Causes of Post-Partum Depression

Differentiating Signs/Symptoms

History of therapeutic use and/or abuse of known causative substances or hormones.
Other symptoms and signs specific to the substance or substances involved may be present.

Differentiating Tests

Urine drug screen may be positive in substance abuse and identifies the substance taken. However, drug screens are not definitive for drug misuse.

Notes on agents

"Methyldopa should be avoided in women with a prior history of depression, because of the increased risk of postnatal depression." "Methyldopa should be avoided post partum because of the risk of postnatal depression." Go through the list of agents that may cause depression here.

Differentiating Signs/Symptoms

Possible symptoms of hyperthyroidism (e.g., weight loss, sweating, nervousness, palpitations) or hypothyroidism (e.g., sluggishness, constipation, cold intolerance).
The time frame for postpartum (painless/lymphocytic) thyroiditis, which is characterized by transient hyper- and hypothyroid phases, may overlap with that for postpartum depression,although there is no established causal relationship between the 2 conditions.

Differentiating Tests

TSH low (hyperthyroidism) or high (primary hypothyroidism).

Differentiating Signs/Symptoms

Symptoms and signs include pallor, fatigue, weakness, decreased exercise tolerance, and shortness of breath with exercise.
Clinical features specific to the underlying cause may also be identified.

Differentiating Tests

Hb less than 12 in women.

Differentiating Signs/Symptoms

Patients have clinical symptoms or signs of the underlying cause. Brain dysfunction may be due to primary cerebral or systemic disease.

Differentiating Tests

Brain CT or MRI may identify a structural neurologic abnormality.

Differentiating Signs/Symptoms

Causes transient emotional lability during the first week after birth and has a wide variety of symptoms typical of low and high mood
Care of the baby is not impaired, hopelessness and worthlessness are not prominent, and women do not feel suicidal.
Self-limiting, but assessment should ensure that the woman is not and does not become more severely depressed.

Differentiating Tests

Clinical diagnosis.

Differentiating Signs/Symptoms

Women with a history of bipolar disorder (1 in 4 deliveries) or a previous puerperal psychosis (1 in 2 deliveries) are at considerably higher risk.
Acute onset of a manic or depressive psychosis soon after birth. There is a very close relationship to childbirth, with >90% of women experiencing an onset in the first postpartum week and 73% of women experiencing an onset of symptoms by day 3.

Differentiating Tests

Clinical diagnosis.

Differentiating Signs/Symptoms

Symptoms such as sleep disturbance, weight change, and loss of energy commonly occur following childbirth without any associated depression.
Characteristic mood changes of depression are absent.

Differentiating Tests

Clinical diagnosis.