A Review of Postpartum Depression

Postpartum depression (PPD) is an irritable, severely depressed mood that occurs within 4 weeks of giving birth and possibly as late as 30 weeks postpartum. Manifestations include crying spells, insomnia, depressed mood, fatigue, anxiety, and poor concentration. Patients may experience mild, moderate, or severe symptoms. Many psychosocial stressors may have an impact on the development of PPD. Recent studies conclude that the majority of factors are largely social in nature. The greatest risk is in women with a history of depression or other affective illness and in those who have experienced depression during past pregnancies. Women with significant risk factors should be followed closely in the postpartum period.

The severity of symptoms and degree of impairment guide the approach to treatment. Treatment should begin with psychotherapy and advance to pharmacotherapy if needed; however, many patients benefit from concomitant treatment with both psychotherapy and medication. Common forms of psychotherapy include interpersonal therapy and short-term cognitive-behavioral therapy. Postpartum depression demands the same pharmacologic treatment as major depression does, with similar doses as those given to patients with nonpuerperal depression. It is essential to use an adequate dose of antidepressants in a duration sufficient to ensure complete recovery. Mothers should continue medication for 6 to 12 months postpartum to ensure a complete recovery.

Inadequate treatment of depression puts women at risk for the sequelae of untreated affective illness, and the depression may become chronic, recurrent, and/or refractory. Family physicians are key players in the detection and treatment of PPD owing to the nature of the disease and the tendency for new mothers to negate their feelings as something other than a treatable psychiatric illness.