Postpartum Blues, Depression, And Psychosis

The peripartum period (during pregnancy to a year postpartum) is associated with an increased risk for mood and psychotic symptoms due to hormonal shifts, sleep deprivation, and the stresses of being a parent.  Postpartum blues, major depressive disorder (MDD) with peripartum onset, and postpartum psychosis vary in clinical presentation, severity, and management, but they share some overlapping features.

Postpartum blues (also known as "baby blues") is very common, affecting 40%-80% of women in the 2 weeks after childbirth.  Factors that may be associated with developing postpartum blues include a personal history of MDD or premenstrual mood disorders, stress related to childcare, and limited social support following childbirth.

In the days following childbirth, patients experience a rapid decrease in estrogen levels, which results in upregulation of monoamine oxidase-A (MAO-A).  Increased MAO-A activity causes depletion of the neurotransmitters dopamine, norepinephrine, and serotonin, which can result in the depressive symptoms seen in patients with postpartum blues.