Emergent Care / Stabilization: For patients with a new diagnosis of postpartum depression, screening should assess for suicide and self-harm risk. If identified, immediate assessment regarding intent, plan, and likelihood of following through on suicidal ideations is necessary. Suicide and overdose by poisoning are the most common causes of birthing parent mortality and are preventable if identified and treated. Emergent inpatient or outpatient care is necessary depending on the initial assessment.

Diagnosis Overview: Postpartum depression is a mood disorder that develops after the delivery of a baby. Depressive symptoms are comparable to those experienced in major depressive disorder in the general population and include dysphoria, anhedonia, hopelessness, weight changes, sleep disturbance, fatigue, and neurocognitive dysfunction. Given that changes in sleep, energy, and appetite are common in the typical postnatal period, the diagnosis of postpartum depression is often delayed or missed.

While a consensus on an exact definition of the postpartum period is lacking, many consider it to be the first 12 months after birth. Perinatal depression affects approximately 15% of women, with 40% of women developing symptoms postpartum. For those who develop symptoms following delivery, onset typically occurs within the first months following parturition. With or without treatment, postpartum depression may resolve or may develop into a chronic depressive disorder. Patients remain at high risk of recurrence of depressive episodes.

Postpartum depression affects bonding between the birthing parent and infant and is associated with abnormal development and cognitive impairment in the children. The condition also may have negative effects on the birthing parent's relationship with their partner and other children. 

The strongest risk factors for postpartum depression include a personal or family history of depression (either perinatal or nonperinatal), race (as a social construct), and intimate partner violence. Several genes and gene polymorphisms are associated with postpartum depression. Newer evidence suggests there are genetic components that may distinguish postpartum depression from nonperinatal depression, in particular the role of GABAergic neurons. Other risk factors include stressful life events, poor social and/or financial support during the perinatal period, young age, veteran or veteran-dependent status, active military service, unemployment, incarceration, single marital status, and unintended pregnancy. Comorbid mental illness is common.