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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

April 2017

Identifying and Treating Postpartum Depression

Postpartum depression, which affects nearly 15 percent of new mothers, can be a debilitating and long-lasting condition that greatly interferes with the well-being of both mother and baby. Complications associated with postpartum depression can be minimized with proper screening and early detection in the primary care setting, and referral of the patient to a behavioral health specialist for appropriate care.

Symptoms and risk factors

Postpartum depression should not be confused with the significantly more common and less severe “baby blues,” which affect many new mothers and are characterized by feelings of worry, sadness, irritability, and fatigue in the few days or weeks following childbirth. While the baby blues subside on their own, the symptoms of postpartum depression are more extreme and persistent, and can hinder a mother’s ability to properly care for her baby. Although all women are at risk of postpartum depression, the following factors can heighten risk:

  • A personal history of depression, postpartum depression, or other mental health disorders
  • A lack of support from family and friends
  • Anxiety or negative feelings about the pregnancy; an unplanned or unwanted pregnancy
  • Stressful life events in the last year, including marriage or money problems
  • Young age
  • Substance abuse

Symptoms of postpartum depression include:

  • Crying
  • Feeling sad, hopeless, and overwhelmed
  • Loss of interest in activities the patient once enjoyed
  • Trouble sleeping, even when the baby is sleeping, or sleeping more than usual
  • Having little energy
  • Difficulty concentrating and making decisions
  • Feeling restless, irritable, or anxious
  • Withdrawal from family and friends
  • Feeling overly worried about the baby or feeling distant and detached from the baby

Detecting postpartum depression

Early detection and treatment of postpartum depression is vital in preserving the health of mother and child. The Edinburgh Postnatal Depression Scale (EPDS) is a reliable tool for detecting postpartum depression. This ten-item questionnaire inquires about mood symptoms and self-destructive thoughts. It can be used in many settings, including primary care, OBGYN, and behavioral health practices. Additionally, the Patient Health Questionnaire (PHQ-9) — referenced in this article from the this article from the September 2015 issue of Network Matters — is a useful, efficient tool for assessing the severity of all types of depression in behavioral health patients. The PHQ-9 can be administered by the primary care physician and completed by the patient in minutes and serves as a base for diagnosing depression and coordinating follow-up care.

Referrals for behavioral health treatment

Treatment options in the initial stages of postpartum depression depend on the severity of the symptoms. The care for a patient diagnosed with postpartum depression may involve collaboration between the PCP and behavioral health practitioners, and may consist of referring the patient for psychotherapy, prescribing antidepressants, or a combination of both. While some new mothers have concerns about whether it is safe to take antidepressant medications while breastfeeding, experts generally agree that women do not need to stop breastfeeding when taking selective serotonin reuptake inhibitors to treat postpartum depression. Additionally, encouraging patients to seek out a support system — a new mother’s group or a group for women dealing with postpartum depression — can also be helpful.
How Optum/UBH can help your patients — For complex clinical situations, Optum/UBH is available to provide consultative assistance. Practitioners can call the Optum/UBH Physicians Consultation Service at 800-292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call Optum at 888-777-4742.

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