Depression, Postpartum

Depression, Postpartum is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • 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

Epidemiology

Incidence
14.5% of women have a new episode of major or minor depression during postpartum period (1).

Prevalence
  • >50% of women with PPD enter pregnancy depressed or have an onset during pregnancy (2).
  • As many as 19.2% women suffer from depression within 3 months postpartum period (3).

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

Risk Factors

  • 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

General Prevention

  • 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
  • MDD

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