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Perinatal psychiatry
After birth three states are distinguished — the baby blues, which pass within two weeks, postpartum depression, which persists and impairs function, and postpartum psychosis, which is an emergency; in pregnancy drugs are decided by balancing the risk of the drug against the risk of untreated illness.
Why it matters in the exam
Exam questions present a woman days or weeks after birth and ask for the diagnosis. The baby blues are very common (most new mothers): crying, sensitivity and tiredness in the first days, passing within two weeks without treatment. Postpartum depression (about 1 in 7–10 women) persists beyond two weeks and impairs function and the bond with the baby; screening uses the EPDS questionnaire, and treatment is psychotherapy and an SSRI — sertraline suits breastfeeding. Zuranolone was approved in 2023 in the United States for postpartum depression. Postpartum psychosis (1–2 per 1000) usually appears in the first two weeks, is strongly linked to bipolar disorder, and endangers mother and baby — so it requires urgent assessment and admission.
In pregnancy remember that untreated illness is dangerous too: untreated depression is linked to preterm birth, poor self-care and postpartum depression. SSRIs are generally acceptable in pregnancy (paroxetine is less favoured because of a small cardiac risk); neonatal adaptation symptoms may occur. Lithium carries a small risk of Ebstein anomaly; it is continued in women who need it, with level monitoring, because renal clearance rises in pregnancy and drops sharply right after birth — when there is a danger of toxicity. Valproate is avoided. Women with bipolar disorder are at very high risk of an episode after birth, so preventive treatment and close follow-up are planned in advance.
Key points
- Baby blues: days 2–5, passes within two weeks.
- Postpartum depression: persists, impairs function; EPDS; SSRI and psychotherapy.
- Postpartum psychosis: first two weeks, bipolar, urgent admission.
- SSRIs acceptable in pregnancy; sertraline in breastfeeding.
- Lithium: level monitoring; danger of toxicity right after birth.
Summary table
| Condition | Timing and picture | Treatment | Exam notes |
|---|---|---|---|
| Baby blues | Days 2–5, passes within two weeks; crying, sensitivity | Support and reassurance | Very common; no significant impairment |
| Postpartum depression | Onset in pregnancy or within 4 weeks after birth (DSM), lasts beyond two weeks | Psychotherapy, SSRI (sertraline in breastfeeding); zuranolone | Screen with the EPDS |
| Postpartum psychosis | Usually in the first two weeks; confusion, delusions, labile mood | Urgent admission; antipsychotic, lithium, ECT | Linked to bipolar disorder; danger to mother and baby |
| SSRIs in pregnancy | Generally acceptable | Sertraline, escitalopram | Paroxetine less favoured; neonatal adaptation symptoms |
| Lithium in pregnancy | Small risk of Ebstein anomaly | Continue when needed; level monitoring and fetal echocardiography | Sharp fall in clearance after birth → danger of toxicity |
| Valproate | Neural tube defects and cognitive harm | Avoid; an alternative as needed | Not a drug for women of reproductive age when another will do |
A free exam question
איזה מבין ה Specifiers לא כלול ב Bipolar disorder לפי 5 DSM ? (the question as examined, in Hebrew)
- א. Paranoid
- ב. Seasonal
- ג. Peripartum
- ד. Catatonia
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Sources
- ACOG Clinical Practice Guideline No. 4, 2023 — Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum
- ACOG Clinical Practice Guideline No. 5, 2023 — Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum
- NICE guideline CG192, 2014, updated 2020 — Antenatal and postnatal mental health
- Kaplan and Sadock's Synopsis of Psychiatry, 12th edition (2021) — Peripartum mood disorders
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.