1. Post-Partum
Mood Disorders
Cassandra Huang
All Saints University School of Medicine
For Dr. Daniel B Martinez, Psychiatry Core Rotation

2. Puerperal Psychosis
• Occurs in the first 1-4 weeks after delivery, with
highest incidence in the first 2 weeks
• 50-75% of childbirths are associated with baby blues
• 10-13% of childbirths are associated with depression
• 0.1-0.2% of childbirths are associated with psychosis
• Suspected to coincide with sudden hormone shifts
after delivery
• Screening tests and level of depression rated via
Edinburgh Postnatal Depression Scale and
Postpartum Depression Screening Scale
• Psychosis is often suspected to be the initial
presentation of bipolar disorder

3. DSM-IV criterion:
Major Depressive Episode
w/Post- Partum Onset specifier
• Onset of major depressive episode within 4 wks of delivery
• 5 of more of the following within the same 2 weeks including
depressed mood and/or anhedonia:
• change in weight or appetite
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue, loss of energy
• Feelings of worthlessness, guilt
• Decreased ability to concentrate or indecisiveness
• Recurrent thoughts of death, suicidal ideation
• Clinically significant distress or impairment in social or occupational
functioning
• Symptoms are not drug induced or due to another underlying general
medical condition

4. Signs and Symptoms
• Psychosis with or without thought insertion
• Cognitive impairment
• Disorganized behaviour
• Restlessness
• Sleep disturbance
• Irritability
• Depressed or elated mood, delirium or mania
• Delusions and hallucinations
• High risk of suicide and/or infanticide
• Anxiety and panic attacks
• Spontaneous crying

5. Risk Factors
• History of depression or another mood
disorder: 30%
• Family history of depression, bipolar or
schizoaffective disorder, or schizophrenia
• History of post-partum depression following
previous deliveries: 50-62%
• Marital instability
• Lack of social support
• Adverse life events

6. Therapies and Treatment
• Antimanic drugs (lithium, valproic acid)
• Atypical antipsychotics (olanzapine)
• Antidepressants (SSRI, TCAs)
• Estrogen prophylaxis*
• Electroconvulsive therapy
• Psychotherapy
• Hospitalization
• Additional help with the baby

7. References
• American Psychiatric Association. “Diagnostic and
Statistical Manual of Mental Disorders DSM-IV TR (Text
Revision)”. Arlington, VA: American Psychiatric
Association; 2000
• Sit, Dorothy, Rothschild, Anthony J., and Katherine L.
Wisner. “A Review of Postpartum Psychosis”. National
Institute of Health; 2011. http://www.ncbi.nlm.nih.gov/
pmc/articles/PMC3109493/
• Sharma, Verinder and Vivien K. Burt. “DSM-V: modifying
the postpartum-onset specifier to include hypomania”.
National Institute of Health; 2011. http://www.ncbi.nlm.
nih.gov/pmc/articles/PMC3032179/