Description

• Major depressive disorder (MDD) that recurs or has its onset most commonly in the early postpartum period but may occur prior to or within 12 months of delivery
• Postpartum depression (PPD) clinical manifestations are similar to nonperinatal depression (sleep disorders, anhedonia, psychomotor changes, etc.).
• Different from postpartum “blues” (sadness and emotional lability), a self-limited condition which is experienced by 30–70% of women and has an onset and resolution within first 10 days postpartum.

Epidemiology

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, or anxiety and depression during pregnancy
• History of premenstrual dysphoria
• Family history of depression
• Exposure to physical, sexual, or psychological violence (including intimate partner violence)
• Unintended or unwanted pregnancy, stressful life events, adolescent or single parenthood
• Low socioeconomic status, lack of social or financial support, lower educational attainment
• Gestational diabetes
• Complications during pregnancy or delivery, preterm birth, having a baby with a congenital abnormality
• Poor sleep quality, multiparity

General Prevention

• Universal screening, using validated rating scales, during pregnancy and postpartum year for better detection. Evidence suggests that screening pregnant and postpartum women for depression reduces depressive symptoms in women with depression and reduces the prevalence of depression in a given population. Evidence for pregnant women was less robust but is also consistent with the evidence for postpartum women regarding the benefits of screening, the benefits of treatment, and screening instrument accuracy (2)[A].
• Psychotherapy/counseling, particularly using cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) based interventions, has been shown to be effective in small randomized trials in the prevention of PPD in at-risk individuals, but the USPSTF concludes that further research is needed (3)[A].
• Use of selective serotonin reuptake inhibitors (SSRIs), specifically sertraline, may be effective in preventing PPD in women at high risk for PPD (3)[A].

Commonly Associated Conditions

• Bipolar mood disorder, depressive disorder not otherwise specified, dysthymic disorder, cyclothymic disorder, MDD
• Postpartum blues