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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:
  1. 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.)
    1. 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)
    2. 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)
    3. 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
    4. Insomnia or hypersomnia nearly every day
    5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
    6. Fatigue or loss of energy nearly every day
    7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
    8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either subjective account or as observed by others)
    9. 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
  2. The symptoms do not meet the criteria for mixed episode (p. 365 DSM-IV)
  3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  4. 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)
  5. 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.