Postpartum depression is a major depressive episode that starts during pregnancy or in the year after birth, and it is more severe and lasting than the common baby blues. It affects the parent, the bond with the baby and the whole family, and it responds well to treatment.
Key symptoms
- Low mood, tearfulness or loss of interest for 2 weeks or more
- Anxiety, irritability or feeling overwhelmed
- Trouble sleeping even when the baby sleeps, low energy
- Guilt, feeling like a bad parent, trouble bonding
- Thoughts of self-harm or of harming the baby
What you find on exam
- Mental status exam: mood, affect, thought content
- Direct questions about suicidal thoughts and thoughts of harming the baby
- Signs of psychosis: confusion, hallucinations, strange beliefs
- Self-care, support at home and how the baby is doing
Tests
- Edinburgh Postnatal Depression Scale (EPDS) or PHQ-9 screening
- TSH to exclude postpartum thyroiditis
- Blood count for anemia
- Screen for bipolar disorder before starting an antidepressant
Treatment basics
- Psychotherapy such as cognitive behavioral or interpersonal therapy
- SSRI such as sertraline, compatible with breastfeeding
- Zuranolone or brexanolone in selected patients
- Protected sleep, family support and peer support groups
- Close follow-up and a safety plan
Red flags
- Suicidal thoughts or a plan
- Thoughts of harming the baby
- Confusion, hallucinations or delusions: postpartum psychosis, an emergency
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.