Postpartum depression

This patient's symptoms are concerning for major depressive disorder (depressed mood, anhedonia, sleep disturbance, poor appetite, impaired concentration, tearfulness, guilt). All patients should be screened for postpartum depression at the postpartum visit. Postpartum depression is diagnosed using the same diagnostic criteria used to diagnose a major depressive episode (>2 weeks of at least 5 of 9 symptoms that include depressed mood plus SIGECAPS: Sleep disturbance, loss of Interest, Guilt, low Energy, impaired Concentration, change in Appetite, Psychomotor retardation or agitation, and Suicidal thoughts). A screening instrument such as Edinburgh Postnatal Depression Scale can also be used to assess which women require a more thorough evaluation.

Postpartum blues is a self-limited condition consisting of milder depressive symptoms with less impact on functioning. It typically peaks at 5 days postpartum and resolves within 2 weeks. By contrast, this patient's depressive symptoms have persisted beyond 2 weeks and appear to be worsening.

Adjustment disorder is diagnosed only if symptoms do not meet the criteria for another specific disorder such as major depressive disorder.

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