🔑 Key Learning

  • Postpartum depression affects 1 in 10 women and typically presents after 1 month, unlike baby blues
  • Edinburgh Postnatal Depression Scale (EPDS) is used to assess postpartum mood
    • Score >13 suggests depression
  • Sertraline and paroxetine are the safest SSRIs during breastfeeding
  • Baby blues are common, self-limiting, and present within the first week postpartum
    • The quick onset helps differentiate from PND (1-3 months)
  • Postpartum psychosis is a psychiatric emergency with sudden mood disturbance and psychotic symptoms

😔 Postpartum Depression (PND)

📈 Epidemiology

  • PND is common! It affects approximately 1 in 10 women
  • Onset typically 1–3 months postpartum (distinguishes from baby blues)

👀 Clinical Features

  • Low mood
  • Anhedonia
  • Fatigue
  • Altered sleep/wake and appetite patterns
  • Tearfulness or anxiety

🧪 Assessment

  • PHQ-9 or Edinburgh Postnatal Depression Scale (EPDS)
    • Score >13 on EPDS suggests a depressive episode

💊 Management

  • Mild to moderate:
    • Refer for facilitated self-help or CBT (based on severity/preference)
  • Moderate to severe:
    • High-intensity therapy: CBT
    • Antidepressants if:
      • Psychological therapy declined
      • Inadequate response
      • Patient preference for medication

Breastfeeding-safe SSRIs:

  • Paroxetine
  • Sertraline
  • These have the lowest milk:plasma ratio

😢 Baby Blues

📈 Epidemiology

  • Affects up to 70% of women postpartum

👀 Clinical Features

  • Occurs 3–7 days after delivery
  • Emotional lability
  • Tearfulness, fatigue
  • Anxiety or irritability

💬 Management

  • Reassurance
  • Support from midwife or health visitor
  • Self-limiting — resolves in days

🧨 Postpartum Psychosis

📈 Epidemiology

  • Rare but serious — affects 2 in 1000 postpartum women

👀 Clinical Features

  • Acute onset — usually 2–3 weeks postpartum
  • Severe mood disturbance (highs or lows)
  • Psychotic symptoms:
    • Delusions
    • Hallucinations
    • Confusion or disorientation

⚠️ Management

  • Urgent admission for psychiatric assessment and treatment
  • High recurrence risk — up to 50% in future pregnancies

📝 Exam Clues & Clinchers

  • Tearful + anxious + 4 days postpartum → baby blues
  • Low mood + poor sleep + 6 weeks postpartum → postnatal depression
  • Visual hallucinations + elated mood + 2 weeks postpartum → postpartum psychosis
  • EPDS score >13 → suggestive of postpartum depression
  • Breastfeeding mother needing antidepressants → choose sertraline or paroxetine

🔗 Useful Links and References

NICE CKS: Depression - antenatal and postnatal