DSM-IV Diagnosis*The DSM-IV does not recognize postpartum depression as a separate diagnosis; rather, patients with a diagnosis of postpartum depression must meet the criteria for both major depressive episode and the criteria for the postpartum onset specifier.
Criteria for Postpartum Onset Specifier:
Onset of major depressive episode must be within 4 weeks after delivery.
Criteria for Major Depressive Episode:
- Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least 1 of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure. (Note: Do not include sysptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.)
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (eg, feels sad or empty) or observation made by others (eg, appears tearful)
- Markedly diminished interest in pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
- Significant weight loss when not dieting or weight gain (eg, change of more than 5% body weight in a month), or decrease or increase in appetite nearly every day
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either subjective account or as observed by others)
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
- The symptoms do not meet the criteria for mixed episode (p. 365 DSM-IV)
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The symptoms are not due to the direct physiological effects of a substance (eg, a drug of abuse, medication) or a general condition (eg, hypothyroidism)
- The symptoms are not better accounted for by bereavement, ie, after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation
*American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV TR (Text Revision). Arlington, VA: American Psychiatric Association; 2000.