Postpartum depression

Last reviewed: 3 Jun 2022
Last updated: 27 Apr 2022

Summary

Definition

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

ACUTE

unipolar depression

bipolar depression

Contributors

Authors

Arianna Di Florio, MD, PhD

Clinical Senior Lecturer

MRC Centre for Neuropsychiatric Genetics and Genomics

Cardiff University

Cardiff

UK

Adjunct assistant professor

University of North Carolina at Chapel Hill

Chapel Hill

NC

Disclosures

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

Cardiff

UK

Disclosures

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

Toronto

Canada

Disclosures

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

NY

Disclosures

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

Bordeaux

France

Disclosures

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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