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Postpartum DepressionAka: Postpartum Blues

See Also
1. Major Depression
Epidemiology
1. Postpartum Blues: 50-80% of post-partum women
2. Postpartum Depression: 5-10% of post-partum women
3. Postpartum Psychosis: 1-2 per thousand postpartum women
Risks
1. Prior history of psychiatric disorder
2. Affective instability during pregnancy
3. Lack of Social Support
Symptoms
1. Depression lasts >2 weeks (contrast with Blues)
2. Comorbid anxiety and agitation
Diagnosis
1. See Depression Screening Tools
2. Edinburgh Postnatal Depression Scale
3. Patient Health Questionaire 9
  1. Validation in Postpartum depression is anticipated publication in 2009
Management
1. Psychotherapy
2. Consider low dose Estrogen Replacement
  1. Transdermal Estrogen postpartum
3. Adjust social situation
  1. Longer maternity leave
  2. Return part-time
4. For Major Depression treatment in Lactation
  1. Nortriptyline
    1. Appears safe in Lactation
  2. Selective Serotonin Reuptake Inhibitors (SSRI)
    1. May also be safe in Lactation (unclear)
    2. New data suggests safety of agents
    3. Consider checking infant drug levels
Resources
1. Patient Education materials form Minnesota Department of Health
  1. http://www.health.state.mn.us/divs/fh/mch/fhv/strategies/ppd/index.html
References
1. Ahokas (2000) J Clin Psychiatry 61:166

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This page was written by Scott Moses, MD. This page was last revised on 11/20/2008 4:33:53 PM. This page was last published on 2/26/2010. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.