Postpartum depression

doi:10.1016/j.ajog.2008.11.033

American Journal of Obstetrics and Gynecology

Volume 200, Issue 4, April 2009, Pages 357-364

https://doi.org/10.1016/j.ajog.2008.11.033 Get rights and content

Postpartum depression (PPD) affects up to 15% of mothers. Recent research has identified several psychosocial and biologic risk factors for PPD. The negative short-term and long-term effects on child development are well-established. PPD is under recognized and under treated. The obstetrician and pediatrician can serve important roles in screening for and treating PPD. Treatment options include psychotherapy and antidepressant medication. Obstacles to compliance with treatment recommendations include access to psychotherapists and concerns of breastfeeding mothers about exposure of the infant to antidepressant medication. Further research is needed to examine systematically the short-term and long-term effect of medication exposure through breastmilk on infant and child development.

Section snippets

Postpartum blues

Postpartum blues have been reported to occur in 15-85% of women within the first 10 days after giving birth, with a peak incidence at the fifth day.¹ Common symptoms include mood swings, mild elation, irritability, tearfulness, fatigue, and confusion.1, 2 Antenatal depression, previous depression not related to pregnancy, and previous premenstrual dysphoria have been identified as risk factors.¹ No clear biologic measure has been identified to be causative or predictive of postpartum blues.

Psychotherapy

Interpersonal psychotherapy (IPT), a short-term efficacious treatment for MDD that addresses interpersonal issues (such as role change, the marital relationship, social support, and life stressors) is highly pertinent to the needs of women during the postpartum period.⁶⁹ A randomized controlled trial (RCT) reported that 12 sessions of individual IPT was superior in efficacy to a waitlist control in 120 women with PPD in reducing depression and improving social adjustment.⁷⁰ A smaller RCT in

Comment

Future efforts hopefully will improve the screening and identification of psychiatric disorders in women at their postpartum visit with the obstetrician and at well-baby visits with the pediatrician. Untreated depression and psychotropic medications for the breastfeeding woman each involve exposure of the child to potential short-term and long-term negative effects. Psychotherapy is a treatment option for women with PPD, with IPT being the most validated psychotherapy to be studied to date.

References (116)

C. Reck et al.
Maternity blues as a predictor of DSM-IV depression and anxiety disorders in the first three months postpartum
J Affect Disord
(2009)
U. Halbreich et al.
Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms
J Affect Disord
(2006)
E. Robertson et al.
Antenatal risk factors for postpartum depression: a synthesis of recent literature
Gen Hosp Psychiatry
(2004)
J. Milgrom et al.
Antenatal risk factors for postnatal depression: a large prospective study
J Affect Disord
(2008)
D.J. Newport et al.
Alterations in platelet serotonin transporter binding in women with postpartum onset major depression
J Psychiatry Res
(2004)
E.L. Moses-Kolko et al.
Serotonin 1A receptor reductions in postpartum depression: a positron emission tomography study
Fertil Steril
(2008)
A.L. Salisbury et al.
Prenatal cocaine use and maternal depression: effects on infant neurobehavior
Neurotoxicol Teratol
(2007)
M.C. Lovejoy et al.
Maternal depression and parenting behavior: a meta-analytic review
Clin Psychol Rev
(2000)
A.S. Carter et al.
Maternal depression and comorbidity: predicting early parenting, attachment security, and toddler social-emotional problems and competencies
J Am Acad Child Adolesc Psychiatry
(2001)
T. Field et al.
Prenatal depression effects on the fetus and newborn: a review
Infant Behav Dev
(2006)

M.L. Gunlicks et al.

Change in child psychopathology with improvement in parental depression: a systematic review

J Am Acad Child Adolesc Psychiatry

(2008)

K.A. Comtois et al.

Psychiatric risk factors associated with postpartum suicide attempt in Washington State, 1992-2001

Am J Obstet Gynecol

(2008)

M.K. Krischer et al.

Motives for maternal filicide: Results from a study with female forensic patients

Int J Law Psychiatry

(2007)

M. O'Higgins et al.

Postnatal depression and mother and infant outcomes after infant massage

J Affect Disord

(2008)

A.J. Daley et al.

The roles of exercise in treating postpartum depression: a review of the literature

J Midwifery Womens Health

(2007)

B.L. Parry et al.

Can critically timed sleep deprivation be useful in pregnancy and postpartum depression?

J Affect Disord

(2000)

A.J. Gregoire et al.

Transdermal oestrogen for treatment of severe postnatal depression

Lancet

(1996)

M.P. Freeman et al.

Omega-3 fatty acids and supportive psychotherapy for perinatal depression: a randomized placebo-controlled study

J Affect Disord

(2008)

C. Henshaw

Mood disturbance in the early puerperium: a review

Arch Womens Ment Health

(2003)

J. Heron et al.

Postnatal euphoria: are “the highs” an indicator of bipolarity?

Bipolar Disord

(2005)

Diagnostic and statistical manual of mental disorders, 4th ed, text revised

(2000)

N.I. Gavin et al.

Perinatal depression: a systematic review of prevalence and incidence

Obstet Gynecol

(2005)

R.C. Boyd et al.

Review of screening instruments for postpartum depression

Arch Womens Ment Health

(2005)

J.L. Cox et al.

Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale

Br J Psychiatry

(1987)

C.T. Beck et al.

Further validation of the Postpartum Depression Screening Scale

Nurs Res

(2001)

B.H. Hanusa et al.

Screening for depression in the postpartum period: a comparison of three instruments

J Womens Health

(2008)

T. Munk-Olsen et al.

New parents and mental disorders: a population-based register study

JAMA

(2006)

O. Vesga-Lopez et al.

Psychiatric disorders in pregnant and postpartum women in the United States

Arch Gen Psychiatry

(2008)

P.M. Dietz et al.

Clinically identified maternal depression before, during, and after pregnancies ending in live births

Am J Psychiatry

(2007)

C.T. Beck

Predictors of postpartum depression: an update

Nurs Res

(2001)

M. Bloch et al.

Effects of gonadal steroids in women with a history of postpartum depression

Am J Psychiatry

(2000)

E.J. Corwin et al.

The psychoneuroimmunology of postpartum depression

J Womens Health

(2008)

J. Zonana et al.

The neurobiology of postpartum depression

CNS Spectr

(2005)

M.E. Silverman et al.

Neural dysfunction in postpartum depression: an fMRI pilot study

CNS Spectr

(2007)

K.A. Lee et al.

REM sleep and mood state in childbearing women: sleepy or weepy?

Sleep

(2000)

M.J. Kang et al.

Longitudinal study for sleep-wake behaviours of mothers from pre-partum to post-partum using actigraph and sleep logs

Psychiatry Clin Neurosci

(2002)

D. Goyal et al.

Patterns of sleep disruption and depressive symptoms in new mothers

J Perinat Neonatal Nurs

(2007)

S.L. Warren et al.

Maternal depressive symptoms and child sleep: models of mutual influence over time

Dev Psychopathol

(2006)

L.E. Ross et al.

Sleep and perinatal mood disorders: a critical review

J Psychiatry Neurosci

(2005)

M. Wake et al.

Prevalence, stability, and outcomes of cry-fuss and sleep problems in the first 2 years of life: prospective community-based study

Pediatrics

(2006)

P. Lam et al.

Outcomes of infant sleep problems: a longitudinal study of sleep, behavior, and maternal well-being

Pediatrics

(2003)

A.M. Heneghan et al.

Factors associated with identification and management of maternal depression by pediatricians

Pediatrics

(2007)

D.K. Gjerdingen et al.