Postpartum depression

Postpartum 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 postpartum depression can negatively impact the wellbeing and quality of life of the mother, as well as the health and development of the infant and of other children within the family.

Exclude postpartum psychosis and bipolar disorder in all patients.

Treatment is with psychological therapy and/or pharmacotherapy. Antidepressants are recommended in certain circumstances, taking into account individual patient factors including severity of depression, treatment history and response, patient preference, and availability of psychological therapies.

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 postpartum psychosis, or manic or mixed episode, is suspected.

Episodes of postpartum depression last 3-6 months on average, but may last for months or even years.

Postpartum depression refers to the development of a depressive illness following childbirth and may form part of a bipolar or, more usually, a unipolar illness. Both the International Classification of Diseases (ICD)-11 and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR) define "mild," "moderate," and "severe" depression based on the number and intensity of symptoms, and on the degree of functional impairment.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text rev (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.[2]World Health Organization. ICD-11 2026 Release. Feb 2026 [internet publication]. https://www.who.int/news/item/16-02-2026-icd-11-2026-release ​ Postpartum depression is not recognized by current classification systems as a distinct diagnostic entity in its own right, but the onset of a depressive episode within 4 weeks of childbirth can be recorded via the peripartum-onset specifier according to DSM-5-TR.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text rev (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. There is evidence that the DSM-5-TR 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 This topic defines the postpartum period as up to 12 months after delivery, in accordance with several international guidelines.​​[4]American College of Obstetricians and Gynecologists. ACOG clinical practice guideline no. 4: screening and diagnosis of mental health conditions during pregnancy and postpartum. Jun 2023 [internet publication]. https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/06/screening-and-diagnosis-of-mental-health-conditions-during-pregnancy-and-postpartum [5]National Institute for Health and Care Excellence (UK). Antenatal and postnatal mental health: clinical management and service guidance. Feb 2020 [internet publication]. https://www.nice.org.uk/guidance/cg192 [6]Vigod SN, Frey BN, Clark CT, et al. Canadian Network for Mood and Anxiety Treatments 2024 clinical practice guideline for the management of perinatal mood, anxiety, and related disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l'humeur, des troubles anxieux et des troubles connexes périnatals. Can J Psychiatry. 2025 Jun;70(6):429-89. https://journals.sagepub.com/doi/10.1177/07067437241303031 http://www.ncbi.nlm.nih.gov/pubmed/39936923?tool=bestpractice.com ​​​​

There is no subthreshold (minor) depression diagnosis in DSM-5-TR, but the label has sometimes been applied to patients with two to four depressive symptoms, including depressed mood or anhedonia, lasting longer than 2 weeks.[7]Kessler RC, Zhao S, Blazer DG, et al. Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey. J Affect Disord. 1997 Aug;45(1-2):19-30. http://www.ncbi.nlm.nih.gov/pubmed/9268772?tool=bestpractice.com [8]Kendler KS, Gardner CO Jr. Boundaries of major depression: an evaluation of DSM-IV criteria. Am J Psychiatry. 1998 Feb;155(2):172-7. https://psychiatryonline.org/doi/10.1176/ajp.155.2.172 http://www.ncbi.nlm.nih.gov/pubmed/9464194?tool=bestpractice.com ​​ Subthreshold depressive symptoms are common in the postpartum period. While clinically relevant and warranting monitoring and sometimes treatment, the majority of this topic focuses on postpartum depression meeting diagnostic criteria for a depressive disorder, given that evidence for treatment recommendations is primarily derived from this population, unless otherwise specified.

Symptom onset in pregnancy (and before pregnancy) is common; therefore, the term "perinatal depression" may be strictly more accurate.​​[9]Wisner KL, Sit DK, McShea MC, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 2013 May;70(5):490-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440326 http://www.ncbi.nlm.nih.gov/pubmed/23487258?tool=bestpractice.com [10]Biaggi A, Conroy S, Pawlby S, et al. Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord. 2016 Feb;191:62-77. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879174 http://www.ncbi.nlm.nih.gov/pubmed/26650969?tool=bestpractice.com

This topic focuses on unipolar postpartum depression. For information on bipolar disorder in the postpartum period, see Bipolar disorder in adults. For information on depression during pregnancy, see Depression in adults.​