Back to diagnoses

What is postpartum depression?

Postpartum depression (PPD) is a subtype of major depressive disorder that emerges during pregnancy or in the 4 weeks after delivery. PPD was recategorized and renamed in the DSM-5 as major depressive disorder with peripartum onset to reflect that half of postpartum depression actually occurs before delivery. The prevalence of PPD is 10-22%, but rates are higher in adolescent mothers (26-53%). PPD the most common psychiatric complication related to child-bearing.

What does PPD look like?

Risk Factors

  • Previous depression during pregnancy
  • Anxiety during pregnancy
  • Stressful life events during pregnancy or the early puerperium
  • Low levels of social support
  • Personal or family history of depression
  • Women with a history of postpartum depression are at increased risk of recurrence

Differential Diagnosis

  • Baby blues
    • Generally appear within 3-4 days after delivery, peak on the postpartum day 7, and disappear within 2 weeks
    • Mood lability, tearfulness, anxiety, insomnia, and irritability that do not meet the full criteria for depression
    • Affects 30-75% of women after childbirth
  • Anxiety disorders
  • Obsessive-compulsive disorder
  • Autoimmune thyroid disorders, hypothyroidism
  • Iron deficiency
  • Delirium

How is PPD investigated?

Screening/Scale Rater Description
Edinburgh Postnatal Depression Scale (EPDS) Client/Clinician 10-question screening questionnaire to assess for symptoms of depression and anxiety during pregnancy and in the year following childbirth

How is PPD treated?

Psychotherapy options should be used as first-line treatment for mild to moderate PPD. In severe PPD, SSRIs should be used as first-line treatment.
  • Selective serotonin reuptake inhibitors (SSRI)
    • Citalopram, escitalopram, sertraline

Nursing Management

See nursing nursing management for major depressive disorder.

References

[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.

[2] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.

[3] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.