Reproductive · Year 2 · from Reproductive
Case 3: Postpartum Depression
Clinical Image
Source: Wikipedia - Postpartum depression - CC BY-SA 4.0
Case Presentation
A 30-year-old G1P1 woman presents for her 6-week postpartum visit. She delivered a healthy infant vaginally without complications. During the visit, she appears tearful and withdrawn. On questioning, she reports persistent sadness, difficulty bonding with her infant, feelings of worthlessness as a mother, severe fatigue despite the baby sleeping through the night, poor appetite, and difficulty concentrating. She initially experienced "baby blues" after delivery but her symptoms have progressively worsened over the past month rather than improving. She denies suicidal ideation or thoughts of harming her infant but admits to intrusive thoughts that something bad will happen to the baby. The Edinburgh Postnatal Depression Scale (EPDS) score is 18 (scores above 10 suggest possible depression). The diagnosis is postpartum depression. The patient is referred for psychiatric evaluation. She is started on sertraline 50 mg daily (chosen for its favorable profile during breastfeeding with minimal transfer into breast milk). She is also referred for cognitive behavioral therapy. At follow-up 8 weeks later, her symptoms have significantly improved, she is bonding well with her infant, and her EPDS score has decreased to 6.
Key Learning Points
- Postpartum depression affects 10-15% of women and is distinguished from "baby blues" (50-80% of women, resolves by 2 weeks) by persistence and severity of symptoms
- Risk factors include history of depression or anxiety, inadequate social support, stressful life events, and previous postpartum depression
- The Edinburgh Postnatal Depression Scale (EPDS) is the recommended screening tool; scores above 10 warrant further evaluation
- SSRIs (particularly sertraline due to low breast milk transfer) are first-line pharmacotherapy; combination with psychotherapy is most effective