Brief reportTiming of depression recurrence in the first year after birth
Introduction
The postpartum period is associated with an increase in risk for the onset of mood disorders. Kendell et al. (1987) found a rise in the rate of psychiatric admission in the first 3 months following childbirth, with a dramatic peak in the first 30 days. Cox et al. (1993) reported that 16 postpartum women developed episodes within 5 weeks of birth, compared with only five control women during the corresponding time period. This threefold higher rate of depression onset within 5 weeks of delivery also demonstrated a clustering of new cases after birth. Like other investigators (O’Hara et al., 1990), Cox and colleagues failed to find a significant difference in the point prevalence of depression later in the postpartum year. Women at 6 months postpartum exhibited a prevalence of depression similar to controls (9.1 and 8.2%, respectively).
These data have implications for the definition of postpartum onset, which is a longitudinal course modifier in the Diagnostic and Statistical Manual (DSM-IV; American Psychiatric Association, 1994) to describe an episode of major depression that begins within 4 weeks of birth. The International Classification of Diseases (ICD-10) permits designation as mental and physical disorders associated with the puerperium only if the disorders begin within the first 6 weeks post-birth and do not meet criteria for other disorders (Elliott, 2000). However, investigators’ definitions vary, and lengths of time up to a year following birth have been used (Kendell et al., 1987). In this study, we prospectively assessed the timing and pattern of recurrence of depression during the first postpartum year in high-risk women who had prior episodes of postpartum major depression (PPMD).
Section snippets
Methods
Women in the study (N=51) from which this report was derived (Wisner et al., 2001) were treated with nortriptyline or placebo postpartum to prevent recurrence of PPMD. The Randomized Clinical Trial (RCT) began immediately after delivery. Subjects were aged 21–45 years and had at least one past episode of PPMD with onset of symptoms within the first 3 months after a live birth (Wisner et al., 2001). The past episode had to fit Research Diagnostic Criteria (RDC; Spitzer et al., 1978) for definite
Results
There were 21 recurrences in 51 subjects in the first postpartum year. In Fig. 1, we display the 19 recurrences that were clustered in the first 28 weeks. Only two additional recurrences (at weeks 50 and 52) were observed.
Discussion
Although our sample was a high-risk group of women with previous episodes of PPMD, we found a pattern of recurrence remarkably similar to that reported in the large epidemiologic study by Kendell et al. (1987). Of 257 women who were admitted to a psychiatric hospital in the first year after birth, 68 (26%) were admitted in the first month. In our investigation, five of the 21 women (24%) who suffered recurrences in the first postpartum year experienced onset in the first month. The majority of
Acknowledgments
Supported by National Institute of Mental Health grants #57102 and #60335 to Drs Wisner and Perel. Also supported by the National Institute of Mental Health Clinical Pharmacology Core (#30915) to Dr Perel.
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