Disease Description (Causes and Symptoms)
- Definition: A condition in which severe depressed mood and related symptoms appear after childbirth (according to the reference, beginning within 4 weeks after childbirth). (peripartum/postpartum depression)
- Causes·pathophysiology: Caused by the combined effects of rapid changes in hormones such as estrogen and progesterone immediately after childbirth, stress from childbirth and childcare, and a history of depression or interpersonal stress (such as marital conflict and conflict with in-laws). The pathophysiology is explained by the interaction between neurobiological changes caused by the sharp decline in hormones and psychosocial stress.
- Risk factors: A history of previous postpartum depression (high risk of recurrence — previous sources reported an approximately 30–50% chance of recurrence), existing depression or anxiety disorder, low social support, sleep deprivation, etc.
- Main symptoms: Persistent depressed mood, anxiety·agitation, mood swings, sudden crying, decreased appetite, insomnia·sleep disturbance, reduced concentration, feelings of guilt, severe burden·anxiety related to childcare, and, in severe cases, self-harm·suicidal thoughts or thoughts of harming the baby (an emergency).
Treatment Methods
- Nonpharmacological treatment (a recommended first-line component)
- Emotional support: Cooperation from the spouse and family, sharing childcare responsibilities, and strengthening social support.
- Psychotherapy: Psychotherapies effective for postpartum depression, such as cognitive behavioral therapy (CBT) and interpersonal therapy (IPT).
- Practical support: Securing sleep·rest, childcare support (family·community resources), etc.
- Pharmacological treatment
- When symptoms interfere with daily functioning or suicidal thoughts are present, consider medication treatment such as antidepressants after consulting a psychiatrist.
- Medication selection and evaluation of benefits·risks are necessary during breastfeeding. Some antidepressants can be used while breastfeeding (specialist judgment is required), but the reference recommends caution regarding the combination of breastfeeding and antidepressants.
- Severe·emergency treatment
- If there is a risk of self-harm·suicide or psychotic symptoms (delusions·hallucinations, etc.), immediate inpatient treatment by a specialist and, if necessary, hospitalization·acute-phase treatment (e.g., electroconvulsive therapy (ECT), etc.) should be considered.
- Lifestyle management and precautions
- Adequate sleep and nutrition, regular activity·light exercise, and stress management.
- When taking medication, follow the doctor’s instructions and be sure to inform them whether you are breastfeeding and about your breastfeeding plans.
- Consult medical staff immediately if symptoms worsen or childcare becomes difficult.
Checklist Before an Outpatient Visit (Preparation and Example Questions)
- Items to bring and information to record in advance
- A list of medications currently being taken (including prescription·nonprescription drugs and herbal medicines)
- Past psychiatric history and family history (including depression·suicide attempts, etc.)
- Recent test results (blood tests, thyroid levels, etc.) and copies of medical certificates (if available)
- The time symptoms began, symptom patterns (changes in sleep·appetite·mood·concentration), breastfeeding status, and records of sleep duration·childcare circumstances (over the past 1–2 weeks)
- Symptom checklists such as the Edinburgh Postnatal Depression Scale (EPDS) (if possible)
- Safety-related questions (self-harm·suicidal thoughts, thoughts of harming the baby, etc.) — Never conceal matters related to an emergency
- Important information to tell medical staff immediately during the outpatient visit
- Severe suicidal thoughts·self-harm impulses, hallucinations·delusions, or inability to care for the baby
- Breastfeeding status (intention to continue breastfeeding), and preferences·refusal regarding medication
General Example Questions to Ask the Doctor
- When will this medication begin to work, and what are its side effects?
- I am breastfeeding. What effects could taking this medication have on the baby?
- What is the prognosis for my symptoms, and how long will treatment take?
- What treatments other than medication do you recommend (such as psychotherapy and local support programs)?
- What lifestyle habits·support systems are needed to prevent my symptoms from recurring?
Examples of Condition-Specific Questions
- I am breastfeeding. Which antidepressants are relatively safe, and do I need to stop breastfeeding while taking them?
- How can I determine whether my current condition is at a level that poses a risk to caring for the baby? What signs indicate that immediate hospitalization is necessary?
Additional Safety Guidance
- If you have suicidal thoughts or are concerned that you may harm the baby, immediately contact an emergency room or a local mental health emergency counseling service and seek medical help promptly.