Postpartum depression and postpartum psychosis

Definition

• Perinatal depression is a mood disorder during pregnancy or within one year after birth; according to DSM-5-TR, a depressive episode beginning in pregnancy or up to 4 weeks postpartum is classified as peripartum onset.
• Postpartum psychosis is the most severe form, with marked confusion, loss of touch with reality, paranoia, delusions, disorganised thinking and hallucinations, and usually begins within days to 6 weeks after birth.
• It is distinguished from the baby blues, with mild, transient depressive symptoms in the first week, which usually last 2 to 3 days (up to 2 weeks), do not substantially impair daily functioning and are not considered a mental disorder.

Classification

Baby blues and depression

• The baby blues appears around the third to fifth day, affects most women and settles within a few days.
• Postnatal depression affects about 10 to 15 per cent of women and often begins insidiously over the first weeks to months.
• The screening tool is the Edinburgh Postnatal Depression Scale.
• Puerperal psychosis is rare (about 1 to 2 per 1000), usually starts early and is a psychiatric emergency.

Occurrence & epidemiology

Epidemiology

• The baby blues are very common; postpartum depression occurs in about 7% of women in the first year after birth, and postpartum psychosis in about 1 to 2 per 1,000 women.
• Up to 50% of perinatal depressions remain undiagnosed, partly because those affected do not disclose symptoms owing to stigma.

Aetiopathogenesis

Aetiology and risk factors

• The exact cause is unknown; the major risk factor is previous depression, and hormonal changes in the puerperium, sleep deprivation and genetic susceptibility may contribute.

Clinical features

Clinical features and complications

• Depression presents with persistent sadness, loss of interest, sleep and appetite disturbance, anxiety, irritability, guilt, feelings of inadequacy as a mother, fear of harming the baby and difficulty bonding; symptoms usually develop insidiously over about 3 months.
• The risk of suicide is increased; the risk of recurrence is about 1 in 3 to 4, and unrecognised postpartum psychiatric disorders increase the risk of suicide and infanticide.
• Postpartum psychosis is a psychiatric emergency, particularly when there is suicidal or homicidal ideation.

Diagnosis

• The diagnosis follows the criteria for major depression: at least 5 symptoms for more than 2 weeks, including depressed mood and/or loss of interest.
• Validated questionnaires such as the Edinburgh Postnatal Depression Scale and the Postpartum Depression Screening Scale are used as screening tools; suicidal or homicidal thoughts are asked about specifically.

Keep learning in the app

Further reading (selection)

1. StatPearls: Perinatal Depression (NCBI Bookshelf)
2. StatPearls: Postpartum Psychosis (NCBI Bookshelf)
3. MSD Manual Professional Edition: Postpartum Depression
4. DocCheck Flexikon, Postpartale Depression

Cross-references