Expired CME Article

A Review of Postpartum Depression for the Primary Care Physician

Authors: CPT Emily C. Clay, MD, MAJ Dean A. Seehusen, MD

Abstract

Postpartum depression (PPD) occurs more commonly in U.S. women than most physicians realize. PPD is present in at least 10% and up to 20% of women in the United States within the first 6 months of delivery. The rate may be 25% or higher in women with a history of postpartum depression after a previous delivery. Over half of all women who develop postpartum depression still suffer symptoms a year later. This condition causes tremendous morbidity in terms of suffering and decreased quality of life. As with other psychiatric disorders, patients with PPD are more likely to seek help from their primary care doctors than from mental health professionals. Therefore, these providers should be equipped with the knowledge and tools necessary to properly care for women with PPD.

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References

1. Miller LJ. Postpartum depression. JAMA 2002; 287: 762–765.
 
2. Gold LH. Postpartum disorders in primary care: Diagnosis and treatment. Prim Care 2002; 29: 27–41, vi.
 
3. Llewellyn AM, Stowe ZN, Nemeroff CB. Depression during pregnancy and the puerperium. J Clin Psychiatry 1997; 58 (Suppl 15): 26–32.
 
4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV–TR). Washington, DC, American Psychiatric Association, 1994, ed 4.
 
5. Epperson CN. Postpartum major depression: Detection and treatment. Am Fam Physician 1999; 59: 2247–2254, 2259–2260.
 
6. Whiffen VE, Gotlib IH. Infants of postpartum depressed mothers: Temperament and cognitive status. J Abnorm Psychol 1989; 98: 274–279.
 
7. Pitt B. “Maternity blues.” Br J Psychiatry 1973; 122: 431–433.
 
8. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150: 782–786.
 
9. Altshuler LL, Hendrick V, Cohen LS. Course of mood and anxiety disorders during pregnancy and the postpartum period. J Clin Psychiatry 1998; 59 (Suppl 2): 29–33.
 
10. Nonacs R, Cohen LS. Postpartum mood disorders. Prim Psychiatry 1998; 5( 11): 51–62.
 
11. Stowe ZN, Nemeroff CB. Women at risk for postpartum-onset major depression. Am J Obstet Gynecol 1995; 173: 639–645.
 
12. Chaudron LH. Postpartum depression: What pediatricians need to know. Pediatr Rev 2003; 24: 154–161.
 
13. Hannah P, Adams D, Lee A, et al. Links between early post-partum mood and post-natal depression. Br J Psychiatry 1992; 160: 777–780.
 
14. Glover V, Liddle P, Taylor A, et al. Mild hypomania (the highs) can be a feature of the first postpartum week: Association with later depression. Br J Psychiatry 1994; 164: 517–521.
 
15. Areias ME, Kumar R, Barros H, et al. Correlates of postnatal depression in mothers and fathers. Br J Psychiatry 1996; 169: 36–41.
 
16. Wrate RM, Rooney AC, Thomas PF, et al. Postnatal depression and child development: A three-year follow-up study. Br J Psychiatry 1985; 146: 622–627.
 
17. Cox AD, Puckering C, Pound A, et al. The impact of maternal depression in young children. J Child Psychol Psychiatry 1987; 28: 917–928.
 
18. Breznitz Z, Friedman SL. Toddlers’ concentration: Does maternal depression make a difference? J Child Psychol Psychiatry 1988; 29: 267–279.
 
19. Seidman D. Postpartum psychiatric illness: The role of the pediatrician. Pediatr Rev 1998; 19: 128–131.
 
20. Cogill SR, Caplan HL, Alexandra H, et al. Impact of maternal postnatal depression on cognitive development of young children. Br Med J (Clin Res Ed) 1986; 292: 1165–1167.
 
21. Richards JP. Postnatal depression: Postnatal depression is not being missed in primary care. BMJ 1998; 317: 1658(letter).
 
22. Cooper PJ, Murray L. Postnatal depression. BMJ 1998; 316: 1884–1886.
 
23. Sinclair D, Murray L. Effects of postnatal depression on children’s adjustment to school: Teacher’s reports. Br J Psychiatry 1998; 172: 58–63.
 
24. Georgiopoulos AM, Bryan TL, Yawn BP, et al. Population-based screening for postpartum depression. Obstet Gynecol 1999; 93: 653–657.
 
25. Susman JL. Postpartum depressive disorders. J Fam Pract 1996; 43 (6 Suppl): S17–S24.
 
26. Spinelli MG. Antepartum and postpartum depression. J Gend Specif Med 1998; 1: 33–36.
 
27. Georgiopoulos AM, Bryan TL, Wollan P, et al. Routine screening for postpartum depression. J Fam Pract 2001; 50: 117–122.
 
28. U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality. Screening for depression: Recommendations and rationale. Ann Intern Med 2002; 136: 760–764.
 
29. Fergerson SS, Jamieson DJ, Lindsay M. Diagnosing postpartum depression: Can we do better? Am J Obstet Gynecol 2002; 186: 899–902.
 
30. Boyce P, Stubbs J, Todd A. The Edinburgh Postnatal Depression Scale: Validation for an Australian sample. Aust N Z J Psychiatry 1993; 27: 472–476.
 
31. Beck CT. Screening methods for postpartum depression. J Obstet Gynecol Neonatal Nurs 1995; 24: 308–312.
 
32. Sharp LK, Lipsky MS. Screening for depression across the lifespan: A review of measures for use in primary care settings. Am Fam Physician 2002; 66: 1001–1008.
 
33. Appleby L, Warner R, Whitton A, et al. A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. BMJ 1997; 314: 932–936.
 
34. Stuart S, O’Hara MW. Treatment of postpartum depression with interpersonal psychotherapy. Arch Gen Psychiatry 1995; 52: 75–76(letter).
 
35. Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry 1996; 153: 1132–1137.
 
36. Wisner KL, Perel JM, Findling RL, et al. Nortriptyline and its hydroxymetabolites in breastfeeding mothers and newborns. Psychopharmacol Bull 1997; 33: 249–251.
 
37. Stowe ZN, Owens MJ, Landry JC, et al. Sertraline and desmethylsertraline in human breast milk and nursing infants. Am J Psychiatry 1997; 154: 1255–1260.
 
38. Epperson CN, Anderson GM, McDougle CJ. Sertraline and breast-feeding. N Engl J Med 1997; 336: 1189–1190(letter).
 
39. Spigset O, Carleborg L, Norstrom A, et al. Paroxetine level in breast milk. J Clin Psychiatry 1996; 57: 39(letter).
 
40. Wright S, Dawling S, Ashford JJ. Excretion of fluvoxamine in breast milk. Br J Clin Pharmacol 1991; 31: 209(letter).
 
41. Lester BM, Cucca J, Andreozzi L, et al. Possible association between fluoxetine hydrochloride and colic in an infant. J Am Acad Child Adolesc Psychiatry 1993; 32: 1253–1255.
 
42. Yoshida K, Smith B, Craggs M, et al. Fluoxetine in breast-milk and developmental outcome of breast-fed infants. Br J Psychiatry 1998; 172: 175–178.