Medicine:Postpartum depression

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Postpartum depression (PPD), also called postnatal depression, is a type of mood disorder associated with childbirth, which can affect both sexes.[1][2] Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns.[1] Onset is typically between one week and one month following childbirth.[1] PPD can also negatively affect the newborn child.[3][4]

While the exact cause of PPD is unclear, the cause is believed to be a combination of physical, emotional, genetic, and social factors.[1][5] These may include factors such as hormonal changes and sleep deprivation.[1][6] Risk factors include prior episodes of postpartum depression, bipolar disorder, a family history of depression, psychological stress, complications of childbirth, lack of support, or a drug use disorder.[1] Diagnosis is based on a person's symptoms.[4] While most women experience a brief period of worry or unhappiness after delivery, postpartum depression should be suspected when symptoms are severe and last over two weeks.[1]

Among those at risk, providing psychosocial support may be protective in preventing PPD.[7] Treatment for PPD may include counseling or medications.[4] Types of counseling that have been found to be effective include interpersonal psychotherapy (IPT), cognitive behavioral therapy (CBT), and psychodynamic therapy.[4] Tentative evidence supports the use of selective serotonin reuptake inhibitors (SSRIs).[4]

Postpartum depression affects roughly 15% of women after childbirth.[8][9] Moreover, this mood disorder is estimated to affect 1% to 26% of new fathers.[2] Postpartum psychosis, a more severe form of postpartum mood disorder, occurs in about 1 to 2 per 1,000 women following childbirth.[10] Postpartum psychosis is one of the leading causes of the murder of children less than one year of age, which occurs in about 8 per 100,000 births in the United States.[11]

Signs and symptoms

Symptoms of PPD can occur any time in the first year postpartum.[12] Typically, a diagnosis of postpartum depression is considered after signs and symptoms persist for at least two weeks.[13]


  • Persistent sadness, anxiousness or "empty" mood[12]
  • Severe mood swings[13]
  • Frustration, irritability, restlessness, anger[12][14]
  • Feelings of hopelessness or helplessness[12]
  • Guilt, shame, worthlessness[12][14]
  • Low self-esteem[12]
  • Numbness, emptiness[12]
  • Exhaustion[12]
  • Inability to be comforted[12]
  • Trouble bonding with the baby[13]
  • Feeling inadequate in taking care of the baby[12][14]
  • Thoughts of self-harm or suicide[15]



  • Diminished ability to make decisions and think clearly[14]
  • Lack of concentration and poor memory[14]
  • Fear that you can not care for the baby or fear of the baby[12]
  • Worry about harming self, baby, or partner[13][14]

Onset and duration

Postpartum depression onset usually begins between two weeks to a month after delivery.[17] A study done at an inner-city mental health clinic has shown that 50% of postpartum depressive episodes there began prior to delivery.[18] Therefore, in the DSM-5 postpartum depression is diagnosed under "depressive disorder with peripartum onset", in which "peripartum onset" is defined as anytime either during pregnancy or within the four weeks following delivery. PPD may last several months or even a year.[19] Postpartum depression can also occur in women who have suffered a miscarriage.[20] For fathers, several studies show that men experience the highest levels of postpartum depression between 3–6 months postpartum.[21]

Parent-infant relationship

Postpartum depression can interfere with normal maternal-infant bonding and adversely affect acute and longterm child development. Postpartum depression may lead mothers to be inconsistent with childcare.[22] These childcare inconsistencies may include feeding routines, sleep routines, and health maintenance.[22]

In rare cases, or about 1 to 2 per 1,000, the postpartum depression appears as postpartum psychosis.[10] In these, or among women with a history of previous psychiatric hospital admissions,[23] infanticide may occur. In the United States, postpartum depression is one of the leading causes of annual reported infanticide incidence rate of about 8 per 100,000 births.[4]


The cause of PPD is not well understood. Hormonal changes, genetics, and major life events have been hypothesized as potential causes.

Evidence suggests that hormonal changes may play a role. Hormones which have been studied include estrogen, progesterone, thyroid hormone, testosterone, corticotropin releasing hormone, and cortisol.[6] Estrogen and progesterone levels drop back to pre-pregnancy levels within 24 hours of giving birth, and that sudden change may cause it.[24]

Fathers, who are not undergoing profound hormonal changes, can also have postpartum depression.[25] The cause may be distinct in males.

Profound lifestyle changes that are brought about by caring for the infant are also frequently hypothesized to cause PPD. However, little evidence supports this hypothesis. Mothers who have had several previous children without suffering PPD can nonetheless suffer it with their latest child.[26] Despite the biological and psychosocial changes that may accompany pregnancy and the postpartum period, most women are not diagnosed with PPD.[27][28] Many mothers are unable to get the rest they need to fully recover from giving birth. Sleep deprivation can lead to physical discomfort and exhaustion, which can contribute to the symptoms of postpartum depression.[29]

Risk factors

While the causes of PPD are not understood, a number of factors have been suggested to increase the risk:

  • Prenatal depression or anxiety[30]
  • A personal or family history of depression[31]
  • Moderate to severe premenstrual symptoms[32]
  • Stressful life events experienced during pregnancy[33][34]
  • Postpartum blues[30]
  • Birth-related psychological trauma
  • Birth-related physical trauma
  • History of sexual abuse[35][36]
  • Childhood trauma[35][36][37]
  • Previous stillbirth or miscarriage[32]
  • Formula-feeding rather than breast-feeding[31]
  • Cigarette smoking[31]
  • Low self-esteem[30]
  • Childcare or life stress[30]
  • Low social support[30]
  • Poor marital relationship or single marital status[30]
  • Low socioeconomic status[30][38]
  • A lack of strong emotional support from spouse, partner, family, or friends[39]
  • Infant temperament problems/colic[30]
  • Unplanned/unwanted pregnancy[30]
  • Low vitamin D levels[40][41]

Of these risk factors a history of depression, and cigarette smoking have been shown to have additive effects.[31] Some studies have found a link with low levels of DHA in the mother.[42]

These above factors are known to correlate with PPD. This correlation does not mean these factors are causal. Rather, they might both be caused by some third factor. Contrastingly, some factors almost certainly attribute to the cause of postpartum depression, such as lack of social support.[43] The relationship between breastfeeding and PPD is not clear.[44]

Women with fewer resources indicate a higher level of postpartum depression and stress than those women with more resources, such as financial. Rates of PPD have been shown to decrease as income increases.[45] Women with fewer resources may be more likely to have an unintended or unwanted pregnancy, increasing risk of PPD. Women with fewer resources may also include single mothers of low income. Single mothers of low income may have more limited access to resources while transitioning into motherhood.

Studies have also shown a correlation between a mother's race and postpartum depression. African American mothers have been shown to have the highest risk of PPD at 25%, while Asian mothers had the lowest at 11.5%, after controlling for social factors such as age, income, education, marital status, and baby's health. The PPD rates for First Nations, Caucasian and Hispanic women fell in between.[45]

One of the strongest predictors of paternal PPD is having a partner who has PPD, with fathers developing PPD 50% of the time when their female partner has PPD.[46]

Sexual orientation[47] has also been studied as a risk factor for PPD. In a 2007 study conducted by Ross and colleagues, lesbian and bisexual mothers were tested for PPD and then compared with a heterosexual sample group. It was found that lesbian and bisexual biological mothers had significantly higher Edinburgh Postnatal Depression Scale scores than did the heterosexual women in the sample.[48] These higher rates of PPD in lesbian/bisexual mothers may reflect less social support, particularly from their families of origin and additional stress due to homophobic discrimination in society.[49]

A correlation between postpartum thyroiditis and postpartum depression has been proposed but remains controversial. There may also be a link between postpartum depression and anti-thyroid antibodies.[50]


A meta-analysis reviewing research on the association of violence and postpartum depression showed that violence against women increases the incidence of postpartum depression.[51] About one-third of women throughout the world will experience physical or sexual violence at some point in their lives.[52] Violence against women occurs in conflict, post-conflict, and non-conflict areas.[52] It is important to note that the research reviewed only looked at violence experienced by women from male perpetrators, but did not consider violence inflicted on men or women by women. Further, violence against women was defined as "any act of gender-based violence that results in, or is likely to result in, physical, sexual, or psychological harm or suffering to women".[51] Psychological and cultural factors associated with increased incidence of postpartum depression include family history of depression, stressful life events during early puberty or pregnancy, anxiety or depression during pregnancy, and low social support.[48][51] Violence against women is a chronic stressor, so depression may occur when someone is no longer able to respond to the violence.[51]



Postpartum depression in the DSM-5 is known as "depressive disorder with peripartum onset". Peripartum onset is defined as starting anytime during pregnancy or within the four weeks following delivery. There is no longer a distinction made between depressive episodes that occur during pregnancy or those that occur after delivery.[53] Nevertheless, the majority of experts continue to diagnose postpartum depression as depression with onset anytime within the first year after delivery.[32]

The criteria required for the diagnosis of postpartum depression are the same as those required to make a diagnosis of non-childbirth related major depression or minor depression. The criteria include at least five of the following nine symptoms, within a two-week period:[53]

  • Feelings of sadness, emptiness, or hopelessness, nearly every day, for most of the day or the observation of a depressed mood made by others
  • Loss of interest or pleasure in activities
  • Weight loss or decreased appetite
  • Changes in sleep patterns
  • Feelings of restlessness
  • Loss of energy
  • Feelings of worthlessness or guilt
  • Loss of concentration or increased indecisiveness
  • Recurrent thoughts of death, with or without plans of suicide

Differential diagnosis

Postpartum blues

Postpartum blues, commonly known as "baby blues," is a transient postpartum mood disorder characterized by milder depressive symptoms than postpartum depression. This type of depression can occur in up to 80% of all mothers following delivery.[54] Symptoms typically resolve within two weeks. Symptoms lasting longer than two weeks are a sign of a more serious type of depression.[55] Women who experience "baby blues" may have a higher risk of experiencing a more serious episode of depression later on.[56]


Postpartum psychosis is not a formal diagnosis, but is widely used to describe a psychiatric emergency that appears to occur in about 1 in a 1000 pregnancies, in which symptoms of high mood and racing thoughts (mania), depression, severe confusion, loss of inhibition, paranoia, hallucinations and delusions begin suddenly in the first two weeks after delivery; the symptoms vary and can change quickly.[57] It is different from postpartum depression and from maternity blues.[58] It may be a form of bipolar disorder.[59] It is important not to confuse psychosis with other symptoms that may occur after delivery, such as delirium. Delirium typically includes a loss of awareness or inability to pay attention.[56]

About half of women who experience postpartum psychosis have no risk factors; but a prior history of mental illness, especially bipolar disorder, a history of prior episodes of postpartum psychosis, or a family history put some at a higher risk.[57]

Postpartum psychosis often requires hospitalization, where treatment is antipsychotic medications, mood stabilizers, and in cases of strong risk for suicide, electroconvulsive therapy.[57]

The most severe symptoms last from 2 to 12 weeks, and recovery takes 6 months to a year.[57] Women who have been hospitalized for a psychiatric condition immediately after delivery are at a much higher risk of suicide during the first year after delivery.[60]


In the US, the American College of Obstetricians and Gynecologists suggests healthcare providers consider depression screening for perinatal women.[61] Additionally, the American Academy of Pediatrics recommends pediatricians screen mothers for PPD at 1-month, 2-month and 4-month visits.[62] However, many providers do not consistently provide screening and appropriate follow-up.[61][63] For example, in Canada, Alberta is the only province with universal PPD screening. This screening is carried out by Public Health nurses with the baby's immunization schedule.

The Edinburgh Postnatal Depression Scale, a standardized self-reported questionnaire, may be used to identify women who have postpartum depression.[64] If the new mother scores 13 or more, she likely has PPD and further assessment should follow.[64]

Healthcare providers may take a blood sample to test if another disorder is contributing to depression during the screening.[65]


A 2013 Cochrane review found evidence that psychosocial or psychological intervention after childbirth helped reduce the risk of postnatal depression.[66][67] These interventions included home visits, telephone-based peer support, and interpersonal psychotherapy.[66] Support is an important aspect of prevention, as depressed mothers commonly state that their feelings of depression were brought on by "lack of support" and "feeling isolated."[68]

In couples, emotional closeness and global support by the partner protect against both perinatal depression and anxiety. Further factors such as communication between the couple and relationship satisfaction have a protective effect against anxiety alone.[69]

In those who are at risk counselling is recommended.[70] In 2018, 24% of areas in the UK have no access to perinatal mental health specialist services.[71]

Preventative treatment with antidepressants may be considered for those who have had PPD previously. However, as of 2017, the evidence supporting such us is weak.[72]


Treatment for mild to moderate PPD includes psychological interventions or antidepressants. Women with moderate to severe PPD would likely experience a greater benefit with a combination of psychological and medical interventions.[73] Light aerobic exercise has been found to be useful for mild and moderate cases.[74][75]


Both individual social and psychological interventions appear equally effective in the treatment of PPD.[76] Social interventions include individual counseling and peer support, while psychological interventions include cognitive behavioral therapy (CBT) and interpersonal therapy (IPT).[77] Other forms of therapy, such as group therapy, home visits, counseling, and ensuring greater sleep for the mother may also have a benefit.[12][5]

Internet-based cognitive behavioral therapy (iCBT) has shown promising results with lower negative parenting behavior scores and lower rates of anxiety, stress, and depression. iCBT may be beneficial for mothers who have limitations in accessing in person CBT. However, the long term benefits have not been determined.[78]


A 2010 review found few studies of medications for treating PPD noting small sample sizes and generally weak evidence.[77] Some evidence suggests that mothers with PPD will respond similarly to people with major depressive disorder.[77] There is evidence which suggests that selective serotonin reuptake inhibitors (SSRIs) are effective treatment for PPD.[79] The first-line anti-depressant medication of choice is sertraline, an SSRI, as very little of the it passes into the breast milk and, as a result, to the child.[80] However, a recent study has found that adding sertraline to psychotherapy does not appear to confer any additional benefit.[81] Therefore, it is not completely clear which antidepressants, if any, are most effective for treatment of PPD, and for whom antidepressants would be a better option than non-pharmacotherapy.[79]

Some studies show that hormone therapy may be effective in women with PPD, supported by the idea that the drop in estrogen and progesterone levels post-delivery contribute to depressive symptoms.[77] However, there is some controversy with this form of treatment because estrogen should not be given to people who are at higher risk of blood clots, which include women up to 12 weeks after delivery.[82] Additionally, none of the existing studies included women who were breastfeeding.[77] However, there is some evidence that the use of estradiol patches might help with PPD symptoms.[8]

In 2019, the FDA approved brexanolone, a synthetic analog of the neurosteroid allopregnanolone, for use intravenously in postpartum depression. Allopregnanolone levels drop after giving birth, which may lead to women becoming depressed and anxious.[83] Some trials have demonstrated an effect on PPD within 48 hours from the start of infusion.[84] Other new allopregnanolone analogs under evaluation for use in the treatment of PPD include SAGE-2017 and ganaxolone.[8]

Brexanolone has risks that can occur during administration, including excessive sedation and sudden loss of consciousness, and therefore has been approved under the Risk Evaluation and Mitigation Strategy (REMS) program.[85] The mother is to enrolled prior to receiving the medication. It is only available to those at certified health care facilities with a health care provider who can continually monitor the patient. The infusion itself is a 60-hour, or 2.5 day, process. People's oxygen levels are to be monitored with a pulse oximeter. Side effects of the medication include dry mouth, sleepiness, somnolence, flushing and loss of consciousness. It is also important to monitor for early signs of suicidal thoughts or behaviors.[85]


Antidepressant medications are generally considered safe to use during breastfeeding.[86] Most antidepressants are excreted in breast milk. However, there are limited studies showing the effects and safety of these antidepressants on breastfed babies.[87] Regarding allopregnanolone, very limited data did not indicate a risk for the infant.[88]


Electroconvulsive therapy (ECT) has shown efficacy in women with severe PPD that have either failed multiple trials of medication-based treatment or cannot tolerate the available antidepressants.[73] Tentative evidence supports the use of repetitive transcranial magnetic stimulation (rTMS).[89]

As of 2013 it is unclear if acupuncture, massage, bright lights, or taking omega-3 fatty acids are useful.[90]


Postpartum depression is found across the globe, with rates varying from 11% to 42%.[91] Around 3% to 6% of women will experience depression during pregnancy or shortly after giving birth.[56] About 1 in 750 mothers will have postpartum depression with psychosis and their risk is higher if they have had postpartum episodes in the past.[56]

Society and culture

Malay culture holds a belief in Hantu Meroyan; a spirit that resides in the placenta and amniotic fluid.[92] When this spirit is unsatisfied and venting resentment, it causes the mother to experience frequent crying, loss of appetite, and trouble sleeping, known collectively as "sakit meroyan". The mother can be cured with the help of a shaman, who performs a séance to force the spirits to leave.[93]

Some cultures believe that the symptoms of postpartum depression or similar illnesses can be avoided through protective rituals in the period after birth. Chinese women participate in a ritual that is known as "doing the month" (confinement) in which they spend the first 30 days after giving birth resting in bed, while the mother or mother-in-law takes care of domestic duties and childcare. In addition, the new mother is not allowed to bathe or shower, wash her hair, clean her teeth, leave the house, or be blown by the wind.[94]

In the US, the Patient Protection and Affordable Care Act included a section focusing on research into postpartum conditions including postpartum depression.[95] Some argue that more resources in the form of policies, programs, and health objectives need to be directed to the care of those with PPD.[96]

The stigma of mental health - with or without support from family members and health professionals - often deters women from seeking help for their PPD.[97] When medical help is achieved, some women find the diagnosis helpful and encourage a higher profile for PPD amongst the health professional community.[98]

See also


  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 "Postpartum Depression Facts". 
  2. 2.0 2.1 Paulson, James F. (2010). "Focusing on depression in expectant and new fathers: prenatal and postpartum depression not limited to mothers". Psychiatric Times 27 (2). 
  3. "The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature". Archives of Women's Mental Health 6 (4): 263–74. November 2003. doi:10.1007/s00737-003-0024-6. PMID 14628179. 
  4. 4.0 4.1 4.2 4.3 4.4 4.5 "Postpartum depression". American Journal of Obstetrics and Gynecology 200 (4): 357–64. April 2009. doi:10.1016/j.ajog.2008.11.033. PMID 19318144. 
  5. 5.0 5.1 "Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics". Annual Review of Medicine 70 (1): 183–196. January 2019. doi:10.1146/annurev-med-041217-011106. PMID 30691372. 
  6. 6.0 6.1 "Reproductive hormone sensitivity and risk for depression across the female life cycle: a continuum of vulnerability?". Journal of Psychiatry & Neuroscience 33 (4): 331–43. July 2008. PMID 18592034. 
  7. "Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes". Agency for Health Care Research and Quality. 
  8. 8.0 8.1 8.2 "Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development". CNS Drugs 33 (3): 265–282. March 2019. doi:10.1007/s40263-019-00605-7. PMID 30790145. 
  9. "Perinatal depression: prevalence, screening accuracy, and screening outcomes". Evidence Report/Technology Assessment (119): 1–8. February 2005. doi:10.1037/e439372005-001. PMID 15760246. 
  10. 10.0 10.1 "Postpartum mood disorders". International Review of Psychiatry 15 (3): 231–42. August 2003. doi:10.1080/09540260305196. PMID 15276962. 
  11. "Maternal infanticide associated with mental illness: prevention and the promise of saved lives". The American Journal of Psychiatry 161 (9): 1548–57. September 2004. doi:10.1176/appi.ajp.161.9.1548. PMID 15337641. 
  12. 12.00 12.01 12.02 12.03 12.04 12.05 12.06 12.07 12.08 12.09 12.10 12.11 12.12 12.13 12.14 12.15 12.16 The Boston Women's Health Book Collective: Our Bodies Ourselves, pages 489–491, New York: Touchstone Book, 2005
  13. 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 WebMD: Understanding Post Partum Depression "The Basics of Postpartum Depression". 
  14. 14.0 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 "Depression Among Women | Depression | Reproductive Health | CDC". 
  15. "Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings". JAMA Psychiatry 70 (5): 490–8. May 2013. doi:10.1001/jamapsychiatry.2013.87. PMID 23487258. 
  16. "Postnatal depression and sexual health after childbirth". Obstetrics and Gynecology 102 (6): 1318–25. December 2003. doi:10.1016/j.obstetgynecol.2003.08.020. PMID 14662221. 
  17. Postpartum Depression from Pregnancy Guide, by Peter J. Chen, at Hospital of the University of Pennsylvania. Reviewed last on: 10/22/2008
  18. "Onset and persistence of postpartum depression in an inner-city maternal health clinic system". The American Journal of Psychiatry 158 (11): 1856–63. November 2001. doi:10.1176/appi.ajp.158.11.1856. PMID 11691692. 
  19. Canadian Mental Health Association > Post Partum Depression Retrieved on June 13, 2010
  20. "Postpartum depression". JAMA 287 (6): 762–5. February 2002. doi:10.1001/jama.287.6.762. PMID 11851544. 
  21. "Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis". JAMA 303 (19): 1961–9. May 2010. doi:10.1001/jama.2010.605. PMID 20483973. 
  22. 22.0 22.1 "Postpartum depression effects on early interactions, parenting, and safety practices: a review". Infant Behavior & Development 33 (1): 1–6. February 2010. doi:10.1016/j.infbeh.2009.10.005. PMID 19962196. 
  23. "Filicide in offspring of parents with severe psychiatric disorders: a population-based cohort study of child homicide". The Journal of Clinical Psychiatry 72 (5): 698–703. May 2011. doi:10.4088/jcp.09m05508gre. PMID 21034682. 
  24. "Postpartum depression" (in en). 2018-04-09. 
  25. "Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health". Journal of Advanced Nursing 45 (1): 26–35. January 2004. doi:10.1046/j.1365-2648.2003.02857.x. PMID 14675298. 
  26. "Postpartum depression: identification of women at risk". BJOG 107 (10): 1210–7. October 2000. doi:10.1111/j.1471-0528.2000.tb11609.x. PMID 11028570. 
  27. "Perinatal psychiatric disorders: an overview". American Journal of Obstetrics and Gynecology 210 (6): 501–509.e6. June 2014. doi:10.1016/j.ajog.2013.10.009. PMID 24113256. 
  28. "Non-psychotic mental disorders in the perinatal period". Lancet 384 (9956): 1775–88. November 2014. doi:10.1016/s0140-6736(14)61276-9. PMID 25455248. 
  29. "NIMH » Postpartum Depression Facts". 
  30. 30.0 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 "A meta-analysis of the relationship between postpartum depression and infant temperament". Nursing Research 45 (4): 225–30. 1996. doi:10.1097/00006199-199607000-00006. PMID 8700656. 
  31. 31.0 31.1 31.2 31.3 "Risk factors for postpartum depression: a retrospective investigation at 4-weeks postnatal and a review of the literature". The Journal of the American Osteopathic Association 106 (4): 193–8. April 2006. PMID 16627773. 
  32. 32.0 32.1 32.2 "Perinatal depression: an update and overview". Current Psychiatry Reports 16 (9): 468. September 2014. doi:10.1007/s11920-014-0468-6. PMID 25034859. 
  33. "Stressful Life Event Experiences of Pregnant Women in the United States: A Latent Class Analysis". Women's Health Issues 27 (1): 83–92. January 2017. doi:10.1016/j.whi.2016.09.007. PMID 27810166. 
  34. "Antenatal Stressful Life Events and Postpartum Depressive Symptoms in the United States: The Role of Women's Socioeconomic Status Indices at the State Level". Journal of Women's Health 26 (3): 276–285. March 2017. doi:10.1089/jwh.2016.5872. PMID 27875058. 
  35. 35.0 35.1 "Antecedent trauma exposure and risk of depression in the perinatal period". The Journal of Clinical Psychiatry 74 (10): e942-8. October 2013. doi:10.4088/JCP.13m08364. PMID 24229763. 
  36. 36.0 36.1 "The association of childhood sexual abuse with depressive symptoms during pregnancy, and selected pregnancy outcomes". Child Abuse & Neglect 23 (7): 659–70. July 1999. doi:10.1016/S0145-2134(99)00040-X. PMID 10442831. 
  37. "Past traumatic events: are they a risk factor for high-risk pregnancy, delivery complications, and postpartum posttraumatic symptoms?". Journal of Women's Health 18 (1): 119–25. January 2009. doi:10.1089/jwh.2008.0774. PMID 19132883. 
  38. "Correlates of early postpartum depressive symptoms". Maternal and Child Health Journal 10 (2): 149–57. March 2006. doi:10.1007/s10995-005-0048-9. PMID 16341910. 
  39. "NIMH » Postpartum Depression Facts". 
  40. "Vitamin D Deficiency and Antenatal and Postpartum Depression: A Systematic Review". Nutrients 10 (4): 478. April 2018. doi:10.3390/nu10040478. PMID 29649128. 
  41. "A systematic review of the associations between maternal nutritional biomarkers and depression and/or anxiety during pregnancy and postpartum". Journal of Affective Disorders 232: 185–203. May 2018. doi:10.1016/j.jad.2018.02.004. PMID 29494902. 
  42. "Seafood consumption, the DHA content of mothers' milk and prevalence rates of postpartum depression: a cross-national, ecological analysis". Journal of Affective Disorders 69 (1–3): 15–29. May 2002. doi:10.1016/S0165-0327(01)00374-3. PMID 12103448. 
  43. The causal role of lack of social support in PPD is strongly suggested by several studies, including O'Hara 1985, Field et al. 1985; and Gotlib et al. 1991.
  44. "Breastfeeding and depression: a systematic review of the literature". Journal of Affective Disorders 171: 142–54. January 2015. doi:10.1016/j.jad.2014.09.022. PMID 25305429. 
  45. 45.0 45.1 "Race/ethnicity and perinatal depressed mood". Journal of Reproductive and Infant Psychology 24 (2): 99–106. 2006. doi:10.1080/02646830600643908. 
  46. Singley, Daniel (2015). "Men's Perinatal Mental Health in the Transition to Fatherhood". Professional Psychology: Research and Practice 46 (5): 309–319. doi:10.1037/pro0000032. 
  47. "Perinatal depressive symptomatology among lesbian and bisexual women". Archives of Women's Mental Health 10 (2): 53–9. 2007. doi:10.1007/s00737-007-0168-x. PMID 17262172. 
  48. 48.0 48.1 "The prevalence of postpartum depression among women with substance use, an abuse history, or chronic illness: a systematic review". Journal of Women's Health 18 (4): 475–86. April 2009. doi:10.1089/jwh.2008.0953. PMID 19361314. 
  49. "Perinatal mental health in lesbian mothers: a review of potential risk and protective factors". Women & Health 41 (3): 113–28. 2005. doi:10.1300/J013v41n03_07. PMID 15970579. 
  50. Horsager, Robyn; Hoffman, Barbara L.; Santiago-Muñoz, Patricia C.; Rogers, Vanessa L.; Worley, Kevin C.; Roberts, Scott W. (2014-10-15). Williams Obstetrics Study Guide (24th ed.). New York: McGraw-Hill Education Medical. ISBN 9780071793278. 
  51. 51.0 51.1 51.2 51.3 "Violence as a risk factor for postpartum depression in mothers: a meta-analysis". Archives of Women's Mental Health 15 (2): 107–14. April 2012. doi:10.1007/s00737-011-0248-9. PMID 22382278. 
  52. 52.0 52.1 Western, Deborah (2013-01-01). "A Conceptual and Contextual Background for Gender-Based Violence and Depression in Women". Gender-based Violence and Depression in Women. SpringerBriefs in Social Work. New York: Springer New York. pp. 13–22. doi:10.1007/978-1-4614-7532-3_3. ISBN 978-1-4614-7531-6. 
  53. 53.0 53.1 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Association.. 2013. 
  54. "The Basics of Postpartum Depression". 
  55. "Clinical practice. Postpartum depression". The New England Journal of Medicine 347 (3): 194–9. July 2002. doi:10.1056/NEJMcp011542. PMID 12124409. 
  56. 56.0 56.1 56.2 56.3 American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 186, ISBN 978-0890425558, 
  57. 57.0 57.1 57.2 57.3 "Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period". Lancet 384 (9956): 1789–99. November 2014. doi:10.1016/s0140-6736(14)61278-2. PMID 25455249. 
  58. "Postpartum Psychosis". Royal College of Psychiatrists. 2014. 
  59. "Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis". The American Journal of Psychiatry 173 (2): 117–27. February 2016. doi:10.1176/appi.ajp.2015.15010124. PMID 26514657. 
  60. "Suicide during Perinatal Period: Epidemiology, Risk Factors, and Clinical Correlates". Frontiers in Psychiatry 7: 138. 12 August 2016. doi:10.3389/fpsyt.2016.00138. PMID 27570512. 
  61. 61.0 61.1 "Screening for Depression During and After Pregnancy". American College of Obstetricians and Gynecologists, Committee Opinion. February 2010. 
  62. "Incorporating recognition and management of perinatal and postpartum depression into pediatric practice". Pediatrics 126 (5): 1032–9. November 2010. doi:10.1542/peds.2010-2348. PMID 20974776. 
  63. "The onset of postpartum depression: Implications for clinical screening in obstetrical and primary care". American Journal of Obstetrics and Gynecology 192 (2): 522–6. February 2005. doi:10.1016/j.ajog.2004.07.054. PMID 15695997. 
  64. 64.0 64.1 "Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale". The British Journal of Psychiatry 150 (6): 782–6. June 1987. doi:10.1192/bjp.150.6.782. PMID 3651732. 
  65. "Postpartum Depression Screening: MedlinePlus Lab Test Information" (in en). 
  66. 66.0 66.1 Dennis, Cindy-Lee, ed (February 2013). "Psychosocial and psychological interventions for preventing postpartum depression". The Cochrane Database of Systematic Reviews 2 (2): CD001134. doi:10.1002/14651858.CD001134.pub3. PMID 23450532. 
  67. PubMed Health. "Preventing postnatal depression". National Center for Biotechnology Information. 
  68. "Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial". BMJ 338: a3064. January 2009. doi:10.1136/bmj.a3064. PMID 19147637. PMC 2628301. 
  69. "Modifiable partner factors associated with perinatal depression and anxiety: a systematic review and meta-analysis". Journal of Affective Disorders 178: 165–80. June 2015. doi:10.1016/j.jad.2015.02.023. PMID 25837550. 
  70. "Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement". JAMA 321 (6): 580–587. February 2019. doi:10.1001/jama.2019.0007. PMID 30747971. 
  71. "Most of UK doesn't provide vital perinatal mental healthcare". OnMedica. 20 April 2018. 
  72. "Therapeutics of postpartum depression". Expert Review of Neurotherapeutics 17 (5): 495–507. May 2017. doi:10.1080/14737175.2017.1265888. PMID 27892736. 
  73. 73.0 73.1 "Identification and Management of Peripartum Depression". American Family Physician 93 (10): 852–8. May 2016. PMID 27175720. 
  74. "Effects of Exercise on Mild-to-Moderate Depressive Symptoms in the Postpartum Period: A Meta-analysis". Obstetrics and Gynecology 129 (6): 1087–1097. June 2017. doi:10.1097/AOG.0000000000002053. PMID 28486363. 
  75. "Does aerobic exercise reduce postpartum depressive symptoms? a systematic review and meta-analysis". The British Journal of General Practice 67 (663): e684–e691. October 2017. doi:10.3399/bjgp17X692525. PMID 28855163. 
  76. "Psychosocial and psychological interventions for treating postpartum depression". The Cochrane Database of Systematic Reviews (4): CD006116. October 2007. doi:10.1002/14651858.CD006116.pub2. PMID 17943888. 
  77. 77.0 77.1 77.2 77.3 77.4 "Treatment of postpartum depression: clinical, psychological and pharmacological options". International Journal of Women's Health 3: 1–14. December 2010. doi:10.2147/IJWH.S6938. PMID 21339932. 
  78. "Therapist-Supported Internet-Based Cognitive Behavior Therapy for Stress, Anxiety, and Depressive Symptoms Among Postpartum Women: A Systematic Review and Meta-Analysis". Journal of Medical Internet Research 19 (4): e138. April 2017. doi:10.2196/jmir.6712. PMID 28455276. 
  79. 79.0 79.1 "Antidepressant treatment for postnatal depression". The Cochrane Database of Systematic Reviews 9 (9): CD002018. September 2014. doi:10.1002/14651858.CD002018.pub2. PMID 25211400. 
  80. "Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics". Annual Review of Medicine 70 (1): 183–196. January 2019. doi:10.1146/annurev-med-041217-011106. PMID 30691372. 
  81. "Depression drug treatment outcomes in pregnancy and the postpartum period: a systematic review and meta-analysis". Obstetrics and Gynecology 124 (3): 526–34. September 2014. doi:10.1097/aog.0000000000000410. PMID 25004304. 
  82. MacReady, Norra (April 7, 2014). "Postpartum VTE Risk Highest Soon After Birth". Medscape. 
  83. "Bench-to-bedside: NIMH research leads to brexanolone, first-ever drug specifically for postpartum depression" (in EN). 2019-03-20. 
  84. "Press Announcements - FDA approves first treatment for post-partum depression". 
  85. 85.0 85.1 Commissioner, Office of the (2019-04-17). "FDA approves first treatment for post-partum depression" (in en). 
  86. "NIMH » Postpartum Depression Facts". 
  87. O'Connor, Elizabeth; Rossom, Rebecca C.; Henninger, Michelle; Groom, Holly C.; Burda, Brittany U.; Henderson, Jillian T.; Bigler, Keshia D.; Whitlock, Evelyn P. (January 2016). "FDA Antidepressant Drug Labels for Pregnant and Postpartum Women". PubMed Health. 
  88. "Healths of Prescribing Information Brexanolone". 
  89. "A systematic review of the safety and effectiveness of repetitive transcranial magnetic stimulation in the treatment of peripartum depression". Journal of Psychiatric Research 115: 142–150. August 2019. doi:10.1016/j.jpsychires.2019.05.015. PMID 31129438. 
  90. "Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression". The Cochrane Database of Systematic Reviews 7 (7): CD006795. July 2013. doi:10.1002/14651858.CD006795.pub3. PMID 23904069. 
  91. "Post partum anxiety and depression in peri-urban communities of Karachi, Pakistan: a quasi-experimental study". BMC Public Health 9: 384. October 2009. doi:10.1186/1471-2458-9-384. PMID 19821971. 
  92. Laderman, Carol (1987). Wives and midwives : childbirth and nutrition in rural Malaysia (1st pbk. ed.). Berkeley: University of California Press. pp. 202. ISBN 9780520060364. 
  93. McElroy, Ann; Townsend, Patricia K., eds (2009). "Culture, Ecology, and Reproduction". Medical Anthropology in Ecological Perspective. pp. 217–66. ISBN 978-0-7867-2740-7. 
  94. "Postpartum depression in Asian cultures: a literature review". International Journal of Nursing Studies 46 (10): 1355–73. October 2009. doi:10.1016/j.ijnurstu.2009.02.012. PMID 19327773. 
  95. "Perinatal depression: a review of US legislation and law". Archives of Women's Mental Health 16 (4): 259–70. August 2013. doi:10.1007/s00737-013-0359-6. PMID 23740222. 
  96. "Continuing education module: postpartum maternal health care in the United States: a critical review". The Journal of Perinatal Education 15 (3): 34–42. 2006. doi:10.1624/105812406X119002. PMID 17541458. 
  97. "Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review". Birth 33 (4): 323–31. December 2006. doi:10.1111/j.1523-536X.2006.00130.x. PMID 17150072. 
  98. "A qualitative study of stigma among women suffering postnatal illness". Journal of Mental Health 14 (5): 471–481. 2005-01-01. doi:10.1080/09638230500271097. 

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