Abstract
Postnatal depression is the most common psychopathological disorder during the postnatal period. It is a mood and anxiety disorder and affects around 15 % of mothers. It involves the development of a major depressive episode whose onset can occur during pregnancy or within 4 weeks of giving birth, and depressive symptoms must be present for at least 2 weeks, but in clinical practice it is considered that it can also have an onset from pregnancy to 3–6 months postpartum, although it is more common during the postpartum period.
There are still many cases of postnatal depression that are not detected in clinical practice; in spite of that, it has deleterious consequences for the mother and for the baby and can delay the physical, social, and cognitive development of the baby.
Social, psychological, and biological factors can contribute to the development of postnatal depression. It is important to educate both professionals and mothers about the risk factors for early detection to prevent depression from developing.
The treatment of depressed women in the postpartum period may be different according to the characteristics of every clinical case; psychotherapy or pharmacotherapy may be used alone or in combination. The therapy may be beneficial for the symptoms and drug treatment is a good option in cases where postpartum depression is considered moderate or severe and in which therapy was not effective.
Keywords
- Depressive Symptom
- Postpartum Period
- Maternal Depression
- Edinburgh Postnatal Depression Scale
- Major Depressive Episode
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Burt VK, Stein K. Epidemiology of depression throughout the female life cycle. J Clin Psychiatry. 2002;63 Suppl 7:9–15.
Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ) 2005;(119):1–8.
MacArthur. Initiative on depression and primary care. Patient health questionnaire (PHQ-9). http://depressionprimarycare.org/clinicians/toolkits/materials/forms/phq9; 2010 April 10.
Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Koren G. Perinatal risks of untreated depression during pregnancy. Can J Psychiatry. 2004;49(11):726–35.
Kendell RE, McGuire RJ, Connor Y, Cox JL. Mood changes in the first three weeks after childbirth. J Affect Disord. 1981;3(4):317–26.
Sit D, Rothschild AJ, Wisner KL. A review of postpartum psychosis. J Womens Health (Larchmt). 2006;15(4):352–68.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed; 2013.
Wisner KL, Parry BL, Piontek CM. Clinical practice. Postpartum depression. N Engl J Med. 2002;347(3):194–9.
Not author listed. The management of postnatal depression. Drug Ther Bull 2000;38(5):33–7.
Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106(5 Pt 1):1071–83.
Halbreich U, Karkun S. Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. J Affect Disord. 2006;91(2–3):97–111.
Affonso DD, De AK, Horowitz JA, Mayberry LJ. An international study exploring levels of postpartum depressive symptomatology. J Psychosom Res. 2000;49(3):207–16.
Brugha TS, Morrell CJ, Slade P, Walters SJ. Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care. Psychol Med. 2011;41(4):739–48.
Dennis CL. Preventing and treating postnatal depression. BMJ. 2009;338:a2975.
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–6.
Buist AE, Barnett BE, Milgrom J, Pope S, Condon JT, Ellwood DA, et al. To screen or not to screen—that is the question in perinatal depression. Med J Aust. 2002;177(Suppl):S101–5.
Lanes A, Kuk JL, Tamim H. Prevalence and characteristics of postpartum depression symptomatology among Canadian women: a cross-sectional study. BMC Public Health. 2011;11:302.
Georgiopoulos AM, Bryan TL, Wollan P, Yawn BP. Routine screening for postpartum depression. J Fam Pract. 2001;50(2):117–22.
Dorr HG, Heller A, Versmold HT, Sippell WG, Herrmann M, Bidlingmaier F, et al. Longitudinal study of progestins, mineralocorticoids, and glucocorticoids throughout human pregnancy. J Clin Endocrinol Metab. 1989;68(5):863–8.
Stalla GK, Bost H, Stalla J, Kaliebe T, Dorr HG, Pfeiffer D, et al. Human corticotropin-releasing hormone during pregnancy. Gynecol Endocrinol. 1989;3(1):1–10.
Bloch M, Daly RC, Rubinow DR. Endocrine factors in the etiology of postpartum depression. Compr Psychiatry. 2003;44(3):234–46.
Skalkidou A, Hellgren C, Comasco E, Sylven S, Sundstrom PI. Biological aspects of postpartum depression. Womens Health (Lond Engl). 2012;8(6):659–72.
Bloch M, Schmidt PJ, Danaceau M, Murphy J, Nieman L, Rubinow DR. Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry. 2000;157(6):924–30.
Ahokas A, Kaukoranta J, Wahlbeck K, Aito M. Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17beta-estradiol: a preliminary study. J Clin Psychiatry. 2001;62(5):332–6.
Gregoire AJ, Kumar R, Everitt B, Henderson AF, Studd JW. Transdermal oestrogen for treatment of severe postnatal depression. Lancet. 1996;347(9006):930–3.
Klier CM, Muzik M, Dervic K, Mossaheb N, Benesch T, Ulm B, et al. The role of estrogen and progesterone in depression after birth. J Psychiatr Res. 2007;41(3–4):273–9.
Harris B, Lovett L, Newcombe RG, Read GF, Walker R, Riad-Fahmy D. Maternity blues and major endocrine changes: Cardiff puerperal mood and hormone study II. BMJ. 1994;308(6934):949–53.
Nappi RE, Petraglia F, Luisi S, Polatti F, Farina C, Genazzani AR. Serum allopregnanolone in women with postpartum “blues”. Obstet Gynecol. 2001;97(1):77–80.
Harris B, Lovett L, Smith J, Read G, Walker R, Newcombe R. Cardiff puerperal mood and hormone study. III. Postnatal depression at 5 to 6 weeks postpartum, and its hormonal correlates across the peripartum period. Br J Psychiatry. 1996;168(6):739–44.
Bou-Saleh MT, Ghubash R, Karim L, Krymski M, Bhai I. Hormonal aspects of postpartum depression. Psychoneuroendocrinology. 1998;23(5):465–75.
Lawrie TA, Hofmeyr GJ, De JM, Berk M, Paiker J, Viljoen E. A double-blind randomised placebo controlled trial of postnatal norethisterone enanthate: the effect on postnatal depression and serum hormones. Br J Obstet Gynaecol. 1998;105(10):1082–90.
Chrousos GP, Gold PW. The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA. 1992;267(9):1244–52.
Kammerer M, Taylor A, Glover V. The HPA axis and perinatal depression: a hypothesis. Arch Womens Ment Health. 2006;9(4):187–96.
Jolley SN, Elmore S, Barnard KE, Carr DB. Dysregulation of the hypothalamic-pituitary-adrenal axis in postpartum depression. Biol Res Nurs. 2007;8(3):210–22.
Taylor A, Glover V, Marks M, Kammerer M. Diurnal pattern of cortisol output in postnatal depression. Psychoneuroendocrinology. 2009;34(8):1184–8.
Corwin EJ, Pajer K. The psychoneuroimmunology of postpartum depression. J Womens Health (Larchmt). 2008;17(9):1529–34.
Maes M, Yirmyia R, Noraberg J, Brene S, Hibbeln J, Perini G, et al. The inflammatory and neurodegenerative (I&ND) hypothesis of depression: leads for future research and new drug developments in depression. Metab Brain Dis. 2009;24(1):27–53.
Raison CL, Capuron L, Miller AH. Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol. 2006;27(1):24–31.
Pter-Levy Y, Feldman M, Vakart A, Ebstein RP, Feldman R. Impact of maternal depression across the first 6 years of life on the child’s mental health, social engagement, and empathy: the moderating role of oxytocin. Am J Psychiatry. 2013;170(10):1161–8.
Viero C, Shibuya I, Kitamura N, Verkhratsky A, Fujihara H, Katoh A, et al. Review: oxytocin: Crossing the bridge between basic science and pharmacotherapy. CNS Neurosci Ther. 2010;16(5):e138–56.
Feldman R. Oxytocin and social affiliation in humans. Horm Behav. 2012;61(3):380–91.
Basraon S, Costantine MM. Mood disorders in pregnant women with thyroid dysfunction. Clin Obstet Gynecol. 2011;54(3):506–14.
Kuijpens JL, Vader HL, Drexhage HA, Wiersinga WM, van Son MJ, Pop VJ. Thyroid peroxidase antibodies during gestation are a marker for subsequent depression postpartum. Eur J Endocrinol. 2001;145(5):579–84.
De CF, Perelli F, Armando M, Vicari S. Selective serotonin reuptake inhibitors (SSRIs) for post-partum depression (PPD): a systematic review of randomized clinical trials. J Affect Disord. 2014;152–154:39–44.
Anderson G, Maes M. Postpartum depression: psychoneuroimmunological underpinnings and treatment. Neuropsychiatr Dis Treat. 2013;9:277–87.
Pawlby S, Hay DF, Sharp D, Waters CS, O’Keane V. Antenatal depression predicts depression in adolescent offspring: prospective longitudinal community-based study. J Affect Disord. 2009;113(3):236–43.
Mehta D, Quast C, Fasching PA, Seifert A, Voigt F, Beckmann MW, et al. The 5-HTTLPR polymorphism modulates the influence on environmental stressors on peripartum depression symptoms. J Affect Disord. 2012;136(3):1192–7.
Mitchell C, Notterman D, Brooks-Gunn J, Hobcraft J, Garfinkel I, Jaeger K, et al. Role of mother’s genes and environment in postpartum depression. Proc Natl Acad Sci USA. 2011;108(20):8189–93.
O’Hara MW, Swain AM. Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry. 1996;8:37–54.
Beck CT. Predictors of postpartum depression: an update. Nurs Res. 2001;50(5):275–85.
Josefsson A, Angelsioo L, Berg G, Ekstrom CM, Gunnervik C, Nordin C, et al. Obstetric, somatic, and demographic risk factors for postpartum depressive symptoms. Obstet Gynecol. 2002;99(2):223–8.
Neter E, Collins NL, Lobel M, Dunkel-Schetter C. Psychosocial predictors of postpartum depressed mood in socioeconomically disadvantaged women. Womens Health. 1995;1(1):51–75.
Johnstone SJ, Boyce PM, Hickey AR, Morris-Yatees AD, Harris MG. Obstetric risk factors for postnatal depression in urban and rural community samples. Aust N Z J Psychiatry. 2001;35(1):69–74.
Brugha TS, Sharp HM, Cooper SA, Weisender C, Britto D, Shinkwin R, et al. The Leicester 500 Project. Social support and the development of postnatal depressive symptoms, a prospective cohort survey. Psychol Med. 1998;28(1):63–79.
Lee DT, Yip AS, Leung TY, Chung TK. Identifying women at risk of postnatal depression: prospective longitudinal study. Hong Kong Med J. 2000;6(4):349–54.
Kumar R, Robson KM. A prospective study of emotional disorders in childbearing women. Br J Psychiatry. 1984;144:35–47.
Nielsen FD, Videbech P, Hedegaard M, Dalby SJ, Secher NJ. Postpartum depression: identification of women at risk. BJOG. 2000;107(10):1210–7.
Warner R, Appleby L, Whitton A, Faragher B. Demographic and obstetric risk factors for postnatal psychiatric morbidity. Br J Psychiatry. 1996;168(5):607–11.
Bartley M. Unemployment and ill health: understanding the relationship. J Epidemiol Community Health. 1994;48:333–7.
Patel V, Araya R, de Lima M, Ludermir A, Todd C. Women, poverty and common mental disorders in four restructuring societies. Soc Sci Med. 1999;49(11):1461–71.
World Health Organization. The World Health Report 2001: determinants of mental and behavioural disorders. Web Site World Health Organization 2001.
Field T. Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behav Dev. 2010;33(1):1–6.
Hughes C, Roman G, Hart MJ, Ensor R. Does maternal depression predict young children’s executive function?—a 4-year longitudinal study. J Child Psychol Psychiatry. 2013;54(2):169–77.
Barker ED, Jaffee SR, Uher R, Maughan B. The contribution of prenatal and postnatal maternal anxiety and depression to child maladjustment. Depress Anxiety. 2011;28(8):696–702.
Feldman R, Eidelman AI. Biological and environmental initial conditions shape the trajectories of cognitive and social-emotional development across the first years of life. Dev Sci. 2009;12(1):194–200.
Cox AD, Puckering C, Pound A, Mills M. The impact of maternal depression in young children. J Child Psychol Psychiatry. 1987;28(6):917–28.
Hay DF, Pawlby S, Sharp D, Asten P, Mills A, Kumar R. Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. J Child Psychol Psychiatry. 2001;42(7):871–89.
Rueda MR, Posner MI, Rothbart MK. The development of executive attention: contributions to the emergence of self-regulation. Dev Neuropsychol. 2005;28(2):573–94.
Farah MJ, Shera DM, Savage JH, Betancourt L, Giannetta JM, Brodsky NL, et al. Childhood poverty: specific associations with neurocognitive development. Brain Res. 2006;1110(1):166–74.
Duncan GJ, Brooks-Gunn J. Family poverty, welfare reform, and child development. Child Dev. 2000;71(1):188–96.
Noble KG, McCandliss BD, Farah MJ. Socioeconomic gradients predict individual differences in neurocognitive abilities. Dev Sci. 2007;10(4):464–80.
Conger RD, Donnellan MB. An interactionist perspective on the socioeconomic context of human development. Annu Rev Psychol. 2007;58:175–99.
Garber J, Cole DA. Intergenerational transmission of depression: a launch and grow model of change across adolescence. Dev Psychopathol. 2010;22(4):819–30.
Hammen C, Shih JH, Brennan PA. Intergenerational transmission of depression: test of an interpersonal stress model in a community sample. J Consult Clin Psychol. 2004;72(3):511–22.
Barker ED. The duration and timing of maternal depression as a moderator of the relationship between dependent interpersonal stress, contextual risk and early child dysregulation. Psychol Med. 2013;43(8):1587–96.
Murray L, Kempton C, Woolgar M, Hooper R. Depressed mothers’ speech to their infants and its relation to infant gender and cognitive development. J Child Psychol Psychiatry. 1993;34(7):1083–101.
Hall PL, Wittkowski A. An exploration of negative thoughts as a normal phenomenon after childbirth. J Midwifery Womens Health. 2006;51(5):321–30.
Petch J, Halford WK. Psycho-education to enhance couples’ transition to parenthood. Clin Psychol Rev. 2008;28(7):1125–37.
Thompson RA. Early sociopersonality development. In: Damon WE, editor. Handbook of child psychology, Social, emotional and personality development, vol. 3. 5th ed. New York: Wiley; 1998. p. 25–104.
Grace SL, Evindar A, Stewart DE. The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Arch Womens Ment Health. 2003;6(4):263–74.
Hay DF, Pawlby S, Angold A, Harold GT, Sharp D. Pathways to violence in the children of mothers who were depressed postpartum. Dev Psychol. 2003;39(6):1083–94.
Hay DF. Postpartum depression and cognitive development. In: Cooper P, Murray L, editors. Postpartum depression and child development. New York: Guilford; 1997. p. 85–110.
Tronick E, Reck C. Infants of depressed mothers. Harv Rev Psychiatry. 2009;17(2):147–56.
Murray L, Cooper P. Effects of postnatal depression on infant development. Arch Dis Child. 1997;77(2):99–101.
Boyce P, Stubbs J, Todd A. The Edinburgh Postnatal Depression Scale: validation for an Australian sample. Aust N Z J Psychiatry. 1993;27(3):472–6.
Sichel DA, Cohen LS, Robertson LM, Ruttenberg A, Rosenbaum JF. Prophylactic estrogen in recurrent postpartum affective disorder. Biol Psychiatry. 1995;38(12):814–8.
Appleby L, Warner R, Whitton A, Faragher B. A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. BMJ. 1997;314(7085):932–6.
Stowe ZNCJLJNC, Casarella J, Landry J, Nemeroff CB. Sertraline in the treatment of women with postpartum major depression. Depression. 1995;3:49–55.
Epperson CN, McDougle CJ, Ward-O’Brien D, Price LH. A controlled study of sertraline versus placebo in the treatment of postpartum depression: preliminary findings. Soc Neurosci. 1996;22:179. Ref Type: Abstract.
Stuart SOM, O’Hara MW. Treatment of postpartum depression with interpersonal psychotherapy [Letter]. Arch Gen Psychiatry. 1995;52:75–6.
Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996;153(9):1132–7.
Epperson CN, Anderson GM, McDougle CJ. Sertraline and breast-feeding. N Engl J Med. 1997;336(16):1189–90.
Lester BM, Cucca J, Andreozzi L, Flanagan P, Oh W. Possible association between fluoxetine hydrochloride and colic in an infant. J Am Acad Child Adolesc Psychiatry. 1993;32(6):1253–5.
Spigset O, Carleborg L, Norstrom A, Sandlund M. Paroxetine level in breast milk. J Clin Psychiatry. 1996;57(1):39.
Wisner KL, Perel JM, Findling RL, Hinnes RL. Nortriptyline and its hydroxymetabolites in breastfeeding mothers and newborns. Psychopharmacol Bull. 1997;33(2):249–51.
Wright S, Dawling S, Ashford JJ. Excretion of fluvoxamine in breast milk. Br J Clin Pharmacol. 1991;31(2):209.
American Academy of Pediatrics Work Group on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 1997;100:1035–9.
WHO-UNFPA. The Millennium Development Goals Report 2012. https://www.unfpa.org/public/publications/pid/6090; 2013
Marcé International Society. http://www.marcesociety.com/About-Marce.aspx; 2013. Ref Type: Internet Communication.
Nott PN. Extent, timing and persistence of emotional disorders following childbirth. Br J Psychiatry. 1987;151:523–7.
Philipps LH, O’Hara MW. Prospective study of postpartum depression: 4 1/2-year follow-up of women and children. J Abnorm Psychol. 1991;100(2):151–5.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Ugarte, A., Fernández, M. (2015). Postnatal Depression. In: Sáenz-Herrero, M. (eds) Psychopathology in Women. Springer, Cham. https://doi.org/10.1007/978-3-319-05870-2_20
Download citation
DOI: https://doi.org/10.1007/978-3-319-05870-2_20
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-05869-6
Online ISBN: 978-3-319-05870-2
eBook Packages: MedicineMedicine (R0)