Postpartum Depression
Postpartum depression is a major depressive episode occurring during pregnancy or within a year after birth, managed per ACOG Clinical Practice Guideline No. 4 (Screening and Diagnosis) and No. 5 (Treatment and Management).
Symptoms
Persistent sadness, loss of interest in the baby or daily life, excessive guilt, sleep and appetite changes beyond what's expected postpartum, difficulty bonding with the baby, and in more severe cases, thoughts of harming oneself -- affecting roughly 1 in 7 birthing parents.
Causes and risk
Rapid hormonal shifts after birth, sleep deprivation, and psychosocial stress all contribute; a personal or family history of depression, depression during pregnancy, and lack of social support all raise risk.
How it is evaluated
The Edinburgh Postnatal Depression Scale (EPDS) is the standard screening tool, with a score of 10 or higher requiring further evaluation; ACOG recommends screening at least once during pregnancy and again postpartum, and the self-harm item must always be reviewed directly with the patient, per ACOG Guideline No. 4.
Treatment
Psychotherapy is first-line for mild-to-moderate PPD; sertraline or escitalopram are first-line medications for more significant symptoms, with the neuroactive steroid zuranolone available as an oral option for moderate-to-severe PPD, per ACOG Guideline No. 5. Screening for bipolar disorder before starting an antidepressant is an important safety step, since antidepressants can trigger mania.
When to seek care
Postpartum psychosis is a psychiatric emergency -- it typically develops rapidly, 3 to 10 days after birth, with confusion, hallucinations, delusions, or bizarre behavior. Per ACOG guidance, a person in this state should not be left alone with the infant, and immediate emergency care is needed: call 911 or go to the nearest emergency room. Any thoughts of self-harm also require immediate crisis support via the 988 Suicide and Crisis Lifeline.