Diagnosis
The criteria used to diagnose depression is the same in postpartum states. In addition to these criteria, other symptoms may include fear or feelings of guilt about being a "bad" mother, or possibly extreme fear that some harm will come to the baby. These thoughts help distinguish postpartum from other kinds of depression (Table 1).
Women with postpartum major depressive episodes may also have severe anxiety, panic attacks, spontaneous crying long after the usual duration of "baby blues" (ie, 3-7 days postpartum), disinterest in the new infant, and insomnia (manifested as difficulty falling asleep).
When assessing whether a symptom is a sign of depression or a normal postpartum reaction, the individual's circumstances need to be considered. A woman's level of exhaustion or irritability may be quite normal when her infant is 2 weeks old and nursing frequently, but may not be normal when her baby is 4 months old and sleeping soundly through the night. Sleep deprivation can cause fatigue and poor concentration, but the degree of these symptoms needs to be carefully assessed.
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