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Edinburgh Postnatal Depression Scale  (EPDS)[1]

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 days:
 

1. I have been able to laugh and see the funny side of things
As much as I always could
Not quite so much now
Definitely not so much now
Not at all
 
2. I have looked forward with enjoyment to things
As much as I ever did
Rather less than I used to
Definitely less than I used to
Hardly at all
 
3. I have blamed myself unnecessarily when things  went wrong
Yes, most of the time
Yes, some of the time
Not very often
No, never
 
4. I have been anxious or worried for no good reason
No, not at all
Hardly ever
Yes, sometimes
Yes, very often
 
5. I have felt scared or panicky for no very good reason
Yes, quite a lot
Yes, sometimes
No, not much
No, not at all
 
6. Things have been getting on top of me
Yes, most of the time I haven't been able to cope at all.
Yes, sometimes I haven't been coping as well as usual
No, most of the time I have coped quite well.
No, I have been coping as well as ever.
 
7. I have been so unhappy that I have had difficulty sleeping
Yes, most of the time
Yes, sometimes
Not very often
No, not at all
 
8. I have felt sad or miserable
Yes, most of the time
Yes, quite often
Not very often
No, not at all
 
9. I have been so unhappy that I have been crying
Yes, most of the time
Yes, quite often
Only occasionally
No, never
 
10. The thought of harming myself has occurred to me
Yes, quite often
Sometimes
Hardly ever
Never


If you have had ANY thoughts of harming yourself or your baby, or you are having hallucinations  please
 tell your doctor or your midwife immediately
OR GO TO YOUR NEAREST HOSPITAL EMERGENCY ROOM.
TOTAL SCORE                                                               

A score of more than 10 suggests minor or major depression may be present. Further evaluation is recommended [1,8].

Postpartum Depression (Postnatal Depression)

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 [5] . 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 [2].

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 [4]. 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 suggested .

Mild depression

  • Psychotherapy such as cognitive-behavioral therapy (CBT) OR interpersonal therapy
     

Mild Depression postpartum while breast-feeding

  • Psychotherapy with or without antidepressant (sertraline or paroxetine)
     

Severe Depression

  • Psychotherapy AND fluoxetine [8].
         Alternative medications: sertraline or  tricyclic antidepressant
     

Severe Depression postpartum while breast-feeding

  • Supportive services AND sertraline [9]
         Alternative medication: Paroxetine [10]
     

Support Groups

More Resources

REFERENCES

1. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987 Jun;150:782-6. PMID:3651732
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. PMID:8353695
3.Sharma V, et al., Missed bipolarity and psychiatric comorbidity in women with postpartum depression. Bipolar Disord. 2008 Sep;10(6):742-7. PMID:18837870  
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. PMID:11058490
http://ajp.psychiatryonline.org/article.aspx?articleid=174439
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. PMID:23487258
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. PMID:15990522
7. Berle JO, Spigset O.Antidepressant Use During Breastfeeding. Curr Womens Health Rev. 2011 Feb;7(1):28-34. PMID:22299006
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.  PMID:21422871
8. PROZAC (fluoxetine hydrochloride) capsule
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=c88f33ed-6dfb-4c5e-bc01-d8e36dd97299
9. ZOLOFT (sertraline hydrochloride)
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=fe9e8b7d-61ea-409d-84aa-3ebd79a046b5
10. PAXIL (paroxetine hydrochloride)
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=584ace29-6e40-432f-950f-ab7e98653d32
11.HALDOL (haloperidol) injection http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=27cfe684-7d11-4f37-9c8b-b2bdd6b5348e

 
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