Postpartum Depression (PPD)

• Prior history of depression.
• Preterm birth.
• Unexpected childbirth experience.
• Prior childbearing loss.
• History of psychological trauma (e.g. sexual, physical or mental abuse).
• Intimate Partner Violence (IPV).
• Prior history of other psychiatric conditions or use of psychiatric medications.
• Stress.

• For women with positive PPD screen, consider laboratory testing for hypothyroidism as low levels can mimic depression.
• Help develop and implement an action plan to address psychological and behavioral therapies needed.
• Discuss medication therapy options with mom and her support team.
• Encourage breastfeeding, when appropriate and if feedings are going well as it can be a protective measure against postpartum depression.
• Teach patients coping skills related to the adjustment to motherhood.
• Make sure the mother has a support system in place.
• Make sure the mother is getting adequate sleep and rest, eating a well-balanced diet and making time for self-care.
• Encourage skin-to-skin contact to increase oxytocin, which helps to decrease stress.
• Encourage the mother to include long Omega-3 fatty acids (e.g. EPA and DHA) in her diet or to take a supplement.
• Encourage the mother to exercise.
• Help the mother to make an appointment with a post-partum depression counselor.
• Prescribe psychotherapy or a breastfeeding-compatible antidepressant or St. John’s Wort.
• Refer her to a Lactation Consultant or community breastfeeding support such as WIC, to help her reach her breastfeeding goals.

Clinical Guidelines

• Evans, A., Marinelli, K. A., Taylor, J. S., & Academy of Breastfeeding Medicine (2014). ABM clinical protocol #2: Guidelines for hospital discharge of the breastfeeding term newborn and mother: "The going home protocol," revised 2014. Breastfeeding Medicine, 9(1), 3–8. 
• Reece-Stremtan, S., & Marinelli, K. A. (2015). ABM clinical protocol #21: guidelines for breastfeeding and substance use or substance use disorder, revised 2015. Breastfeeding Medicine, 10(3), 135–141. 
• Sriraman, N. K., Melvin, K., & Meltzer-Brody, S. (2015). ABM Clinical Protocol #18: Use of Antidepressants in Breastfeeding Mothers. Breastfeeding Medicine, 10(6), 290–299.

References

1. Kathleen Kendall-Tackett, PhD
2. Campbell, S. H., Lauwers, J., Mannel, R., & Spencer, B. (2019). Core curriculum for interdisciplinary lactation care. Jones & Bartlett Learning.
3. Chaves, K., Eastwood, J., Ogbo, F. A., Hendry, A., Jalaludin, B., Khanlari, S., & Page, A. (2019). Intimate partner violence identified through routine antenatal screening and maternal and perinatal health outcomes. BMC Pregnancy and Childbirth, 19(1), 357. 
4. Lawrence, R. A., & Lawrence, R. M. (2016). Breastfeeding: A guide for the medical profession (8th ed.). Elsevier. 
5. Uvnäs Moberg, K., Handlin, L., Kendall-Tackett, K., & Petersson, M. (2019). Oxytocin is a principal hormone that exerts part of its effects by active fragments. Medical Hypotheses, 133, 109394.