Review article
Postpartum mood disorders – update 2012

The aim of this paper is to highlight the up-to-date knowledge on postpartum mood disorders: postpartum depression (PPD), postpartum psychosis (PP), postpartum hypomania (PH), and maternal blues (MB).

Postpartum depression (characterized by the features of a moderate or severe major depressive episode) affects about 7-20% of postpartum women. Current evidence suggest that women are susceptible to developing PPD during the entire first year following delivery. The core clinical features of PPD are low self-esteem, tension, and hypochondria. The Edinburgh Postnatal Depression Scale is a standard tool used in screening for PPD. PPD has been included in the Ghaemi et al.’s diagnostic criteria for bipolar spectrum disorders.

Postpartum psychosis is a psychiatric emergency condition, characterized by high severity and rapid deterioration of symptoms, once described as ‘psychosis of delirium-like appearance’. It affects 0.1-0.2% of postpartum women. 72-80% of PP cases are due to bipolar disorder (BD) or schizoaffective disorder. The condition is an obligatory indication for hospitalization. Mood stabilizers (usually in combination with atypical antipsychotics) are a mainstay of therapy for subjects with ‘bipolar’ PP.

Typically PH develops on the first day postpartum. Its prevalence has been estimated at 10-20%. The disorder is a significant risk factor for developing PPD. The ‘Highs’ Questionnaire is a validated tool used in screening for PH.

Maternal blues is a syndrome of mild, self-restricting mood disorders, usually developing in the early postpartum period. Although often considered to be a physiological phenomenon, it is an established risk factor for developing PPD or postpartum anxiety disorders.