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Postpartum Major Depression KATHRYN P. HIRST, MD, and CHRISTINE Y. MOUTIER, MD University of California, San Diego, School of Medicine, La Jolla, California Postpartum major depression is a disorder that is often unrecognized and must be distinguished from “baby blues.” Antenatal depressive symptoms, a history of major depressive disorder, or previous postpartum major depression significantly increase the risk of postpartum major depression. Screening with the Edinburgh Postnatal Depression Scale may be appropriate. Some women with postpartum major depression may experience suicidal ideation or obses- sive thoughts of harming their infants, but they are reluctant to volunteer this information unless asked directly. Psychotherapy or selective serotonin reuptake inhibitors may be used to treat the condition. In patients with moder- ate to severe postpartum major depression, psychotherapy may be used as an adjunct to medication. No evidence suggests that one antidepressant is superior to others. Antidepressants vary in the amount secreted into breast milk. If left untreated, postpartum major depression can lead to poor mother-infant bonding, delays in infant growth and development, and an increased risk of anxiety or depressive symptoms in the infant later in life. (Am Fam Physician. 2010;82(8):926-933. Copyright © 2010 American Academy of Family Physicians.) ▲ Patient information: he term “postpartum depression” Etiology A handout on postpartum commonly includes major and The etiology of postpartum major depression depression, written by the minor depression, which differ in remains unclear. Some women may be sensi-