Postpartum Depression & Psychosis

Postpartum mood disorders exist on a severity spectrum. Baby blues affect up to 80% of new mothers, onset within 2–3 days after delivery, and resolve by day 10–14 without treatment — tearfulness, mood swings, and irritability are normal and self-limiting. Postpartum depression (PPD) is a clinical disorder affecting 10–15% of mothers, onset anytime within the first 12 months but commonly by 4–6 weeks. Hallmarks include persistent sadness, feelings of worthlessness or guilt, inability to care for the infant, sleep and appetite disturbances unrelated to newborn care, and possible suicidal ideation. The Edinburgh Postnatal Depression Scale (EPDS) is the validated screening tool; a score of 10 or higher warrants further evaluation. Postpartum psychosis is rare (1–2 per 1,000 births) but a psychiatric emergency, typically emerging within the first 48–72 hours to 2 weeks. It presents with hallucinations, delusions, severe confusion, paranoia, and disorganized behavior. Risk of infanticide and suicide is real — the client requires immediate psychiatric referral and should never be left alone with the newborn. Risk factors for both include history of depression or bipolar disorder, lack of social support, complicated delivery, and NICU admission.