Treatment Guideline Chart

Postpartum depression is the occurrence of a major depressive episode within 4 weeks following delivery or up to a year after childbirth.

It may peak at 2-4 weeks and 10-14 weeks after childbirth.

Symptoms are similar to that of major depression but with additional features distinctive of the postpartum period like feelings of being overwhelmed and inadequate as a parent.

Postpartum%20depression Management

Expert Referral

  • A referral to a psychiatrist or a mental health professional is needed when patient’s symptoms are severe and unresponsive to initial therapy, and if patient has mania, psychosis or thoughts of harming oneself or others, eg baby
  • Evaluation for treatment is done within 2 weeks of referral and psychological interventions provided within 4 weeks of initial evaluation
  • Consider hospitalization if patient is acutely suicidal

Follow Up

  • Patients should be followed up regularly to evaluate adherence to medications, response to treatment, and for any suicidal ideation
    • Risk factors for attempting suicide include history of major depressive disorder or recurrent depression, psychiatric hospitalization within the first year after childbirth, young maternal age (eg adolescents)
  • Patients with mild to moderate PPD may be seen 4-6 weeks after diagnosis and initiation of therapy while for severe PPD, it is 2-4 weeks
  • Use standardized questionnaires to measure treatment response, eg Patient Health Questionnaire
  • Breastfed infants of mothers on antidepressant therapy should also be evaluated for drug effects


  • Depression during pregnancy should be treated to prevent PPD as women with untreated depression are 5-7x more at risk than women without antenatal depressive symptoms
    • Psychotherapy or medical therapy given during the 1st trimester in women with depression decreases risk of PPD
  • Women with significant risk factors for developing PPD or those who have depressive symptoms which do not meet PPD definition may benefit from supportive and psychological interventions done postnatally than when done during pregnancy
  • Recurrence rate had been estimated at 25-41% in women during the first postnatal year
    • Risk of recurrence is very high for women with bipolar disorder
    • Studies have shown that treatment with antidepressants may help prevent recurrence of PPD
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