Postpartum Depression Diagnosis and Treatment

Diagnostic Approach

The American Psychological Association recommends screening for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS), which has demonstrated criterion validity and is available in over 60 languages 3
A cutoff score of 11 or higher on the EPDS maximizes combined sensitivity and specificity for detecting postpartum depression, with the scale consisting of 10 questions yielding a total score between 0-30 3
Postpartum depression affects 10-15% of new mothers, with meta-analyses estimating prevalence at 19.2% for minor and 7.1% for major postpartum depression within three months after delivery 1, 2
The American Psychiatric Association recommends confirming diagnosis using DSM-5 criteria for major depressive disorder with peripartum onset, which specifies symptom onset during pregnancy or within the first four weeks postpartum 1, 2
Duration of symptoms should be at least two weeks with significant functional impairment, according to the American Psychiatric Association 2
History of depression during previous pregnancies is a critical risk factor to identify, according to the American College of Obstetricians and Gynecologists 1, 2
Psychosocial stressors, including lack of social support, are also important risk factors, as noted by the American College of Obstetricians and Gynecologists 1

The American College of Obstetricians and Gynecologists recommends initiating sertraline as the preferred SSRI for postpartum women, particularly those who are breastfeeding, due to minimal passage into breastmilk and decades of safety data 6
The standard starting dose of sertraline is typically 25-50 mg daily, titrated based on response, although the initial dose should be the lowest effective dose 6
The American Academy of Pediatrics notes that most antidepressants, including sertraline, are compatible with breastfeeding 6
Neonates exposed to sertraline in late third trimester may develop transient neonatal adaptation syndrome, with symptoms including crying, irritability, tremors, poor feeding, hypertonia, tachypnea, sleep disturbance, and rarely hypoglycemia or seizures, as reported by the American Academy of Pediatrics 7, 6
These neonatal symptoms typically resolve within 1-4 weeks and are generally mild, according to the American Academy of Pediatrics 7, 6
Multiple reviews have not identified adverse neurodevelopmental outcomes in infants exposed to SSRIs during pregnancy, as noted by the American College of Obstetricians and Gynecologists 6

The American College of Obstetricians and Gynecologists recommends arranging early follow-up after delivery if the patient was treated with sertraline in the third trimester, as infants are at risk for withdrawal or toxicity symptoms over the first week of life 6
The American Academy of Pediatrics advises monitoring the infant carefully for irritability, insomnia, feeding difficulty, and respiratory symptoms 8, 9, 6
The American College of Obstetricians and Gynecologists recommends informing the pediatric team about maternal sertraline use so they can anticipate and manage neonatal adaptation syndrome if it occurs 6

The American Psychiatric Association warns against abruptly discontinuing sertraline, as this can cause withdrawal symptoms including anxiety, irritability, mood changes, restlessness, sleep disturbances, headache, sweating, nausea, dizziness, and electric shock-like sensations 1, 2
Postpartum blues is a risk factor for postpartum depression but distinct from it, with symptoms typically resolving within two weeks, as noted by the American College of Obstetricians and Gynecologists 1
ADHD symptoms may worsen postpartum but require different diagnostic criteria and treatment, according to the American Academy of Pediatrics 10, 8
Inadequate treatment puts women at risk for chronic, recurrent, or refractory depression, and adversely affects infant cognitive, behavioral, and emotional development, as reported by the American College of Obstetricians and Gynecologists 1, 2