Snapshot A 25-year-old woman presents to the clinic 3 days after delivery of her newborn son. She experiences the following situations (3 separate vignettes are presented): Occasional tearfulness and feeling sad several days out of the week. She still takes good care of her baby and has no thought of hurting the baby. (Postpartum blues) Loss of pleasure and a severely depressed mood most days of the week. She takes care of her baby but sometims has thoughts of hurting the baby. (Major depressive disorder with peripartum onset (postpartum depression) Is hearing voices telling her to drown the baby so that the world will be safe. (Peripartum psychosis) Introduction Overview postpartum depression is a mood disorder that can affect women after childbirth postpartum blues login to view 1 more bullet major depressive disorder with peripartum onset (postpartum depression) login to view 1 more bullet peripartum psychosis login to view 1 more bullet Epidemiology Postpartum blues incidence 50-85% of postpartum women Major depressive disorder with peripartum onset incidence 10-15% of postpartum women Peripartum psychosis incidence 0.1-0.2% of postpartum women Risk factors history of premenstrual mood changes (postpartum blues) depressive syndromes pre-pregnancy family history of depression or psychiatric illness stressful life events during pregnancy or after delivery Presentation Symptoms postpartum blues mild depressive symptoms login to view 6 more bullets mood lability generally diagnosed if 3 or 4 depressive symptoms present major depressive disorder with peripartum onset depressed mood Sleep disturbance, loss of Interest, Guilt or feelings of worthlessness, Energy loss and fatigue, Concentration problems, Appetite/weight changes, Psychomotor retardation or agitation, and Suicidal ideations (mnemonic: SIG E CAPS) login to view 2 more bullets peripartum psychosis rapid onset of psychotic symptoms, including hallucinations and delusions typically accompanied by manic and/or depressed mood login to view 2 more bullets Treatment Lifestyle no treatment required for postpartum blues, which generally resolves spontaneously evaluate for postpartum depression if login to view 2 more bullets Medical treatment of postpartum major depression antidepressant medications along with psychotherapy login to view 2 more bullets psychotherapy alone is reasonable if depressive syndrome does not include suicidal ideation treatment of peripartum psychosis hospitalization of mother until stable login to view 1 more bullet antipsychotic medications login to view 2 more bullets