From the Guidelines
Postpartum depression is a clinical condition that lasts for at least two weeks, creates significant impairment in functioning, and typically requires professional treatment. According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) 1, the same criteria used to diagnose major depressive disorder apply in the postpartum period. A postpartum specifier can be attached to the diagnosis if symptom onset occurred within four weeks after delivery. The International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) lists criteria for postpartum depressive episodes similar to those in the DSM-IV-TR, but it specifies symptom onset within six weeks postpartum.
Key Characteristics of Postpartum Depression
- Persistent feelings of sadness, anxiety, emptiness, and hopelessness that interfere with daily functioning and bonding with the baby
- Common symptoms include crying spells, irritability, fatigue, changes in appetite or sleep patterns, difficulty concentrating, withdrawal from loved ones, and sometimes thoughts of harming oneself or the baby
- Can be a first episode of depression (de novo), or it may be preceded by depressive symptoms in the present pregnancy, in previous pregnancies, or in previous postpartum periods
- Affects not only the mother but also the newborn’s cognitive, behavioral, and emotional development
Prevalence of Postpartum Depression
- Most reports indicate that 10% to 15% of new mothers experience PPD, with the most recent meta-analysis estimating the prevalence within three months after delivery at 19.2% for minor and 7.1% for major PPD 1
- A systematic review reported a pooled prevalence of postpartum depression of 14% (95% CI 12–15) 1
Risk Factors for Postpartum Depression
- Women with a personal or family history of depression, limited social support, or pregnancy complications face higher risk
- High levels of stress, low levels of social resources, and strained personal or close relationships increase a woman’s risk of PPD 1
- Biological factors such as endocrine, immune/inflammatory, and genetic/epigenetic risk factors also play a role in the development of PPD 1
From the Research
Definition of Postpartum Depression
Postpartum depression (PPD) is a type of depression that occurs in women after childbirth. According to the study 2, it is defined as depression onset within 3 months of delivery, with a subset of women meeting strict DSM-IV criteria for PPD (onset within 4 weeks of delivery).
Key Characteristics
- Occurs in roughly 10% of postpartum women 2
- Negatively impacts the mother and her offspring 2
- Can be treated with selective serotonin reuptake inhibitors (SSRIs) 2, 3
- SSRIs have been shown to be efficacious and well tolerated in the treatment of PPD 3
Diagnosis and Treatment
- Diagnosis is typically made based on the presence of depressive symptoms within a certain time frame after childbirth 2
- Treatment options include SSRIs, such as sertraline and fluoxetine 2, 3, 4
- Nonpharmacologic approaches, such as cognitive-behavioral therapy, may also be effective in treating PPD 3, 5