Edinburgh Postnatal Depression Scale (EPDS)
The questionnaire below is called the Edinburgh Postnatal
Depression Scale (EDPS) The EDPS was developed to identify women who may have postpartum
depression. Each answer is given a score of 0 to 3 . The maximum
score is 30.
Please select the answer that comes closest to how you have felt in the past 7
A score of more than 10 suggests minor or major
depression may be present. Further evaluation is recommended [1,8].
Postpartum Depression (Postnatal
Postpartum depression is major depression that occurs after
giving birth. Symptoms are present for most of the day and last for
at least 2 weeks.
As many as 1 in every 7 women (14%) suffers
postpartum depression  . In a study of 209 women referred for major
depression during or after pregnancy 11.5% reported start of depression during
pregnancy , 66.5 % reported start of depression within 6 weeks after
childbirth (early postpartum), and 22%
reported onset 6 weeks after childbirth (late postpartum) . One woman
reported onset of depression at more than 27 weeks after childbirth
Racing thoughts, psychotic symptoms (such as hallucinations or delusions), or a family history of bipolar
disorder (BPD) may indicate bipolar disorder is present [3,5]. The Mood Disorder
Questionnaire (MDQ) is a screening tool used to screen for bipolar disorder .
The MDQ is available at http://www.integration.samhsa.gov/images/res/MDQ.pdf
Treatment [6,7 ]
Treatment of depression during pregnancy and after childbirth is based on
expert opinion. "Within the limits of expert opinion and with the expectation
that future research data will take precedence, these guidelines provide some
direction". The following are some treatment options that have been
Psychotherapy such as cognitive-behavioral therapy (CBT) OR interpersonal
Mild Depression postpartum while breast-feeding
- Psychotherapy with or without antidepressant (sertraline or paroxetine)
- Psychotherapy AND fluoxetine .
Alternative medications: sertraline or tricyclic antidepressant
Severe Depression postpartum while breast-feeding
- Supportive services AND sertraline 
Alternative medication: Paroxetine 
1. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development
of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987
2.Cox JL, et al., A controlled study of the onset, duration and prevalence of
postnatal depression. Br J Psychiatry. 1993 Jul;163:27-31.
3.Sharma V, et al., Missed bipolarity and psychiatric comorbidity in women with postpartum
depression. Bipolar Disord. 2008 Sep;10(6):742-7.
4. Hirschfeld RM, et. al., Development and validation of a screening instrument
for bipolar spectrum disorder: the Mood Disorder Questionnaire.
Am J Psychiatry. 2000 Nov;157(11):1873-5.
5. Wisner KL, Onset timing, thoughts of self-harm, and diagnoses in postpartum
women with screen-positive depression findings.
JAMA Psychiatry. 2013 May;70(5):490-8.
6. Altshuler LL, et al., Treatment of depression in women: a summary of the
expert consensus guidelines. J Psychiatr Pract. 2001 May;7(3):185-208.
7. Berle JO, Spigset O.Antidepressant Use During Breastfeeding. Curr Womens
Health Rev. 2011 Feb;7(1):28-34.
8. Yonkers KA, et. al., Diagnosis, pathophysiology, and management of mood
disorders in pregnant and postpartum women.
Obstet Gynecol. 2011 Apr;117(4):961-77.
8. PROZAC (fluoxetine hydrochloride) capsule
ZOLOFT (sertraline hydrochloride)
PAXIL (paroxetine hydrochloride)
11.HALDOL (haloperidol) injection