Clinical Review

Management of postnatal depression

BMJ 2008; 337 doi: (Published 08 August 2008) Cite this as: BMJ 2008;337:a736
  1. Charles Musters, specialist registrar in perinatal psychiatry1,
  2. Elizabeth McDonald, consultant in perinatal psychiatry1,
  3. Ian Jones, senior lecturer in perinatal psychiatry2
  1. 1East London NHS Foundation Trust, City and Hackney Centre for Mental Health, London E9 6SR
  2. 2Department of Psychological Medicine, University Hospital of Wales, Cardiff CF14 4XN
  1. Correspondence to: C Musters charles.musters{at}

    Summary points

    • Postnatal depression occurs after 13% of births

    • A previous history of postnatal depression or of any mental illness, poor social support, and depression during the pregnancy all increase the risk of developing the illness

    • Postnatal depression needs to be identified and treated promptly and adequately because it can result in a range of lasting adverse outcomes for mother and child

    • A range of psychological therapies is effective in treating postnatal depression

    • Drugs are also effective and some antidepressants are thought to be safer in breastfeeding mothers than others

    • Drugs are recommended for women who decline psychological therapy, or for whom there would be an unacceptable delay in providing non-pharmacological measures

    Depression is common in the postpartum period. It can be severe and may have serious consequences for the woman and her child (figure). The term postnatal depression, however, is often applied indiscriminately to all occurrences of psychological distress after childbirth. It is important to identify and to treat postnatal depression—recently published National Institute for Health and Clinical Excellence (NICE) guidance supports a range of effective psychological and pharmacological interventions.1 Here, we discuss current thinking on the clinical features, aetiology, and management of postnatal depression.

    Mother with postnatal depression

    What is postnatal depression?

    Postnatal depression may form part of a bipolar or, more usually, a unipolar illness. Estimates vary but the overall prevalence of clinically relevant postnatal depression is 13%.2 Although classification systems consider onset within four weeks (Diagnostic and Statistical Manual of Mental Disorders) or six weeks (ICD-10; international classification of diseases, 10th revision) to be “postpartum,” onsets within six months or even longer are usually included in clinical practice. Because several of the diagnostic features (box 1)—such as tiredness, disturbed sleep, and reduced libido—are common perinatally, other symptoms—particularly feelings of worthlessness and hopelessness and early morning wakening before the baby—need …

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