Postpartum Depression

Depression arising in the weeks to months after childbirth — persistent low mood, exhaustion beyond normal new-parent tiredness, disconnection from the baby, guilt, and sometimes frightening intrusive thoughts. It affects roughly 1 in 7 mothers, is driven by hormonal crash plus sleep deprivation plus identity upheaval, and is highly treatable once recognised.

Evidence synthesis: Screening (EPDS) and psychological therapy — particularly CBT and interpersonal therapy — have strong randomised-trial evidence for PPD; SSRIs are effective and sertraline has extensive breastfeeding-safety data. The baby blues (tearfulness, overwhelm, resolving within two weeks) is hormonally normal; persistence beyond two weeks distinguishes depression. Omega-3s have mixed prevention trials; a meta-analysis suggests possible benefit but insufficient for treatment. Saffron has small RCTs in depression including one in postpartum women showing improvement comparable to fluoxetine, though replication is limited. Untreated PPD has documented effects on infant development, which is why treatment matters beyond the mother. Postpartum psychosis — delusions, hallucinations, thoughts of harm that feel justified — is a psychiatric emergency requiring same-day care.