While pregnancy and having a new baby can be a joyful time, it can also be difficult and stressful. In fact, depression is one of the most common complications in pregnancy and postpartum, affecting roughly 12% of women. Peripartum depression involves a major depressive episode that occurs during pregnancy or up to 1 year postpartum. Not surprisingly, the greatest risk factor for developing peripartum depression is a previous history of depression, especially untreated depression during pregnancy. Other risk factors for depression during this sensitive period include increased obstetric visits, low socioeconomic status, intimate partner violence, and poor support systems (Stewart & Vigod, 2016).
Peripartum depression frequently goes underrecognized by healthcare providers with fewer than 20% of women disclosing symptoms (Prevatt, 2018). Validated screening tools can be used during obstetric and well-child visits to identify patients who may need intervention. The Patient Health Questionnaire 9 (PHQ9) and Edinburgh Postnatal Depression Scale (EPDS) are free and highly sensitive screeners. Positive screens merit follow-up, especially because peripartum depression is very treatable.
Mild to moderate peripartum depression is effectively treated with therapy. Specifically, Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) show the greatest evidence. For moderate to severe peripartum depression or women at elevated risk given a prior history of depression, pharmacologic intervention is standard of care. SSRIs are considered first-line given their safety both during pregnancy and breastfeeding, with minimal placental and breast-milk passage according to a recent publication in New England Journal of Medicine (Stewart and Vigod, 2016). While no medications are risk-free, the risks of untreated peripartum depression significantly outweigh the risks of SSRI for both mother and baby, as well as for the mother-baby dyad.
The screening tools listed above can be found on the perinatal depression section of the Illinois DocAssist Website. You can also access a medication algorithm for treating perinatal depression as well as medication chart with more information on individual medications in pregnancy and breastfeeding.