Preparation for Child Psych PRITE and Boards
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General overview of depression can be found in the main article.

Epidemiology and Risk

  • The incidence of MDD during pregnancy is 7.5%, while period prevalence is 12.7%.
  • The strongest risk factor is a history of postpartum MDD with a previous pregnancy (25-50% recurrence rate)
  • Depression during pregnancy is associated with increased risk of pre-term birth and low birth-weight (Meta-analysis, Grote 2010)
  • Women treated with SSRI's have 2-3x greater risk for preterm birth and delivering low-birth-weight infants, compared to women not treated with SSRIs.
  • Despite in-utero SSRI exposure, there was no effect in infant growth at 12-mo in a prospective observational study, i.e., premature and low-weight babies caught up.


  • Baby blues refers to a brief period (<10days) of depressed mood and mild dysfunction without suicidality.
    • prevalence if "baby blues" is 80% [1]
  • postpartum depression is DSM-IV specifier for major depressive disorder, ("with postpartum onset") defined as onset within four weeks of delivery.
    • feeling of guilt and worthlessness often dominate, while depressed mood is less common.
    • up to 60% of women with postpartum MDD may have obsessive/intrusive thoughts about harming the infant.
    • MD must rule out postpartum autoimmune thyroiditis (8% of postpartum women), which can mimic MDD


  • Interpersonal therapy and cognitive behavior therapy are effective in treating MDD with postpartum onset.
  • Light therapy has not been shown to be effective in patients with postpartum major depression.
  • SSRIs are affective in moderate and severe depression; they are generally considered safe in breastfeeding.


[2] Groto NK, A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010 Oct;67(10):1012-24

[3] Wisner KL, Does Fetal Exposure to SSRIs or Maternal Depression Impact Infant Growth? Am J Psychiatry. 2013 May 1;170(5):485-93.

[4] Hirst KP., et.el. Postpartum Major Depression. Am Fam Physician. 2010 Oct 15;82(8):926-933