Not what I thought it would. In the DSM-IV, to diagnose Major Depressive Disorder with Postpartum Onset, symptoms needed to appear in the first 4-6 weeks. As you know, many moms don’t recognize postpartum depression symptoms until much later in the first year. It’s my belief that this has led to moms going to see their docs and being told they couldn’t have PPD because it was too late.
My understanding was that in the new DSM-V, that would change. To make the qualification for Major Depressive Disorder with Postpartum Onset, symptoms could appear any time in the first four months. Others have said the discussion leading up to revisions of the DSM also revolved around extending it to as far as six months.
Yet yesterday I got a copy of the new pages (pg. 186 and 187) and it still says 4 weeks. So frustrating.
With peripartum onset: This specifier can be applied to the current or, if full criteria are not currently met for a major depressive episode, most recent episode of major depression if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery.
The DSM does now recognize antenatal depression, since the listing has changed from a postpartum onset specifier to a peripartum onset specifier.
The DSM-V also offers a detailed note on using the Major Depressive Disorder with Peripartum Onset diagnosis:
Note: Mood episodes can have their onset either during pregnancy or postpartum. Although the estimates differ according to the period of follow-up after delivery, between 3% and 6% of women will experience the onset of a major depressive episode during pregnancy or in the weeks or months following delivery.
What the heck made them decide on that low number? 3%? Y’all must be kidding. It’s more like 10-15%.
Fifty percent of “postpartum” major depressive episodes actually begin prior to delivery. Thus, these episodes are referred to collectively as peripartum episodes. Women with peripartum major depressive episodes often have severe anxiety and even panic attacks.
Good. Great points to have added about antenatal depression and about the anxious nature of postpartum depression.
Prospective studies have demonstrated that mood and anxiety symptoms during pregnancy, as well as the “baby blues,” increase the risk for a postpartum major depressive episode.
Peripartum-onset mood episodes can present either with or without psychotic features. Infanticide is most often associated with postpartum psychotic episodes that are characterized by command hallucinations to kill the infant or delusions that the infant is possessed, but psychotic symptoms can also occur in severe postpartum mood episodes without such specific delusions or hallucinations.
Postpartum mood (major depressive or manic) episodes with psychotic features appear to occur in from 1 in 500 to 1 in 1000 deliveries and may be more common in primiparous women.
Primiparous means first pregnancy.
The risk of postpartum episodes with psychotic features is particularly increased for women with prior postpartum mood episodes but is also elevated for those with a prior history of depressive or bipolar disorder (especially bipolar 1 disorder) and those with a family history of bipolar disorders.
Once a woman has had a postpartum episode with psychotic features, the risk of recurrence with each subsequent delivery is between 30 and 50%. Postpartum episodes must be differentiated from delirium occurring in the postpartum period, which is distinguished by a fluctuating level of awareness or attention. The postpartum period is unique with respect to the degree of neuroendocrine alterations and psychosocial adjustments, the potential impact of breast-feeding on treatment planning, and the long-term implications of a history of postpartum mood disorder on subsequent family planning.
There you have it. What do you think about the new postpartum depression listing?
Photo credit and citation: American Psychiatric Association