Postpartum depression

Obstetricians must be familiar with the diagnosis and treatment of postpartum depression (PPD), as they are the first contact physicians of most postpartum depressed women. Postpartum depression is particularly critical to treat as it has significant impact on the mother, the infant, and the family if left untreated. Clinicians should be able to identify the risk factors for depression in postpartum women. Self-report scales can be used to detect depressive symptoms in new mothers especially in nonpsychiatric settings, to facilitate making the diagnosis of postpartum depression. Although the symptoms of PPD are not significantly different from a major depressive episode, physicians must note that the neurovegetative signs of depression may be confused with normal physiological changes associated with the puerperal period. Assessment of suicide risk is essential, although the postpartum period is regarded as a low-risk period for self harm. Psychiatric referral is mandatory if there is any suspicion of suicidal or infanticidal ideation. The presence of psychotic and manic symptoms also requires referral to a psychiatrist as this may be a manifestation of postpartum psychosis or bipolar disorder. PPD should be treated as any major depressive episode. Untreated PPD has significant impact on the child including adverse effects on cognitive, emotional, and social development of the child in addition to impaired mother-infant bonding.