Key Points

1. Stabilize and transfer as necessary
2. Utilize the Edinburgh Depression Scale to assess depression. If less than two weeks postpartum, consider “baby blues”
3. DSM-5 criteria: depressed mood, diminished interest, significant weight change, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, diminished ability to concentrate (indecisiveness), and recurrent thoughts of death, recurrent suicidal ideations, or a suicide attempt/plan
4. Management: consultation with social work and psychiatry. Initiate antidepressants or refer for psychotherapy as needed.
5. Determine suicide and infanticide risk early and consider inpatient psychiatric hospitalization. 

Synopsis

Peripartum depression occurs in approximately 9% of pregnancies (Vesga-Lopez, 2008) although it is usually underreported and undertreated. Symptoms are comparable to features of major depressive episodes outside of the peripartum period. A severe episode of peripartum unipolar depression can be determined by the onset of symptoms during pregnancy, the average score of 20 on the Edinburgh Postnatal Depression Scale, symptoms of anxiety and suicidal ideation, and obstetric complications. Suicide is one of the leading causes of postnatal death and ranges from 1 to 5 per 100,000 live births. Suicidal ideations occur in approximately 3 percent however very few of those women had active ideation with plans, intent, and access to means. Ruminations about harming the baby can occur in postpartum depression often described as “scary thoughts” and should prompt an evaluation for psychotic symptoms such as delusions or hallucinations. While rare, infanticide incidence ranged from 2 to 7 per 100,000 infants and was more likely to occur during psychosis. Some behaviors to assess are anxiety about the health of the infant, concern about one’s ability to care for the infant, and lack of interest in the infant’s activities. 

Management

For less severe symptoms, start on an antidepressant and refer to mental health services. For severe symptoms, obtain psychiatric consultation and consider inpatient management. 

Resources

1-833-9-HELP4MOMS – National Maternal Mental Health Hotline | MCHB