Peripartum Depression

Last Updated: July 13, 2023

Postpartum depression is a transient depressive state that occurs after the birth of a child and is a target for antidepressant compounds that have been confirmed to be safe for both mother and child.

Peripartum Depression falls under theMental Healthcategory.

What is peripartum depression?

Peripartum depression (PPD) is an episode of depression that begins either during pregnancy or following delivery. The technical psychiatric term for PPD in American psychiatry, per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is a depressive episode “with peripartum onset”, i.e., one which began during pregnancy (antepartum) or within 4 weeks of delivery (post-partum). The depressive episode may be an episode of major depression, of dysthymia, or of unspecified depressive disorder.[1] However, other definitions of PPD allow for onset up to one year following delivery.[2] Roughly 1 in 10 to 1 in 5 new birthing parents experience PPD, with higher rates in adolescents.[3][4] Globally, the number may be closer to 1 in 4.[2] It’s also possible for a non-birthing parent (such as a father) to experience PPD.[5][6] PPD is different from the “baby blues,” which are a normal occurrence that affects the majority of new birthing parents.

What are the main signs and symptoms of PPD?

There are no signs of PPD, and the symptoms largely overlap with depression. The American Psychiatric Association lists the following symptoms of PPD on its website:ref

  • Feeling sad or having a depressed mood
  • Loss of interest or pleasure in activities once enjoyed
  • Changes in appetite
  • Trouble sleeping or sleeping too much
  • Loss of energy or increased fatigue
  • Increase in purposeless physical activity (e.g., inability to still still, pacing, handwringing) or slowed movements or speech. These actions must be severe enough to be observable by others.
  • Feeling worthless or guilty
  • Difficulty thinking, concentrating, or making decisions
  • Thoughts of death or suicide
  • Crying for “no reason”
  • Lack of interest in the baby, not feeling bonded to the baby, or feeling very anxious about/around the baby
  • Feelings of being a bad mother
  • Fear of harming the baby or oneself

To be considered PPD, the depressive episode must begin during pregnancy or within four months of birth (per the APA).

How is PPD diagnosed?

The American College of Obstetricians and Gynecologists recommends depression and anxiety screening for all birthing parents using a standardized, validated tool, such as the Edinburgh Postnatal Depression Scale (EPDS).[7]

Anyone identified by screening, or who suspects they may be experiencing PPD, should be diagnosed by a healthcare provider, who will assess their depressive symptoms. Per the American Psychiatric Association, the diagnostic criteria for peripartum depressive episodes match those of the respective depressive episode, with the additional criterion of onset within 4 months of delivery.[1]ref

What are some of the main medical treatments for PPD?

Unlike the “baby blues,” which are a normal part of pregnancy and childbirth and resolve without treatment, treatment is essential for PPD. Treatment for PPD is similar to treatment for non-peripartum depression, and may include:

  • Talk therapy, such as cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), and/or group therapy
  • Medication
  • Lifestyle changes
  • Social supports

Pregnant or nursing people should discuss risks and benefits of any medication with a healthcare provider.ref[8]

Have any supplements been studied for PPD?

Supplements studied for PPD include vitamin B6,[9] vitamin D,[10][11][12] fish oil/omega-3 fatty acids,[13][14][15][16][17] folate,[18] and saffron.[19][20]

While the symptoms of PPD match those of major depression, many more supplements have been studied for major depression than have been evaluated for safety during pregnancy/ postpartum and for efficacy in PPD.

How could diet affect PPD?

A healthy diet, i.e., a balanced diet that is rich in fruits and vegetables and low in processed foods, may help reduce the risk of perinatal depression. A 2015 systematic review found an association between poor or unhealthy diets and prenatal depression/stress. However, the postnatal evidence they reviewed was mixed.[21] A 2019 review found an inverse association between a “healthy” diet and perinatal anxiety and depression.[22] Finally, a 2020 systematic review noted an inverse association between healthy postpartum diet and postpartum depression.[23] All three reviews concluded that more research is needed: more longitudinal studies with plenty of participants, as well as studies of specific dietary interventions.

Are there any other treatments for PPD?

Several alternative treatments have been studied, including repetitive transcranial magnetic stimulation, exercise, massage, bright light therapy, acupuncture, and yoga.

What causes PPD?

While no single cause of PPD has been determined, many risk factors have been identified. A 2023 meta-analysis found the following as major risk factors: a personal history of mental illness, childcare stress, the baby’s temperament (e.g., infantile colic, inconsolable crying), stressful life events, inadequate social support, the maternity blues, and conflict or dissatisfaction with one’s partner.[2] Low socioeconomic status, abuse, gestational diabetes, vitamin D deficiency, and pregnancy or delivery complications have also been identified as risk factors for PPD.[8][24] Additionally, a 2013 Canadian study found that women who lived in cities of over 500,000 people were at higher risk of postpartum depression, possibly due to lack of social support.[25] Neuroendocrinological factors, genetic predisposition and family history may also be at play.[26] Exclusive breastfeeding is associated with a lower risk of PPD,[27] although it’s unclear whether this is a cause or effect.

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References
  1. ^American Psychiatric AssociationDiagnostic and Statistical Manual of Mental Disorders, 5th ed, pp. 162, 169, 186(2013)
  2. ^Al-Abri K, Edge D, Armitage CJPrevalence and correlates of perinatal depression.Soc Psychiatry Psychiatr Epidemiol.(2023-Jan-16)
  3. ^Peripartum and Postpartum Depression: PsychDB(Februrary 2021)
  4. ^Torres,FWhat Is Peripartum Depression (formerly Postpartum): Psychiatry.org(Oct 2020)
  5. ^Varma, SExpert Q&A on Peripartum Depression: Psychiatry.org
  6. ^Iwata H, Mori E, Maehara K, Kimura K, Toyama F, Kakehashi A, Seki M, Abe S, Kosaka MPreventive interventions for paternal perinatal depression: a scoping review protocol.BMJ Open.(2023-Mar-08)
  7. ^ACOG Committee Opinion No. 757: Screening for Perinatal DepressionObstet Gynecol.(2018 Nov)
  8. ^Alhusen JL, Alvarez CPerinatal depression: A clinical update.Nurse Pract.(2016-May-19)
  9. ^Maryam Khodadad, Parvin Bahadoran, Gholam Reza Kheirabadi, Ali Mohammad SabzghabaeeCan Vitamin B6 Help to Prevent Postpartum Depression? A Randomized Controlled TrialInt J Prev Med.(2021 Oct 19)
  10. ^Vaziri F, Nasiri S, Tavana Z, Dabbaghmanesh MH, Sharif F, Jafari PA randomized controlled trial of vitamin D supplementation on perinatal depression: in Iranian pregnant mothersBMC Pregnancy Childbirth.(2016 Aug 20)
  11. ^Amini S, Jafarirad S, Amani RPostpartum depression and vitamin D: A systematic review.Crit Rev Food Sci Nutr.(2019)
  12. ^Gould JF, Gibson RA, Green TJ, Makrides MA Systematic Review of Vitamin D during Pregnancy and Postnatally and Symptoms of Depression in the Antenatal and Postpartum Period from Randomized Controlled Trials and Observational Studies.Nutrients.(2022-May-30)
  13. ^Juliana Dos Santos Vaz, Dayana Rodrigues Farias, Amanda Rodrigues Amorim Adegboye, Antonio Egidio Nardi, Gilberto KacOmega-3 supplementation from pregnancy to postpartum to prevent depressive symptoms: a randomized placebo-controlled trialBMC Pregnancy Childbirth.(2017 Jun 9)
  14. ^Su KP, Huang SY, Chiu TH, Huang KC, Huang CL, Chang HC, Pariante CMOmega-3 fatty acids for major depressive disorder during pregnancy: results from a randomized, double-blind, placebo-controlled trialJ Clin Psychiatry.(2008 Apr)
  15. ^Makrides M, Gibson RA, McPhee AJ, Yelland L, Quinlivan J, Ryan P; DOMInO Investigative TeamEffect of DHA supplementation during pregnancy on maternal depression and neurodevelopment of young children: a randomized controlled trialJAMA.(2010 Oct 20)
  16. ^Taciana Maia de Sousa, Luana Caroline Dos SantosEffect of antenatal omega-3 supplementation on maternal depressive symptoms from pregnancy to 6 months postpartum: a randomized double-blind placebo-controlled trialNutr Neurosci.(2022 May 2)
  17. ^Mi-Mi Zhang, Yan Zou, Su-Min Li, Li Wang, Yu-Hui Sun, Le Shi, Lin Lu, Yan-Ping Bao, Su-Xia LiThe efficacy and safety of omega-3 fatty acids on depressive symptoms in perinatal women: a meta-analysis of randomized placebo-controlled trialsTransl Psychiatry.(2020 Jun 17)
  18. ^Deligiannidis KM, Freeman MPComplementary and alternative medicine therapies for perinatal depression.Best Pract Res Clin Obstet Gynaecol.(2014-Jan)
  19. ^Jamshid Tabeshpour, Farzaneh Sobhani, Seyed Alireza Sadjadi, Hossein Hosseinzadeh, Seyed Ahmad Mohajeri, Omid Rajabi, Zhila Taherzadeh, Saeid EslamiA double-blind, randomized, placebo-controlled trial of saffron stigma (Crocus sativus L.) in mothers suffering from mild-to-moderate postpartum depressionPhytomedicine.(2017 Dec 1)
  20. ^L Kashani, S Eslatmanesh, N Saedi, N Niroomand, M Ebrahimi, M Hosseinian, T Foroughifar, S Salimi, S AkhondzadehComparison of Saffron versus Fluoxetine in Treatment of Mild to Moderate Postpartum Depression: A Double-Blind, Randomized Clinical TrialPharmacopsychiatry.(2017 Mar)
  21. ^Baskin R, Hill B, Jacka FN, O'Neil A, Skouteris HThe association between diet quality and mental health during the perinatal period. A systematic review.Appetite.(2015-Aug)
  22. ^Silva DFO, Cobucci RN, Gonçalves AK, Lima SCVCSystematic review of the association between dietary patterns and perinatal anxiety and depression.BMC Pregnancy Childbirth.(2019-Jun-24)
  23. ^Opie RS, Uldrich AC, Ball KMaternal Postpartum Diet and Postpartum Depression: A Systematic Review.Matern Child Health J.(2020-Aug)
  24. ^Iris Agrawal, Ashok M Mehendale, Ritika MalhotraRisk Factors of Postpartum DepressionCureus.(2022 Oct 31)
  25. ^Simone N Vigod, Lesley A Tarasoff, Barbara Bryja, Cindy-Lee Dennis, Mark H Yudin, Lori E RossRelation between place of residence and postpartum depressionCMAJ.(2013 Sep 17)
  26. ^Rawashdeh H, Alalwani Z, Sindiani A, Alodetalah R, Alqudah MThe Association between Late Third-Trimester Oxytocin Level and Early-Onset Postpartum Depression Symptoms among Jordanian Mothers: A Cross-sectional Study.Depress Res Treat.(2022)
  27. ^Alimi R, Azmoude E, Moradi M, Zamani MThe Association of Breastfeeding with a Reduced Risk of Postpartum Depression: A Systematic Review and Meta-Analysis.Breastfeed Med.(2022-Apr)
  28. ^Beck CTPredictors of postpartum depression: an update.Nurs Res.(2001)
  29. ^Tosto V, Ceccobelli M, Lucarini E, Tortorella A, Gerli S, Parazzini F, Favilli AMaternity Blues: A Narrative Review.J Pers Med.(2023-Jan-13)
  30. ^Wilson CA, Seed P, Flynn AC, Howard LM, Molyneaux E, Sigurdardottir J, Poston LIs There an Association Between Diet, Physical Activity and Depressive Symptoms in the Perinatal Period? An Analysis of the UPBEAT Cohort of Obese Pregnant Women.Matern Child Health J.(2020-Dec)
  31. ^Lee HJ, Kim SM, Kwon JYRepetitive transcranial magnetic stimulation treatment for peripartum depression: systematic review & meta-analysis.BMC Pregnancy Childbirth.(2021-Feb-09)
  32. ^Carter T, Bastounis A, Guo B, Jane Morrell CThe effectiveness of exercise-based interventions for preventing or treating postpartum depression: a systematic review and meta-analysis.Arch Womens Ment Health.(2019-Feb)
  33. ^Morres ID, Tzouma NA, Hatzigeorgiadis A, Krommidas C, Kotronis KV, Dafopoulos K, Theodorakis Y, Comoutos NExercise for perinatal depressive symptoms: A systematic review and meta-analysis of randomized controlled trials in perinatal health services.J Affect Disord.(2022-Feb-01)
  34. ^Pentland V, Spilsbury S, Biswas A, Mottola MF, Paplinskie S, Mitchell MSDoes Walking Reduce Postpartum Depressive Symptoms? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.J Womens Health (Larchmt).(2022-Apr)
  35. ^Sheffield KM, Woods-Giscombé CLEfficacy, Feasibility, and Acceptability of Perinatal Yoga on Women's Mental Health and Well-Being: A Systematic Literature Review.J Holist Nurs.(2016-Mar)
  36. ^Elizabeth H Eustis, Samantha Ernst, Kristen Sutton, Cynthia L BattleInnovations in the Treatment of Perinatal Depression: the Role of Yoga and Physical Activity Interventions During Pregnancy and PostpartumCurr Psychiatry Rep.(2019 Dec 4)
  37. ^Quansheng Tan, Shuai Liu, Dajie ChenPoor vitamin D status and the risk of maternal depression: a dose-response meta-analysis of observational studiesPublic Health Nutr.(2021 Jun)
  38. ^Pooja Dhiman, Raji Ramachandran Pillai, Anand Babu Wilson, Nancy Premkumar, Balaji Bharadwaj, Veena P Ranjan, Soundravally RajendiranCross-sectional association between vitamin B12 status and probable postpartum depression in Indian womenBMC Pregnancy Childbirth.(2021 Feb 17)
Examine Database References
  1. Postpartum Depression Symptoms - Juliana Dos Santos Vaz, Dayana Rodrigues Farias, Amanda Rodrigues Amorim Adegboye, Antonio Egidio Nardi, Gilberto KacOmega-3 supplementation from pregnancy to postpartum to prevent depressive symptoms: a randomized placebo-controlled trialBMC Pregnancy Childbirth.(2017 Jun 9)
  2. Postpartum Depression Symptoms - Su KP, Huang SY, Chiu TH, Huang KC, Huang CL, Chang HC, Pariante CMOmega-3 fatty acids for major depressive disorder during pregnancy: results from a randomized, double-blind, placebo-controlled trialJ Clin Psychiatry.(2008 Apr)
  3. Postpartum Depression Symptoms - Doornbos B, van Goor SA, Dijck-Brouwer DA, Schaafsma A, Korf J, Muskiet FASupplementation of a low dose of DHA or DHA+AA does not prevent peripartum depressive symptoms in a small population based sampleProg Neuropsychopharmacol Biol Psychiatry.(2009 Feb 1)
  4. Postpartum Depression Symptoms - Rees AM, Austin MP, Parker GBOmega-3 fatty acids as a treatment for perinatal depression: randomized double-blind placebo-controlled trialAust N Z J Psychiatry.(2008 Mar)
  5. Postpartum Depression Symptoms - Llorente AM, Jensen CL, Voigt RG, Fraley JK, Berretta MC, Heird WCEffect of maternal docosahexaenoic acid supplementation on postpartum depression and information processingAm J Obstet Gynecol.(2003 May)
  6. Depression Symptoms - Mozurkewich EL, Clinton CM, Chilimigras JL, Hamilton SE, Allbaugh LJ, Berman DR, Marcus SM, Romero VC, Treadwell MC, Keeton KL, Vahratian AM, Schrader RM, Ren J, Djuric ZThe Mothers, Omega-3, and Mental Health Study: a double-blind, randomized controlled trialAm J Obstet Gynecol.(2013 Apr)
  7. Depression Symptoms - Freeman MP, Davis M, Sinha P, Wisner KL, Hibbeln JR, Gelenberg AJOmega-3 fatty acids and supportive psychotherapy for perinatal depression: a randomized placebo-controlled studyJ Affect Disord.(2008 Sep)
  8. Depression Symptoms - Jamshid Tabeshpour, Farzaneh Sobhani, Seyed Alireza Sadjadi, Hossein Hosseinzadeh, Seyed Ahmad Mohajeri, Omid Rajabi, Zhila Taherzadeh, Saeid EslamiA double-blind, randomized, placebo-controlled trial of saffron stigma (Crocus sativus L.) in mothers suffering from mild-to-moderate postpartum depressionPhytomedicine.(2017 Dec 1)
  9. Depression Symptoms - L Kashani, S Eslatmanesh, N Saedi, N Niroomand, M Ebrahimi, M Hosseinian, T Foroughifar, S Salimi, S AkhondzadehComparison of Saffron versus Fluoxetine in Treatment of Mild to Moderate Postpartum Depression: A Double-Blind, Randomized Clinical TrialPharmacopsychiatry.(2017 Mar)