AKT · Psychiatry/Mood

Postpartum depression

Overview

Depressive episode with onset typically within the first weeks–months postpartum. Distinct from transient "baby blues" (days 3–10, self-limiting) and from postpartum psychosis (a psychiatric emergency).

Recognise

Persistent low mood, tearfulness, anhedonia, guilt (often about mothering)
Anxiety, poor sleep beyond the baby’s needs
Thoughts of harm to self or rarely the baby — must ask

Red flags

Thoughts of harming the baby, psychotic features, or marked functional decline → urgent perinatal mental health referral

Differentials & how to tell them apart

Baby bluesdays 3–10, mild and self-limiting, no functional impairment

Postpartum psychosisrapid onset days 1–2 weeks, mania/delusions/confusion — emergency

Hypothyroidism (postpartum thyroiditis)check TFTs

Investigations

Clinical; Edinburgh Postnatal Depression Scale (EPDS) is the screening tool. Risk assessment of mother and infant.

Management

1Mild–moderate: guided self-help/CBT or IPT first-line.
2Moderate–severe or no response: antidepressant (sertraline if breastfeeding) ± psychological therapy; consider perinatal mental-health team.

Sertraline — preferred SSRI in breastfeeding (low milk transfer)

CBT / interpersonal therapy — first-line for mild–moderate

Key points

Always weigh breastfeeding; sertraline/paroxetine have low milk levels. Screen future pregnancies (recurrence risk).

Monitor & prognosis

Mood, mother–infant bonding, suicide and infant-harm risk.

Good with treatment; recurrence risk in future pregnancies.

Source: NICE CKS Depression-antenatal/postnatal / NG192