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- Major depressive disorder (MDD) that recurs or has its onset in the postpartum period
- May also occur in mothers adopting a baby or in fathers
- Postpartum depression (PPD) is similar to nonpregnancy depression (sleep disorders, anhedonia, psychomotor changes, etc.); it most often has its onset within the first 12 weeks postpartum yet can occur within 1 year after delivery.
- Different than postpartum “blues” (sadness and emotional lability), which is experienced by 30–70% of women and has an onset and resolution within first 10 days postpartum
14.5% of women have a new episode of major or minor depression during postpartum period (1).
Etiology and Pathophysiology
- May be related to sensitivity in hormonal fluctuations, including estrogen; progesterone; and other gonadal hormones as well as neuroactive steroids; cytokines; hypothalamic-pituitary-adrenal (HPA) axis hormones; altered fatty acid, oxytocin, and arginine vasopressin levels; and genetic and epigenetic factors
- Multifactorial including biologic–genetic predisposition in terms of neurobiologic deficit, destabilizing effects of hormone withdrawal at birth, inflammation, and psychosocial stressors
- Previous episodes of PPD
- History of MDD
- MDD during pregnancy
- Anxiety during pregnancy
- History of premenstrual dysphoria
- Family history of depression
- Unwanted pregnancy
- Socioeconomic stress
- Low self-esteem
- Young maternal age
- Alcohol abuse
- Marital conflict
- Multiple births
- African Americans and Hispanics may have higher rates of PPD.
- Postpartum pain, sleep disturbance, and fatigue
- Recent immigrant status
- Increased stressful life events
- History of childhood sexual abuse
- Decision to decrease antidepressants during pregnancy
- Intimate partner violence (4)
- Prepregnancy diabetes
- Universal screening during pregnancy to allow for detection and treatment
- Screen using Edinburgh Postnatal Depression Scale during pregnancy and postpartum year.
- Postnatal visits, psychotherapy, and/or psychoeducation for high-risk women
- For women with depression during pregnancy, psychotherapy or treatment with antidepressants during pregnancy may prevent PPD.
- Depression care manager who provides education, routine telephone contact, and follow-up to engage women in treatment
Commonly Associated Conditions
- Bipolar mood disorder
- Depressive disorder not otherwise specified
- Dysthymic disorder
- Cyclothymic disorder