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Postpartum depression

How do doctors diagnose postpartum depression?

It is not always easy to diagnose postpartum depression.

It is not always easy to diagnose postpartum depression. There are several reasons for this.

Source:
Clay EC, Seehusen DA.
A review of postpartum depression for the primary care physician.
Southern Medical Journal. 2004; 97: 157-161.

It can be confused with a common condition called the baby blues. For more information, see The baby blues.
Some of the warning signs, such as weight loss, sleep problems and exhaustion, are a normal part of being a new mother.
Women are often reluctant to talk about their feelings because they worry that other people will think they are bad mothers.

But it is important to see your doctor early on if you think you may be depressed. There are treatments that may help you get better faster.

Here are some things your doctor might do to help figure out if you have postpartum depression.

Questions your doctor might ask

Your doctor may ask you some questions about how you feel.

Source:
World Health Organization.
International classification of diseases and related health problems.
Version 10, 2nd edition. World Health Organisation, Geneva, Switzerland; 2005.

Do you feel depressed for most of the day?
Have you lost interest or pleasure in things that usually make you happy, like playing with your baby?
Do you feel tired and like you don't have any energy?

Your doctor will probably say you have postpartum depression if you answer "yes" to the questions above and to any four of the following ones.

Have you lost your confidence and self-esteem?
Do you feel guilty for no reason?
Have you been thinking a lot about killing yourself (suicide) or about death, either your death or your baby's?
Is it hard for you to concentrate?
Do you feel agitated or slowed down?
Are you sleeping too little or too much?
Are you eating too little or too much?

Your doctor will probably say you have mild depression if you have four of these last seven symptoms. If you have five or six symptoms, you have medium depression (your doctor might call this moderate depression). And if you have all seven, your depression is very bad (your doctor might say you have severe depression).

Source:
National Institute for Clinical Excellence.
Depression: management of depression in primary and secondary care.
December 2008. NICE clinical guideline 23. Available at http://www.nice.org.uk/cg23 (accessed on 27 February 2009).

If you answer "yes" to either of the questions below, you may have a more serious illness called postpartum psychosis.

Source:
Wisner KL, Parry BL, Piontek CM.
Clinical Practice. Postpartum depression.
New England Journal of Medicine. 2002; 347: 194-199.

⁴

Have you had four days in a row when you felt so good, high, excited or "hyper" that other people thought you were not your normal self or you got into trouble?
Have you had four days in a row when you were so irritable that you shouted at people or started fights or arguments?

If you have postpartum psychosis, you will need to see a specialist called a

psychiatrist
A psychiatrist is a medical doctor who specializes in psychiatry, a branch of medicine that covers the science and practice of treating mental, emotional or behavioral disorders.

psychiatrist. Also, you will probably need to be cared for in the hospital. For more on that illness, see Postpartum psychosis.

Physical exam

There aren't any physical signs of postpartum depression. But your doctor may still do some or all of the following:

Feel your tummy to see if your womb (uterus) is getting back to normal
Check your

blood pressure
Blood pressure is the amount of force exerted by the blood on the walls of the vessels that carry it. You can think of it like the water pressure in your home: the more pressure you have, the faster and more forcefully the water flows out of the shower. Blood pressure is measured in millimeters of mercury (written as mm Hg). When your blood pressure is taken, the measurement is given as two numbers, for example 120/80 mm Hg. The first, higher, number is called the systolic pressure, and the second, lower, number is the diastolic pressure. The systolic number is the highest pressure that occurs while the heart is pushing blood into the arteries. The diastolic number is the lowest pressure that happens when the heart is relaxing and is not pushing the blood.

blood pressure, if it has been high
Examine your birth canal (vagina) if you have had any tearing, bleeding or pain
Check your

pulse rate
Your pulse rate is the number of times that your heart beats in one minute. A normal rate is between 60 and 100 beats per minute, but the heart can speed up under certain circumstances, such as when you exert yourself or when you have an infection.

pulse and temperature if you are feeling unwell.

Tests your doctor might do

There aren't any physical tests for postpartum depression. But there are questionnaires that doctors and other health professionals can use to help spot postpartum depression.

The most popular questionnaire is called the Edinburgh Postpartum Depression Scale (EPDS for short).

Source:
Cox JL, Holden JM, Sagovsky R.
Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale.
British Journal of Psychiatry. 1987; 150: 782-786.

⁵

This questionnaire is a kind of screening. With a screening, a doctor, nurse or other health professional tests everybody to see if they might have a condition. That means testing you whether you have clear symptoms or not. For more information, see Screening for postpartum depression.

Your doctor may also offer you a blood test to check for problems with your

thyroid gland
Your thyroid gland is a small organ that sits in your neck, just in front of your windpipe. It sends out a hormone called thyroxine. This acts on receptors within cells. By acting on the receptors it gives the cells a message to speed up their metabolism and work harder.

thyroid gland. You are more likely to get thyroid problems in the weeks and months after having a baby than at other times.

Source:
Wisner KL, Parry BL, Piontek CM.
Clinical Practice. Postpartum depression.
New England Journal of Medicine. 2002; 347: 194-199.

⁴ Problems with your thyroid gland can affect your mood.

Sources for the information on this page:

Clay EC, Seehusen DA.A review of postpartum depression for the primary care physician.Southern Medical Journal. 2004; 97: 157-161.

World Health Organization.International classification of diseases and related health problems.Version 10, 2nd edition. World Health Organisation, Geneva, Switzerland; 2005.

National Institute for Clinical Excellence.Depression: management of depression in primary and secondary care.December 2008. NICE clinical guideline 23. Available at http://www.nice.org.uk/cg23 (accessed on 27 February 2009).

Wisner KL, Parry BL, Piontek CM.Clinical Practice. Postpartum depression.New England Journal of Medicine. 2002; 347: 194-199.

Cox JL, Holden JM, Sagovsky R.Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale.British Journal of Psychiatry. 1987; 150: 782-786.

This information was last updated on Mar 06, 2009

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment.
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