Postpartum depression

Last reviewed: 23 Aug 2023
Last updated: 01 Nov 2022



History and exam

Key diagnostic factors

  • depressed mood
  • anhedonia
  • 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
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • history of depressed mood, depression, or anxiety
  • recent stressful life events
  • poor social support
  • discontinuation of psychopharmacologic treatments
  • sleep deprivation
  • postpartum 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
More risk factors

Diagnostic investigations

1st investigations to order

  • Depression identification questions
More 1st investigations to order

Investigations to consider

  • Edinburgh Postnatal Depression Scale (EPDS)
  • Mood Disorder Questionnaire (MDQ)
  • Thyroid function tests
  • CBC
  • urine drug screen
  • brain CT or MRI
More investigations to consider

Treatment algorithm


unipolar depression

bipolar depression



Arianna Di Florio, MD, PhD

Professor of Psychiatry

MRC Centre for Neuropsychiatric Genetics and Genomics

Cardiff University



Adjunct assistant professor

University of North Carolina at Chapel Hill

Chapel Hill



ADF is an author of references cited in this topic.

Ian Jones, MB BS, MRCPsych, PhD

Professor of Psychiatry

MRC Centre for Neuropsychiatric Genetics and Genomics

Cardiff University




IJ has received grant income from Takeda. He has participated in an advisory board meeting for Sanofi and is a trustee of the Maternal Mental Health Alliance and of Action on Postpartum Psychosis. IJ is an author of references cited in this topic.

Peer reviewers

Donna Stewart, MD

Centre for Mental Health

University of Toronto




DS declares that she has received author royalties from UptoDate on depression in pregnancy. DS has been an expert witness in a lawsuit related to postnatal depression.

Margaret Spinelli, MD

Associate Professor of Psychiatry

Columbia University

New York



MS declares that she has no competing interests.

Anne-Laure Sutter, MD, PhD

Head of the Perinatal Psychiatry Network

University Department of Adult Psychiatry

CH Charles Perrens




ALS declares that she has no competing interests.

  • Differentials

    • Minor mood disorder (postpartum blues or "baby blues")
    • Postpartum (puerperal) psychosis
    • Obsessive compulsive disorder
    More Differentials
  • Guidelines

    • Involving and supporting partners and other family members in specialist perinatal mental health services: good practice guide
    • Antenatal and postnatal mental health: clinical management and service guidance
    More Guidelines
  • Patient leaflets

    Postpartum depression

    Depression in adults: questions to ask your doctor

    More Patient leaflets
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