Editorials

Treatment of postnatal depression

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7422.1003 (Published 30 October 2003) Cite this as: BMJ 2003;327:1003
  1. Victoria Hendrick, associate professor (vhendric@ucla.edu)
  1. Unversity of California at Los Angeles, Department of Psychiatry, 300 Med Plaza, Suite 2345, Los Angeles, CA 90095, USA

    Effective interventions are available, but the condition remains underdiagnosed

    Major depressive episodes after childbirth are referred to as postnatal depression or, in the United States, as postpartum depression. During the first six months after delivery the prevalence of major depression is estimated at 12-13%.w1 The precise time frame for defining postnatal depression has varied across studies, typically from one month to one year after childbirth. In an effort to standardise the terminology, the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, restricted the specifier of postpartum onset to depressive episodes occurring within four weeks of delivery. However, most studies of postnatal depression have continued to use wider time frames, in part because epidemiological studies show that women's heightened vulnerability to depression continues for at least the first six months after childbirth. Postnatal depression must be distinguished from postnatal blues (“baby blues”), a common experience following childbirth, in which new mothers experience lability of mood and tearfulness. This mild and self limiting condition typically disappears two weeks after delivery.

    Unfortunately postnatal depression is often overlooked in primary care clinics. In a study of 214 women who brought their children to a general paediatric clinic, 86 reported high levels of depressive symptoms on the psychiatric symptom index. Of these women, only 29% were identified as depressed by the paediatricians.1 The mother's suffering, coupled with the burden that her depression …

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