive episodes occurring within 6 to 12 months of delivery may be considered to be postnatal depression. This topic defines the postnatal period as up to 12 months after delivery, in accordance with several international guidelines.
This topic focuses on postnatal depression within a unipolar illness. For more information on postnatal depression in the context of a bipolar illness, please see our BMJ Best Practice topic on Bipolar disorder in adults. For information on depression during pregnancy, please see the topic Depression in adults.
History and exam
Key diagnostic factors
- presence of risk factors
- depressed mood
- decreased energy or increased fatigability
- suicidal ideation
- loss of confidence or self-esteem
- unreasonable feelings of self-reproach or excessive and inappropriate guilt
- poor concentration
Other diagnostic factors
- change in psychomotor activity
- sleep disturbance
- change in appetite
- change in weight
- obsessive thoughts
- significant self-harm or neglect or mistreatment of children
- personal or family history of hypomania or mania
- psychotic symptoms
- history of depressed mood, depression, or anxiety
- recent stressful life events
- poor social support
- discontinuation of psychopharmacological treatments
- sleep deprivation
- postnatal hypomania
- personality traits
- pregnancy- and delivery-related complications
- poor socioeconomic status
- age less than 16 years
- familial and genetic factors
- violence by partner during pregnancy
1st investigations to order
- Depression identification questions
Investigations to consider
- Edinburgh Postnatal Depression Scale (EPDS)
- Mood Disorder Questionnaire (MDQ)
- Thyroid function tests
- urine drug screen
- brain CT or MRI
- Minor mood disorder (postnatal blues or 'baby blues')
- Postnatal (puerperal) psychosis
- Obsessive compulsive disorder
- Postnatal care
- Involving and supporting partners and other family members in specialist perinatal mental health services: good practice guide
Postnatal depression: questions to ask your doctorMore Patient leaflets
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