Recognizing postpartum depression (PPD)
Recognizing postpartum depression (PPD)
Insights to aid in the differential diagnosis of PPD.
Early distinction between PPD—the most common medical complication of childbirth—and the “baby blues”—a milder, transient form of symptoms—is important.1-13
Differentiating PPD from the baby blues.
Onset of PPD symptoms may occur during pregnancy or after delivery. Opinions of experts vary as to the timing of occurrence of symptoms in PPD after delivery. For example:
- According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), PPD symptoms can begin during pregnancy or in the 4 weeks following childbirth16
- ACOG, World Health Organization (WHO), and the Centers for Disease Control and Prevention (CDC) state that PPD symptoms can occur during pregnancy and up to 1 year after giving birth15,17,18
- Frequent crying
- Mood swings
Note: While symptoms of the baby blues overlap with those of PPD, they are typically less severe, go away on their own, and do not interfere with daily activities.1,14,19
According to the National Institute of Mental Health, symptoms include21:
- Feeling sad, hopeless, empty, or overwhelmed
- Crying more often than usual or for no apparent reason
- Worrying or feeling overly anxious
- Feeling moody, irritable, or restless
- Insomnia or hypersomnia
- Trouble concentrating
- Experiencing anger or rage
- Losing interest in activities that are usually enjoyable
- Physical aches and pains
- Changes in appetite
- Withdrawing from friends and family
- Trouble bonding with her baby
- Persistently doubting her ability to care for her baby
- Thoughts of harming herself or her baby
Symptoms of PPD may vary.
Commonly reported symptoms include the following: feeling sad, hopeless, empty, or overwhelmed; crying more often than usual or for no apparent reason; worrying or feeling overly anxious; feeling moody, irritable, or restless; Insomnia or hypersomnia; trouble concentrating; experiencing anger or rage; losing interest in activities that are usually enjoyable; physical aches and pains; changes in appetite; withdrawing from friends and family; trouble bonding with her baby; persistently doubting her ability to care for her baby; thoughts of harming herself or her baby.21
Anxiety can be a prominent component of PPD. This may manifest as intrusive and or obsessive thoughts about the newborn.23
The American College of Obstetricians and Gynecologists (ACOG) recommends screening patients at least once during the perinatal period using a standardized, validated tool.17
Some examples of these tools include the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9).
Very rarely, a new mother may develop postpartum psychosis.3,14
Women with postpartum psychosis may show symptoms of paranoia, hallucinations, confusion, and extreme agitation, and are a danger to themselves and their children. They should never be left alone.
Patients exhibiting signs of postpartum psychosis require immediate admission to an emergency department for evaluation and care.
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