Postnatal Mood Disorders | Obstetrics

Table of Contents

Overview – Postnatal Mood Disorders

Postnatal mood disorders encompass a spectrum of psychological conditions that can affect mothers (and occasionally fathers) in the weeks to months following childbirth. These range from mild, self-limiting symptoms such as the “baby blues” to severe and life-threatening illnesses like postnatal psychosis. Prompt identification, risk factor recognition, and early intervention are crucial to reduce long-term complications for both mother and child. This page outlines the clinical presentation, risk factors, and management approaches for the various forms of postnatal mood disturbance.

Classification of Postnatal Mood Disorders

1. “The Baby Blues” (Mild)

Affects up to 80% of new mothers
Onset typically between Day 3–10 postpartum
Symptoms include:
- Tearfulness
- Mood swings
- Anxiety
- Irritability
Management:
- Self-limiting and usually resolves with supportive care and reassurance

2. Postnatal Depression (Moderate)

Affects 12–15% of mothers and up to 10% of fathers
Onset can range from 24 hours to several months postpartum
Symptoms include:
- Insomnia, anorexia
- Crying, exhaustion
- Loss of enjoyment or interest in daily activities
- Irritability, anxiety
- Low confidence, guilt
- Social withdrawal (fear of being alone or with others)
- Suicidal ideation
Management:
- Psychological support from family and community
- Psychotherapy (e.g. cognitive behavioural therapy)
- Pharmacological: Antidepressants such as selective serotonin reuptake inhibitors (SSRIs)
- If severe, consider electroconvulsive therapy (ECT)

3. Postnatal Psychosis (Severe)

Rare but serious: affects 1 in 500 mothers
Onset typically within the first month postpartum
Symptoms include:
- Loss of insight – mother often unaware she is unwell
- Severe mood disturbance (manic or depressive)
- Disordered or bizarre thoughts
- Insomnia
- Inappropriate responses to infant
- Can pose life-threatening risk to both mother and baby
Management:
- Urgent hospitalisation
- Antipsychotic medications ± antidepressants

Postnatal Depression: In-Depth

Definition

Non-psychotic depression occurring within the first 4 weeks postpartum
Typically lasts 2–6 months
May lead to maternal detachment, suicidal thoughts, or infanticidal ideation if untreated
Risk of recurrence in subsequent pregnancies is less than 50%

Presentation

Affected women may present with:
- Depressive and anxious features
- Fatigue, irritability, tearfulness
- Delayed bonding or negative feelings toward the infant
- Somatic symptoms
- Reluctance to seek help or discuss feelings
Often recognised by:
- Midwives or health visitors
- Concerned partners or family members

Risk and Protective Factors

Risk Factors

Younger maternal age
Lower socio-economic status
Minority background
Absence of partner or social support
Traumatic or complicated birth
Not breastfeeding
Marital conflict
History of abuse or psychiatric illness
No employment to return to
Reluctance to seek help

Protective Factors

Higher self-esteem and optimism
Higher education level
Good socio-economic conditions
Strong, supportive relationship with partner

Screening Tools

EPDS (Edinburgh Postnatal Depression Scale):
- 10 questions, takes ~5 minutes
- Used to screen and guide further assessment
K10 score (if applicable)

Effects on the Infant

Impaired bonding and attachment
Development of insecure attachment
Poor emotional regulation and behavioural issues
Increased risk of delayed milestones
Higher long-term risk of mental health conditions

Summary – Postnatal Mood Disorders

Postnatal mood disorders range from mild, self-limiting baby blues to severe psychiatric conditions like postnatal psychosis. While postnatal depression is the most common moderate condition, early screening, support, and intervention can significantly improve outcomes for both mother and child. Awareness of risk factors and appropriate referral pathways is essential. For a broader context, see our Obstetrics Overview page.