Practice Easily missed?

Postnatal depression

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4500 (Published 14 August 2014) Cite this as: BMJ 2014;349:g4500
  1. Ian Jones, director1,
  2. Judy Shakespeare, clinical champion for perinatal mental health2
  1. 1National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
  2. 2Royal College of General Practitioners, London, UK
  1. Correspondence to:
    I Jones, Cardiff CF24 4HQ, UK jonesir1{at}cf.ac.uk

A 26 year old woman visited her general practitioner six weeks after the birth of her first baby for her postnatal examination. Initially she mentioned only some problems with breast feeding, but it soon became clear that she was low in mood, and she said she had a difficulty socialising. She minimised her symptoms, however, claiming that she just had a touch of the “baby blues,” and she was reluctant to talk about how she was feeling. On closer questioning, she admitted that she felt overwhelmed, anxious about the baby, and guilty about not being a good mother.

What is postnatal depression?

Many women experience the baby blues—mood symptoms that develop within two to three days of birth, peak on the fifth day, and resolve within two weeks. However, episodes of more substantial postnatal depression are also common and can cause considerable disruption for the woman and her family. The most severe form of postpartum mood disorder—postpartum (or puerperal) psychosis—involves the acute onset of a manic, mixed, or depressive psychosis in the immediate postpartum period.

Box 1 How common is postnatal depression?

  • Postpartum blues, or baby blues, is a transient condition that affects 30-80% of women after birth

  • The overall prevalence of clinically significant postpartum depressive symptoms is estimated to be between 7% and 19%.1 Around a third of “postnatal depression” begins in pregnancy and around a quarter begins before pregnancy2

  • Postpartum psychosis occurs after about 0.1% (1 in 1000) deliveries3

  • Women with bipolar disorder are at particularly high risk of postnatal depression in the postpartum period, with around half of deliveries followed by a clinically significant postpartum episode4

Why is postnatal depression missed?

Good evidence exists that episodes of postpartum depression are missed or misdiagnosed. One study found that only 15% of 211 postpartum women—who according to interview had experienced a mood disorder during the first year after childbirth—had sought help, …

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