From the Guidelines
Laboratory tests for postpartum depression (PPD) screening should include thyroid function tests (TSH, free T4), complete blood count (CBC), and comprehensive metabolic panel to rule out medical causes that can mimic depression symptoms, as recommended by general medical knowledge and supported by studies such as 1 and 1. When screening for postpartum depression, it is essential to consider the potential medical causes that can present with similar symptoms.
- Thyroid function tests (TSH, free T4) can help identify thyroid dysfunction, which is a common condition that can mimic or exacerbate depression symptoms.
- A complete blood count (CBC) can help diagnose anemia, a condition that can contribute to fatigue, weakness, and mood disorders.
- A comprehensive metabolic panel can help identify other medical conditions, such as nutritional deficiencies or electrolyte imbalances, that can affect mood and overall health. Additionally, assessing vitamin B12 and folate levels can be beneficial, as deficiencies in these vitamins can contribute to mood disorders. Checking vitamin D levels may also be helpful, as low levels have been associated with depression. If there are concerns about substance use, toxicology screening might be appropriate. These tests are important because medical conditions like thyroid dysfunction, anemia, and nutritional deficiencies can present with symptoms similar to PPD or exacerbate existing depression. While laboratory testing is a helpful component of evaluation, it should complement, not replace, validated screening tools like the Edinburgh Postnatal Depression Scale (EPDS) or Patient Health Questionnaire-9 (PHQ-9), as suggested by studies such as 1 and 1. The timing for these labs is typically during the comprehensive postpartum visit, but can be ordered earlier if symptoms warrant immediate evaluation.
From the Research
Postpartum Depression Screening Labs
To screen for postpartum depression (PPD), several labs and assessments can be utilized:
- Thyroid function tests, including Thyroid Stimulating Hormone (TSH) levels, as an association between PPD and thyroid function disturbances has been suggested 2
- The Edinburgh Postnatal Depression Scale (EPDS) is a widely used and validated tool for screening depression in pregnant and postpartum women 3, 4, 5
- Other screening tools, such as the Patient Health Questionnaire-9, Beck Depression Inventory, and the ten-item Kessler Psychological Distress Scale, can also be used, although the EPDS is often preferred due to its excellent performance 3
- A comprehensive postpartum visit should include a full assessment of mood and emotional well-being, including screening for postpartum depression and anxiety with a validated instrument 4
Laboratory Tests
Laboratory tests that may be drawn for PPD screening include:
- TSH levels, as elevated levels have been associated with an increased risk of depressive symptoms at six months postpartum 2
- Other labs may be ordered based on individual patient needs and risk factors, although there is limited evidence to support the use of specific laboratory tests for PPD screening
Screening Recommendations
The American College of Obstetricians and Gynecologists recommends that obstetrician-gynecologists and other obstetric care providers screen patients at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool 4