Postpartum Depression (PPD) (also known as Peripartum Depression, or Major Depressive Disorder with peripartum onset in the DSM-5) is a subtype of depression that occurs during pregnancy or in the first 4
weeks after delivery. However, women remain at risk for developing depression up to several months following delivery. PPD is the most common psychiatric complication related to child-bearing.
The diagnosis of postpartum depression is the same the diagnostic criteria for major depressive disorder, except that the onset of symptoms are during the course of pregnancy or up to 4
weeks after delivery.
Name | Rater | Description | Download |
---|---|---|---|
Edinburgh Postnatal Depression Scale (EPDS) | Patient/Clinician | The EPDS is a 10-question screening questionnaire (not diagnostic) to assess for symptoms of depression and anxiety during pregnancy and in the year following the birth of a child. | EPDS Download |
3
to 4
days after delivery, peak on the postpartum day 7, and disappear within 2
weeks. Symptoms are mainly mood lability, tearfulness, anxiety, insomnia, and irritability that do not meet the full criteria for depression. Since these are mild and transient symptoms, no treatment is required. The baby blues affect 30% to 75% of women shortly after childbirth. The “Blues” may sometimes be the early manifestation of postpartum depression or puerperal psychosis.1st line | Monotherapy: cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT) (individual or group) |
---|---|
2nd line | Monotherapy: citalopram, escitalopram, sertraline Combination therapy: combination SSRI + CBT or IPT |
3rd line (in order of evidence) | • Structured exercise, acupuncture (depression specific), bright-light therapy • Bupropion, desvenlafaxine, duloxetine, fluoxetine, fluvoxamine, mirtazapine, TCAs (caution with clomipramine due to risk of cardiac malformations!), venlafaxine • Electroconvulsive therapy (for severe, psychotic, or treatment-resistant depression) • Therapist-assisted Internet CBT, mindfulness-based CBT, supportive psychotherapy, couples therapy, psychodynamic psychotherapy, rTMS • Combination SSRI + CBT or IPT |
1st line | Monotherapy: cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT) (individual or group) |
---|---|
2nd line | Monotherapy: citalopram, escitalopram, sertraline Combination therapy: combination SSRI + CBT or IPT |
3rd line | • Structured exercise, acupuncture (depression specific), therapist-assisted Internet CBT, or behavioural activation • Fluoxetine, fluvoxamine, paroxetine, TCAs (except doxepin, do not use!) • Bupropion, desvenlafaxine, duloxetine, mirtazapine, venlafaxine, rTMS, bright-light therapy • Electroconvulsive therapy (ECT) (for severe, psychotic, or treatment-resistant depression) • Mindfulness-based CBT, supportive psychotherapy, couples therapy, psychodynamic psychotherapy |
Guideline | Location | Year | Website | |
---|---|---|---|---|
BC Best Practice Guidelines for Mental Health in the Perinatal Period | Canada | 2014 | Link | |
American College of Obstetricians and Gynecologists (ACOG) Psychotropic Medication Guidelines | USA | 2008 | • Link (AAFP) • Link (ACOG) |
|
American Psychiatric Association (APA) and ACOG Depression Guidelines | USA | 2009 | - | Link |
National Institute for Health and Care Excellence (NICE) | UK | 2014, 2020 | - | Link |
British Association for Psychopharmacology (BAP) | UK | 2017 | Link | |
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) | Australia, New Zealand | 2018 | Link |