POSTPARTUM DEPRESSIVE-DISORDERS

Despite the high prevalence of postpartum depressive disorders, many s igns and symptoms of this illness are dismissed as normal physiologic changes associated with childbirth. Prompt recognition and treatment a re imperative in order to limit the negative impact on both the mother and infant. Mood disturbances may have a minor functional impact that respond well to social support (eg, postpartum blues) or cause signif icant functional compromise requiring more aggressive therapy (eg, pos tpartum depression). The most extreme case of postpartum depressive di sorder, postpartum psychosis, occurs when patients develop psychosis, mania, or thoughts of infanticide. Depression during pregnancy or the presence of risk factors suggests the need for careful follow-up. If p ostpartum depression develops, psychotherapy is the first-line treatme nt. Antidepressant treatment may be warranted for some patients, and t he risks and benefits to both the mother and infant should be consider ed in the decision to institute pharmacotherapy.