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Postpartum Depression

What is Postpartum Depression?

An episode of Major Depressive Disorder that occurs in the first year after childbirth.1-4

Prevalence

13%3-6

Symptoms

Emotional Symptoms: guilt, anxiety, obsessions and compulsions, suicidal ideation, reduced pleasure or interest, depressed mood. Somatic Symptoms: difficulty sleeping, diminished energy, reduced concentration, appetite or weight changes, psychomotor functioning changes.

Emotional Symptoms

  • Include many of the most common symptoms of postpartum depression.
    • Guilt4, 8, 9
    • Anxiety7-12
    • Obsessive-compulsive symptoms7
      • Often involving thoughts of harm visiting the infant7-9
    • Suicidal ideation8
    • Reduced interest or pleasure8, 9, 13
    • Depressed mood8
      • Less common in postpartum depression than in depression without postpartum onset9, 13, 14

Somatic Symptoms

  • Less useful for diagnosis since most typically present after childbirth.15
    • Difficulty sleeping8 that persists even when the infant is asleep9
    • Diminished energy8, 13
    • Reduced ability to make decisions or think clearly8, 14
    • Change in appetite or weight8
    • Change in psychomotor functioning8, 14

Course

  • Not significantly different from Major Depressive Disorder without postpartum-onset.7, 16
  • Average duration of three months17, 18
  • Recurrence likely17-20

Etiology

  • Unknown, thought to develop from a convergence of biological, psychological, and social vulnerabilities.1, 21
    • Biological factors such as hormonal changes not consistently identified in relation to the onset of postpartum depression.1, 2, 21 Biological, psychological, and social factors each influence the individual.
    • 

  • See Risk Factors for information on which psychological and social factors contribute to the onset of postpartum depression.

What are Other Postpartum Psychiatric Disorders?

See Types of Postpartum Mood and Anxiety Disorders

References

  1. Registered Nurses’ Association of Ontario (2005). Nursing best practice guideline: Interventions for postpartum depression. Retrieved from http://www.rnao.org/Storage/11/600_BPG_Post_Partum_Depression.pdf
  2. Scottish Intercollegiate Guidelines Network. (2002). Postnatal depression and puerperal psychosis: A national clinical guideline. Retrieved from http://www.sign.ac.uk/pdf/sign60.pdf
  3. American Academy of Pediatrics, Committee on Psychosocial Aspects of Child and Family Health. (2010). Clinical report: Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. doi: 10.1542/peds.2010-2348
  4. Neiman, S., Carter, S., Van Sell, S., & Kindred, C. (2010). Best practice guidelines for the nurse practitioner regarding screening, prevention, and management of postpartum depression. Critical Care Nursing Quarterly, 33(3), 212-218. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20551735
  5. Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics & Gynecology, 106(5), 1071-1083. doi: 10.1097/01.AOG.0000183597.31630.db
  6. O’Hara, M. W., Swain A. M. (1996). Rates and risk of postpartum depression: A meta analysis. International Review of Psychiatry, 8, 37-54. doi: 10.3109/09540269609037816
  7. American Psychiatric Association. (2010). Practice guidelines for the treatment of major depressive disorder (3rd ed.). doi: 10.1176/appi.books.9780890423387.654001
  8. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). doi: 10.1176/appi.books.9780890423349.9498
  9. Hirst, K. P., & Moutier, C. Y. (2010). Postpartum major depression. American Family Physician, 82(8), 926-933. Retrieved from http://www.aafp.org/afp/990415ap/2247.html
  10. Ross, L. E., Evans, S. E. G., Sellers, E. M., & Romach, M. K. (2003). Measurement issues in postpartum depression part 1: Anxiety as a feature of postpartum depression. Archives of Women’s Mental Health, 6(1), 51. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=aph&AN=9243058&site=ehost-live&scope=site
  11. Hendrick, V., Altshuler, L., Strouse, T., & Grosser, S. (2000). Postpartum and nonpostpartum depression: Differences in presentation and response to pharmacologic treatment. Depression & Anxiety (1091-4269), 11(2), 66-72. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=aph&AN=11772892&site=ehost-live&scope=site
  12. Beck, C. T., & Indman, P. (2005). The many faces of postpartum depression. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 34(5), 569-576. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2009037973&site=ehost-live&scope=site
  13. Andersson, L., Sundström-Poromaa, I., Wulff, M., Åström, M., & Bixo, M. (2006). Depression and anxiety during pregnancy and six months postpartum: A follow-up study. Acta Obstetricia Et Gynecologica Scandinavica, 85(8), 937-944. doi:10.1080/00016340600697652
  14. Bernstein, I. H., Rush, A. J., Yonkers, K., Carmody, T. J., Woo, A., McConnell, K., & Trivedi, M. H. (2008). Symptom features of postpartum depression: Are they distinct? Depression & Anxiety, 25(1), 20-26. doi:10.1002/da.20276
  15. Pearlstein, T., Howard, M., Salisbury, A., & Zlotnick, C. (2009). Postpartum depression. American Journal of Obstetrics & Gynecology, 200(4), 357-364. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2010232537&site=ehost-live&scope=site
  16. Serretti, A., Olgiati, P., & Colombo, C. (2006). Influence of postpartum onset on the course of mood disorders. BMC Psychiatry, 6, 4-7. doi:10.1186/1471-244X-6-4
  17. Nonacs, R. M. (2005). Postpartum mood disorders. In L. S. Cohen & R. M. Nonacs (Eds.), Mood and anxiety disorders during pregnancy and postpartum (Vol. 24, pp. 77-96). Washington, DC: American Psychiatric Publishing.
  18. Coates, A. O., Schaefer, C. A., & Alexander, J. L. (2004). Detection of postpartum depression and anxiety in a large health plan. Journal of Behavioral Health Services & Research, 31(2), 117-133. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=aph&AN=12910992&site=ehost-live&scope=site
  19. Beeghly, M., Olson, K. L., Weinberg, M. K., Pierre, S. C., Downey, N., & Tronick, E. Z. (2003). Prevalence, stability, and socio-demographic correlates of depressive symptoms in black mothers during the first 18 months postpartum. Maternal & Child Health Journal, 7(3), 157-168. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=c8h&AN=2004033558&site=ehost-live&scope=site
  20. Hay, D. F., Pawlby, S., Waters, C. S., & Sharp, D. (2008). Antepartum and postpartum exposure to maternal depression: Different effects on different adolescent outcomes. Journal of Child Psychology and Psychiatry, 49(10), 1079-1088. Retrieved from https://auth-lib-unc-edu.libproxy.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com.libproxy.lib.unc.edu/login.aspx?direct=true&db=eric&AN=EJ814291&site=ehost-live&scope=site
  21. National Institute for Health and Clinical Excellence. (2007). Antenatal and postnatal mental health: Clinical management and service guidance. Retrieved from http://www.nice.org.uk/nicemedia/live/11004/30433/30433.pdf

Last Updated July 18, 2011