Postpartum Depression

Difference between Postpartum Depression, Blues, and Psychosis

Onset and duration distinguish postpartum depression from postpartum blues and postpartum psychosis. Postpartum blues are a temporary condition characterized by mild mood swings, irritability, anxiety, crying spells, loss of appetite, and decreased concentration; these symptoms typically begin within several days after delivery and resolve within two weeks. Postpartum depression can occur any time within one year after giving birth and is severe enough to warrant psychiatric treatment. Postpartum psychosis, the most severe of postpartum disorders, is rare and usually appears within two weeks of childbirth. Its symptoms include thoughts of harming herself or her baby and thereby warrant close medical monitoring.

Diagnostic Criteria

While the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), published by the American Psychiatric Association, establishes the diagnostic criteria used by clinicians in diagnosing major depression, postpartum depression is not considered as a separate diagnosis. Attention is paid, however, to the clinical manifestations of postpartum depression that arise within four weeks after childbirth.

Epidemiology, Cause, and Clinical Features

Postpartum depression is estimated to develop in 10 to 15 percent of women following birth, a rate similar to that of depression reported by women in the general population. However, research has shown that the onset of new cases of depression is higher in the weeks following childbirth than in women who had not just experienced pregnancy.

Postpartum depression presents itself clinically by way of changes in sleep, appetite, energy level, digestive function, and sex drive. These indicators should be evaluated within the context of normal expectations and bodily changes during the period following pregnancy. Disturbances in sleep and eat patterns beyond what would be expected could be indicative of postpartum depression.

In addition, intense anxiety, irritability, guilt, or feelings of inadequacy or failure as a mother are also warning signs of postpartum depression. A perceived inability to bond with the baby may induce great shame and lead the woman to conceal her suffering from family, friends, and her healthcare provider.

The combination of genetic predisposition, pregnancy, and the hormonal changes the woman experiences during it may account for the variability in symptoms from woman to woman, though no single hormonal factor (e.g., estrogen, progesterone, testosterone) has been labeled as causative.

Prevention and Screening for Postpartum Depression

Given the propensity for women who suffer from postpartum depression to conceal feeling of shame or worthlessness associated with the disorder, screening in a clinical care setting becomes an important tool for detection and treatment of postpartum depression. The Edinburgh Postnatal Depression Scale (EPDS) is a self-report questionnaire used by health-care providers to survey maternal depression that consists of 10 items and has been translated into at least 12 languages.

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