Section 1: Postpartum Depression (PPD) by the Numbers

What are the symptoms of PPD?

photo of depressed woman

The DSM-5 identifies nine symptoms of major depressive disorder, shown in the following table. A diagnosis of PPD requires that at least five of the nine diagnostic criteria be present for two weeks or longer. Symptom 1 or symptom 2 must be present for a PPD diagnosis. In addition, symptoms other than symptom 9 must be present and prominent on most days.

Symptoms of Major Depressive Disorder, DSM-5

  1. Depressed mood most of the time on most days, either by subjective report (for example: feelings of sadness, hopelessness, or emptiness) or by observed behavior (for example: tearfulness).
  2. Substantially decreased interest or ability to enjoy all or most activities (may be reported subjectively or observed).
  3. Psychomotor retardation or agitation.
  4. Feelings of worthlessness or guilt.
  5. Indecisiveness or difficulty concentrating.
  6. Significant change in weight (gain or loss) or appetite (increase or decrease).
  7. Insomnia or hypersomnia.
  8. Decreased energy or excessive fatigue.
  9. Frequent thoughts of death (not just fear of death), suicide attempt, or suicidal thoughts (with or without a plan).

Who is at risk?

The greatest risk factor for PPD is a personal history of depression. Women with a history of anxiety or mood symptoms during pregnancy also have an increased risk.

Other recognized risk factors include:

  • Personal or family history of mental illness.
  • Stressful life situations.
  • Isolation and lack of social support.
  • Caring for an infant with medical issues or a difficult temperament.
  • Hormonal changes following pregnancy.

Women with no known risk factors can also develop PPD.

illustration of depressed woman

Postpartum psychosis, the most severe form of PPD, is uncommon. However, in about half of cases, postpartum onset represents the first episode of psychosis. Any woman with psychotic symptoms at the time of evaluation or in the recent past should be referred for emergent psychiatric evaluation.