Postpartum depression

PPD Basics - Not Just the Blues

• PPD is a major depressive episode with onset during pregnancy or within 4 weeks of delivery, though symptoms can arise anytime in the first year.
• Distinguished from transient, milder “postpartum blues.”

Risk Factors - Recipe for PPD

• 📌 Mnemonic: SAD MOTHERS
• Anxiety/depression during pregnancy (strongest predictor)
• Depression history (personal/family)
• Stressful life events & poor social support
• Marital conflict
• Obstetric complications
• Traumatic birth experience
• History of prior PPD
• Economic/low socioeconomic status
• Racial/ethnic minority
• Substance use

⭐ The strongest predictor is depression or anxiety during the pregnancy itself. Screening for this is critical.

Diagnosis - Screening & Symptoms

• Core Criterion: Meets DSM-5 criteria for a major depressive episode with peripartum onset.

• Timing: Onset during pregnancy or within 4 weeks following delivery.

• Screening: Universal screening is key.

  • Tool: Edinburgh Postnatal Depression Scale (EPDS).
  • Threshold: Score >10 suggests PPD and warrants full diagnostic assessment.

• Key Symptoms (≥5 for ≥2 weeks):

  • Depressed mood, Anhedonia (loss of interest)
  • Sleep/appetite changes, low energy
  • Feelings of worthlessness/guilt
  • Suicidal ideation

⭐ Unlike postpartum "blues" (transient, mild), PPD symptoms are more severe, persistent (≥2 weeks), and cause significant functional impairment.

Management - The Treatment Ladder

• Treatment is guided by severity and patient preference, especially regarding breastfeeding.
• Psychotherapy: Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) are first-line for mild to moderate PPD.
• Pharmacotherapy: SSRIs (Sertraline, Paroxetine) are first-line for moderate to severe PPD.
• Severe/Refractory: Electroconvulsive therapy (ECT) is a rapid and effective option, especially with psychosis.

⭐ Untreated maternal depression often poses a greater risk to infant development and bonding than potential exposure to SSRIs through breast milk. Sertraline is frequently preferred.

• Onset is typically within 4 weeks postpartum, but can occur anytime in the first year.
• Differentiated from postpartum blues by duration >2 weeks and significant functional impairment.
• The Edinburgh Postnatal Depression Scale (EPDS) is a validated screening tool.
• Core features include anhedonia, sleep disturbance, and feelings of guilt or inadequacy.
• Always screen for thoughts of harming the infant or self.
• First-line treatment is psychotherapy and SSRIs (sertraline is a preferred agent for breastfeeding mothers).