Focus on Women’s Health: Postpartum Depression

One of the most frequent conditions we encounter in women’s behavioral health is postpartum depression. What follows is a brief summary of how we support our patients and the educational content we make available to their providers.

Primary care providers and OBGYNs are often the first line of defense in identifying a condition that occurs in the shadows of new parenthood. Postpartum depression is not merely a “rough patch”; it is a significant clinical mood disorder. While the "baby blues" typically resolve within 14 days, postpartum depression can be characterized by persistent, severe symptoms that require professional intervention to prevent long-term morbidity for both mother and child.

By integrating behavioral health screening into routine postpartum care, we move toward a more holistic model of women’s behavioral health—one that recognizes perinatal wellness as foundational to pediatric outcomes and family stability.

Postpartum depression affects approximately 10-20% of new mothers, marking it as one of the most prevalent complications of the puerperium. Despite its frequency, many women suffer in silence due to the stigma surrounding maternal behavioral health or lack of knowledge that this isn’t simply normal. In addition to providing direct behavioral health support to patients, the Concert Health team also advises providers on their role in integrating perinatal behavioral health management into their clinical practice, and transitioning from reactive treatment to proactive behavioral health management.

Clinical Presentation and Differential Diagnosis

Symptoms can manifest during pregnancy or anytime within the first year postpartum, with a peak incidence around three months. Recognizing the triad of postpartum depression symptoms is essential for an accurate diagnosis:

• Emotional: Persistent low mood, intense irritability, or feelings of worthlessness and guilt.
• Physical: Chronic fatigue, sleep disturbances (often independent of the infant’s sleep cycle), and somatic aches without clear etiology.
• Cognitive: "Brain fog," difficulty with executive function, and loss of interest in previously enjoyed activities (anhedonia).

The Adjacent Diagnosis: Postpartum Anxiety
It’s important to note that postpartum anxiety is more common than postpartum depression but frequently overlooked because symptoms are often subsumed under a depression diagnosis. Postpartum anxiety presents as uncontrollable worry—specifically regarding the infant's health or safety—and physical "on-edge" activation.

A comprehensive behavioral health assessment should identify patients at higher risk, including those with:

• A personal or family history of mood disorders.
• Significant sleep deprivation or lack of psychosocial support.
• Obstetric complications or significant hormonal fluctuations.

Evidence-Based Treatment Protocols

To be effective, treatment for patients with postpartum depression should be individualized, focusing on the patient's history and current functional status. There are two main components to this:

1. Psychotherapy - Cognitive Behavioral Therapy and Interpersonal Therapy remain the first-line non-pharmacological interventions.

2. Pharmacotherapy - When medication is indicated, clinical data suggests the following approach:

• Prior Success: If a patient has a history of a successful antidepressant trial, re-initiating that specific medication is preferred to minimize the trial-and-error period.
• De Novo Treatment: For patients without prior history, certain SSRIs are typically preferred and have the most robust data regarding low relative infant doses in breastmilk.
• Dosing Strategy: To improve adherence, start at half the usual starting dose for the first week to mitigate transient side effects like nausea or physical activation. Patients should know that full therapeutic effects typically require 4–6 weeks.

Connecting Patients to Resources

Improving women’s behavioral health requires a network of care. In addition to working directly with patients and providers, the Concert Health team also recommends resources to support ongoing success. One example is Postpartum Support International, which offers vital, free resources for both patients and providers:

• For Patients: Online support groups and local coordinators to help navigate care.
• For Prescribers: A Perinatal Psychiatric Consult Program to assist you in complex cases.

By standardizing these screenings and treatments, we can ensure that behavioral health is not an elective addition to postpartum care, but a core component of it.