Recognising and Diagnosing Postpartum Depression: From Antenatal Identification to Collaborative Care
This interactive case study was organised and funded by Biogen, Inc. Medical writing assistance was provided by Jessica Jinks and Alexander Perkins, EMJ, UK.
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Reproductive health
These interactive case studies were developed with support from Kevin LaGuerre, Associate Medical Director, Global Medical; and Nathan Rodeberg, Associate Director, Scientific Communications, Biogen.
Intended for healthcare professionals only.
Biogen-293591 | September 2026
The following patient cases are based on clinical experiences but are fictitious and intended for educational purposes only. Individual patient experiences may vary. This resource is not intended for medical advice or as a substitute for consultation and review of reference materials and medical literature pertaining to individual clinical circumstances. HCPs should make all medical decisions based on the context of the situation and their independent clinical judgement. The screening tools presented are provided for your information only and are not endorsements, referrals, or recommendations from Biogen. The use of tools in practice is at the discretion of an HCP's independent medical judgement. Use of the screening and rating tools for PPD provided in this deck should be accompanied by further evaluation for complete diagnosis.
By the end of this case study, you will be able to:
Identify key risk factors for postpartum depression in the antenatal period
Learning Objectives
RCC: refractory chronic cough. 1. Morice AH et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J. 2020;55(1):1901136. 2. Chung KF et al. Cough hypersensitivity and chronic cough. Nat Rev Dis Primers. 2022;8(1):45. 3. Gibson PG, Vertigan AE. Management of chronic refractory cough. BMJ. 2015:351:h5590. 4. Chung KF et al. Chronic cough as a disease: implications for practice, research, and health care. Lancet Respir Med. 2025;13(2):110-2. 5. Irwin RS, Madison JM. Unexplained or refractory chronic cough in adults. N Engl J Med. 2025;392(12):1203-14.
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References and abbreviations
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Select and interpret validated screening tools in the perinatal context
Map clinical symptoms to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria for major depressive episode with peripartum onset
Explain and apply the principles of collaborative care in perinatal mental health
Make a formal diagnosis of postpartum depression, including accurate International Classification of Diseases 10th Revision (ICD-10) coding
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Your patient, Maya, is pregnant with her second child. Click to explore her medical history before her next visit.
Introducing Maya: Patient Background and Past Medical History
Specialty: OB-GYN Practice: Outpatient Length of patient–provider relationship: 2 years
MDD: major depressive disorder; OB-GYN: obstetrics and gynaecology.
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About Maya: Age: 26 years Sex: Female Gender: Female Race: Latin American Education: College (Bachelor's degree) Employment: Full-time, paid maternity leave
Provider information
None
Current treatments
No known drug allergy
Allergy
History of psychiatric disorder (MDD) One episode, currently in remission One previous pregnancy with no complications
Medical history
Maternal history of bipolar disorder
Family history
Social history
Supportive partner and family living nearby
Married 1 toddler Non-smoker, never smoked Reports no illicit drug use Reports no alcohol use
Which aspects of Maya’s medical history are suggestive of risk factors for PPD? Select all that apply.
Previous childbirth without perinatal complications
D
B
Family history of bipolar disorder
A
MDD history
Age <30 years
C
1. Agrawal I et al. Risk factors of postpartum depression. Cureus. 2022;14(10):e30898. 2. Hill JB et al. Screening, diagnosing, and managing perinatal depression: review of six national guidelines. Eur J Obstetrics Gynecol. 2026;319:114977. 3. Zacher Kjeldsen MM et al. Family history of psychiatric disorders as a risk factor for maternal postpartum depression: a systematic review and meta-analysis. JAMA Psychiatry. 2022;79(10):1004-13. Abbreviations: MDD: major depressive disorder; PPD: postpartum depression.
Answer rationale: A history of MDD is a well-established and strong risk factor for PPD, reflecting vulnerability to recurrence during hormonal and psychosocial stressors of the perinatal period.1,2 A family history of psychiatric illness increases risk through genetic predisposition and shared environmental influences.1-3
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Leading health organisations consistently recommend routine screening to ensure timely identification and support for those at risk.1-6
Multiple Professional Societies Recommend Screening for PPD Risk
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Every perinatal patient should be screened for anxiety and depression. ACOG recommends the use of a validated tool to screen for depression and anxiety. ACOG recommends that screening for perinatal depression and anxiety occur at the initial prenatal visit, later in pregnancy, and at postpartum visits.1 PHQ-91 EPDS1
ACOG
APA
All perinatal patients should receive mental health screening and assessment.2 Mothers should be screened for PPD at paediatric care appointments.3
Clinical guidelines recommend that all perinatal patients be monitored for depression and mood disorders throughout pregnancy and in the postpartum period. Screening should occur in each trimester and postpartum.⁴ EPDS⁴ PHQ-9⁴ PHQ-2⁴ Whooley Questionnaire⁴
CANMAT
All women should be asked about their mental health at booking and postpartum appointments. Screening should include asking about low mood and how a woman is feeling about parenthood and her own wellbeing.⁵ EPDS⁵ PHQ-9⁵
NICE
WHO
Screening for depression and anxiety should be conducted using validated tools during postnatal contacts, and mental health support should be made available as part of routine postnatal care.⁶ EPDS⁶ PHQ-9⁶
1. ACOG. Screening and diagnosis of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 4. Obstet Gynecol. 2023;141(6):1232-61. 2. APA. Position statement on screening and treatment of mood and anxiety disorders during pregnancy and postpartum. 2025. Available at: https://www.psychiatry.org/getattachment/bf2c29a1-98f5-4c8f-9e4a-4119fa64bcca/Position-Pregnancy-Postpartum- Mood-Anxiety-Disorders.pdf. Last accessed: 7 August 2026. 3. Earls MF et al. Incorporating recognition and management of perinatal depression into pediatric practice. Pediatrics. 2019;143(1):e201832591. 4. Vigod SN et al. Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the management of perinatal mood, anxiety, and related disorders. Can J Psychiatry. 2025;70(6):429-89. 5. NICE. Antenatal and postnatal mental health: clinical management and service guidance. National Clinical Guideline no 192. 2014. Available at: https://www.nice.org.uk/guidance/cg192/resources/antenatal-and-postnatal-mental-health-clinical-management-and- service-guidance-pdf-35109869806789. Last accessed: 7 August 2026. 6. WHO. WHO recommendations on maternal and newborn care for a positive postnatal experience. Available at: https://www.who.int/publications/i/item/9789240045989. Last accessed: 7 August 2026. Abbreviations: ACOG: American College of Obstetricians and Gynecologists; APA: American Psychiatric Association; CANMAT: Canadian Network for Mood and Anxiety Treatments; EPDS: Edinburgh Postnatal Depression Scale; NICE: National Institute for Health and Care Excellence; PHQ-2: Patient Health Questionnaire-2; PHQ-9: Patient Health Questionnaire-9; PPD: postpartum depression; WHO: World Health Organization.
Before Maya’s next visit, a quick check-in: Which of the following best describes the current guideline consensus on screening for PPD?
Screening for psychiatric conditions is the responsibility of specialist perinatal mental health services
Screening should occur during pregnancy and again in the postpartum period for all patients
Screening is recommended only if a risk factor is identified at booking
Screening is primarily indicated in patients with a prior psychiatric history
1. ACOG. Screening and diagnosis of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 4. Obstet Gynecol. 2023;141(6):1232-61. 2. Vigod SN et al. Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the management of perinatal mood, anxiety, and related disorders. Can J Psychiatry. 2025;70(6):429-89. 3. NICE. Antenatal and postnatal mental health: clinical management and service guidance. National Clinical Guideline no 192. 2014. Available at: https://www.nice.org.uk/guidance/cg192/resources/antenatal-and-postnatal-mental-health-clinical-management-and- service-guidance-pdf-35109869806789. Last accessed: 7 August 2026. Abbreviations: ACOG: American College of Obstetricians and Gynecologists; CANMAT: Canadian Network for Mood and Anxiety Treatments; NICE: National Institute for Health and Care Excellence; PPD: postpartum depression.
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Answer rationale: Across multiple health organisations including NICE, ACOG, and CANMAT, universal screening at both antenatal and postnatal contacts is strongly recommended and not reserved for high-risk cases.1-3 As you work through this case study, consider how and when screening might have made a difference for your patient.
Third Trimester Visit
Maya arrives at her third trimester visit on time. She says everything is going well. However, she is looking tired in a way that goes beyond the usual exhaustion of late pregnancy.
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She mentions in passing that she hasn't been sleeping well, adding “And I don't know why, because everything is fine.”
She mentions she's been a bit less sociable than usual lately. She says she's just been focused on getting ready for the baby. When you ask about her appetite, she says: "It's fine." Her husband isn't sure everything is fine, saying that she seems distant. She seems surprised he's brought it up. “I'm just tired,” she says. “Everything is good. We have a lot of support.”
What you're hearing:
Third Trimester Visit: A Clinical Perspective
Stigma remains a significant barrier to women seeking help for PPD, often compounded by limited awareness and support. OB-GYNs are well-placed to reduce this through empathetic, non-judgemental responses to disclosure. Reassuring women they are not alone, acknowledging the problem openly, and signposting community resources such as online peer support forums can be pivotal in encouraging help-seeking.1
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1. Place JMS et al. Barriers to help-seeking for postpartum depression mapped onto the socio-ecological model and recommendations to address barriers. Front Glob Womens Health. 2024;5:1335437. Abbreviations: OB-GYN: obstetrics and gynaecology; PPD: postpartum depression.
“I know I have nothing to complain about.”
“I just feel like I can't keep up.”
Sleep disturbance beyond physical discomfort Minimisation, attributing symptoms to external circumstance Social withdrawal and reduced engagement with existing child Pervasive guilt and low mood Appetite changes
“And I don't know why, because everything is fine.”
You've just heard Maya's story. What's your next step?
Advise optimisation of sleep, social support, and stress reduction measures before formal assessment
Refer to a perinatal psychiatrist for screening
Reassure her that stress in the third trimester is normal and follow up postpartum
Administer a validated screening tool for perinatal depression
1. ACOG. Screening and diagnosis of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 4. Obstet Gynecol. 2023;141(6):1232-61. 2. Vigod SN et al. Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the management of perinatal mood, anxiety, and related disorders. Can J Psychiatry. 2025;70(6):429-89. 3. NICE. Antenatal and postnatal mental health: clinical management and service guidance. National Clinical Guideline no 192. 2014. Available at: https://www.nice.org.uk/guidance/cg192/resources/antenatal-and-postnatal-mental-health-clinical-management-and- service-guidance-pdf-35109869806789. Last accessed: 7 August 2026. Abbreviations: ACOG: American College of Obstetricians and Gynecologists; CANMAT: Canadian Network for Mood and Anxiety Treatments; MDD: major depressive disorder; NICE: National Institute for Health and Care Excellence; PPD: postpartum depression.
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Answer rationale: Maya has multiple risk factors for PPD and signs of possible perinatal depression: a personal history of MDD, a first-degree relative with bipolar disorder, low mood, sleep disturbance, withdrawal, and she is minimising her symptoms. Reassurance alone risks missing a critical window. Immediate specialist referral isn't yet indicated without first establishing the clinical picture. Waiting until postpartum to screen for PPD is not in line with guideline recommendations: NICE, ACOG, and CANMAT all advocate screening during pregnancy, not just after.1-3 The right move is to screen now, using a validated tool.
Before we look at Maya's results, let's get familiar with a key tool.
Screening Tools: What Are We Using and Why?
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1. Cox JL et al. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-6. 2. Walfisch A et al. Screening for depressive symptoms. Can Fam Physician. 2011;57(7):777-8. 3. Milgrom J, Gemmill AW. Screening for perinatal depression. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):13-23. 4. ACOG. Screening and diagnosis of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 4. Obstet Gynecol. 2023;141(6):1232-61. 5. APA. Position statement on screening and treatment of mood and anxiety disorders during pregnancy and postpartum. 2025. Available at: https://www.psychiatry.org/getattachment/bf2c29a1-98f5-4c8f-9e4a- 4119fa64bcca/Position-Pregnancy-Postpartum-Mood-Anxiety-Disorders.pdf. Last accessed: 7 August 2026. 6. Earls MF et al. Incorporating recognition and management of perinatal depression into pediatric practice. Pediatrics. 2019;143(1):e201832591. 7. Vigod SN et al. Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the management of perinatal mood, anxiety, and related disorders. Can J Psychiatry. 2025;70(6):429-89. 8. NICE. Antenatal and postnatal mental health: clinical management and service guidance. National Clinical Guideline no 192. 2014. Available at: https://www.nice.org.uk/guidance/cg192/resources/antenatal-and-postnatal-mental-health-clinical-management-and- service-guidance-pdf-35109869806789. Last accessed: 7 August 2026. 9. WHO. WHO recommendations on maternal and newborn care for a positive postnatal experience. Available at: https://www.who.int/publications/i/item/9789240045989. Last accessed: 7 August 2026. Abbreviations: EPDS: Edinburgh Postnatal Depression Scale; PPD: postpartum depression.
EPDS Developed in 1987 specifically for the postnatal context, the EPDS has been validated for use during pregnancy.1,2 Its key advantage: it deliberately excludes somatic symptoms, fatigue, appetite changes, and sleep disruption, which are normal features of pregnancy and would skew a general depression screen.3 It is made up of 10 items, is self-reported, and takes around 5 minutes to complete.1
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EPDS Screening Thresholds1,2 - Score ≥12: Strong indicator of possible depressive illness - Score 9–10: Suggested cutoff for routine screening in primary care settings - Item 10 (self-harm): Any response above "never" requires immediate follow- up, regardless of total score - A low score doesn't rule out depression, clinical judgment still applies, especially if other risk factors are present - EPDS is a screening tool, not a diagnosis, always follow up with clinical evaluation
Why is screening important? Screening for PPD is recommended in guidelines globally and is crucial for the early identification and management of mental health conditions in the postnatal period.4-9 Screening tools like the EPDS work best as a starting point for conversation, not a verdict, with kind, well-trained staff key to avoiding stigma or intrusiveness.9
Maya’s EPDS score meets the threshold for possible antenatal depression.1 Here is a patient who is actively minimising her symptoms, has a personal history of MDD, and a first-degree family history of bipolar disorder.
Third Trimester Screening: Maya’s Results
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1. Cox JL et al. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-6. Abbreviations: EPDS: Edinburgh Postnatal Depression Scale; MDD: major depressive disorder.
Take a moment to think, what are your next steps?
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Recommended next steps at this visit: Tick the to do list to read more
Talk to the patient: Don't let the subthreshold scores close the door. Name what you're seeing, gently, directly. Maya is unlikely to volunteer more without being asked. A simple "I want to talk a little more about how you've been feeling" can open space that a questionnaire can’t.1
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1. WHO recommendations on maternal and newborn care for a positive postnatal experience. Available at: https://www.who.int/publications/i/item/9789240045989. Last accessed: 7 August 2026. 2. Riseup-PPD Consortium. Evidence-based clinical practice guidelines for the prevention, screening, and treatment of peripartum depression. Version 05c. 2023. Available at: https://riseupppd18138.com/clinical-practice-guidelines-html/. Last accessed: 7 August 2026. Abbreviations: CBT: cognitive behavioural therapy; EPDS: Edinburgh Postnatal Depression Scale; MDD: major depressive disorder.
Address stigma: Help Maya understand what she's experiencing and why her risk profile matters. Normalise the conversation around perinatal mental health without normalising her symptoms away.1
Safety planning: Given her history and family risk, establish a clear plan, who she contacts if things escalate, what warning signs to watch for, and that her care team is actively monitoring.1
Closer follow-up: Don't wait until the next routine appointment. Schedule an earlier check-in and flag her notes so that whoever she sees next has full context.1,2
Offer psychological intervention: Given Maya's risk profile and EPDS score, a low-intensity psychological intervention such as guided self-help or brief CBT-based programme is appropriate at this stage.1,2
Consider consultation with a psychiatrist: Her risk profile, prior MDD, maternal bipolar disorder, and EPDS score is sufficient grounds to collaborate with a perinatal mental health specialist now, rather than waiting for thresholds to be crossed.1
Research reports that maternal–infant bonding difficulties are a core, often underreported feature of PPD, and one of the most distressing for mothers to disclose. The guilt of not feeling what you're ‘supposed to feel’ compounds the depression itself.1,2
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Symptoms: Week 6 Postnatal Visit
Six weeks have passed since Maya gave birth. She's back for her routine postpartum check. She's quieter than usual. When you ask how she's doing, she says things are going okay.
She mentions the sleep first. Even on nights the baby settles, she's awake. Her thoughts won't quiet down. “Just noise,” she says.
Her mother has been visiting more than usual to help. Her husband mentions, carefully, that she's been a bit withdrawn, quieter than normal, less herself. Maya doesn't disagree, but doesn't add to it either.
She hasn't seen her friends since the birth. She's not sure why, she says. Things have just been busy.
When you ask how she feels about the baby, she pauses. “I'm doing everything I should be,” she says. “I just thought it would feel different by now.”
She stopped breastfeeding a few weeks ago and switched to formula. She doesn't say much about it, but it's clearly sitting with her.
1. O'Dea GA et al. Associations between maternal psychological distress and mother-infant bonding: a systematic review and meta-analysis. Arch Womens Ment Health. 2023;26(4):441-52. 2. Klier CM. Mother-infant bonding disorders in patients with postnatal depression: The Postpartum Bonding Questionnaire in clinical practice. Arch Womens Ment Health. 2006;9(5):289-91. Abbreviation: PPD: postpartum depression.
6-Week Screening: Maya’s EPDS Results
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Why screen with EPDS pre- and postpartum? Prenatal screening identifies risks for positive screens and persistent depressive symptoms.2 However, a substantial proportion of women continue to experience persistent depressive symptoms after giving birth, therefore pre- and postpartum screening is important for the continued support and recognition of maternal mental health needs across the perinatal period.2,3
1. Cox JL et al. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-6. 2. Koire A et al. Prenatal depression screening with postpartum follow-up in an integrated healthcare system identifies risks for positive screens and persistent depressive symptoms. J Affect Disord Rep. 2023;12:100509. 3. Radoš SN et al. Evidence-based clinical practice guidelines for prevention, screening and treatment of peripartum depression. Br J Psychiatry. 2025;227(5):1-12. Abbreviations: EPDS: Edinburgh Postnatal Depression Scale.
Let’s think about next steps…
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Given Maya’s EPDS score, the next step in the process is to conduct formal diagnostic workup for PPD. In this case, the DSM-V is being used.
DSM-V: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; EPDS: Edinburgh Postnatal Depression Scale; PPD: postpartum depression.
Maya's experience
Map What Maya is Describing to the DSM-V Criteria for Major Depressive Episode with Peripartum Onset:
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1. American Psychiatric Association (APA), Diagnostic and Statistical Manual of Mental Disorders (2022) 5th edition, Washington, DC: American Psychiatric Publishing.
Symptoms present for more than two weeks. Specifier: with peripartum onset.
DSM-V criterion1
Based on Maya's presentation at her 6-week visit, which of the following best supports a diagnosis of MDD with peripartum onset?
She meets the required number of DSM-V symptom criteria, symptoms have been present for more than 2 weeks, and there is evidence of functional impairment
Her EPDS score has crossed the threshold for probable depression, which is sufficient for diagnosis on its own
She has a personal history of MDD and a first-degree family history of bipolar disorder, which confirms the diagnosis
1. American Psychiatric Association (APA), Diagnostic and Statistical Manual of Mental Disorders (2022) 5th edition, Washington, DC: American Psychiatric Publishing. Abbreviations: DSM-V: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; EPDS: Edinbrugh Postnatal Depression Scale; MDD: major depressive disorder.
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Answer rationale: Maya satisfies all three components of B, symptom threshold, duration, and functional impairment. A DSM-V diagnosis requires five or more symptoms present for at least 2 weeks, including depressed mood or anhedonia, plus evidence of functional impairment.1 Maya's EPDS is a clinical prompt, not a diagnostic tool. Her risk history increases her likelihood of PPD but doesn't confirm it. And while depressed mood and anhedonia are the two gateway symptoms, at least three additional criteria must also be met.
She is experiencing low mood and sleep disturbance, which are the two core criteria required for diagnosis
Diagnosis
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Based on Maya's presentation, history, and screening results, you are ready to make a formal diagnosis.
1. World Health Organization (WHO). International statistical classification of diseases and related health problems (11th ed.). 2019. Available at: https://icd.who.int/browse10. Last accessed: 7 August 2026. 2. ICD-10-CM. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), 2022. Centers for Disease Control and Prevention, National Center for Health Statistics; 2022 Apr. Available online: https://ftp.cdc.gov/pub/health_statistics/nchs/publications/ICD10CM/2022/icd10cm-tabular-2022-April-1.pdf. Last accessed: 7 August 2026. Abbreviations: ICD-10: International Statistical Classification of Diseases and Related Health Problems 10th Revision; MDD: major depressive disorder; PPD: postpartum depression; vs: versus.
Maya is diagnosed with PPD, moderate severity.
F53.0 is used as the primary code to distinguish this episode clearly from Maya's prior MDD history.1
MDD vs PPD, What's the difference?
MDD¹ Onset at any time and in a variety of contexts Greater risk of suicide Most prominent symptoms are disinterest and sad mood2 Risk factors may include neuroticism, adverse childhood experiences, heritability, separation or divorce, female gender, and intimate partner violence3
PPD can result in maternal suicide, and peripartum suicidality has been considered a leading cause of maternal mortality in the first year postpartum.11,12
PPD1,4 Onset during pregnancy or postpartum Greater risk of anxiety symptoms5 Most prominent symptoms are restlessness/agitation, impaired concentration/decision-making, and guilt about not being a good mother Risk factors may include high-risk pregnancy or complications, lifestyle factors, history of moderate-to-severe premenstrual syndrome, and lack of social support6-10 May include thoughts about causing harm to infant
1. Radoš SN et al. Diagnosis of peripartum depression disorder: a state-of-the-art approach from the COST Action Riseup-PPD. Compr Psychiatry. 2024;130:152456. 2. Bernstein IH et al. Symptom features of postpartum depression: are they distinct? Depress Anxiety. 2008;25(1):20-6. 3. Gutiérrez-Rojas L et al. Prevalence and correlates of major depressive disorder: a systematic review. Braz J Psychiatry. 2020;42(6):657-72. 4. Carlson K et al. Perinatal Depression [internet] (2025) Treasure Island: StatPearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK519070/. Last accessed: 7 August 2026. 5. Hendrick V et al. Postpartum and nonpostpartum depression: differences in presentation and response to pharmacologic treatment. Depress Anxiety. 2000;11(2):66-72. 6. Buttner MM et al. Examination of premenstrual symptoms as a risk factor for depression in postpartum women. Arch Womens Ment Health. 2013;16(3):219-25. 7. Agrawal I et al. Risk factors of postpartum depression. Cureus. 2022;14(10):e30898. 8. O'Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol. 2013;9:379-407. 9. Ghaedrahmati M et al. Postpartum depression risk factors: a narrative review. J Educ Health Promot. 2017;6:60. 10. Payne JL, Maguire J. Pathophysiological mechanisms implicated in postpartum depression. Front Neuroendocrinol. 2019;52:165-180. 11. Gressier F et al. Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses. J Psychiatr Res. 2017;84:284-91. 12. MBRRACE-UK. Saving lives, improving mothers’ care. Mothers and babies: reducing risk through audits and confidential enquiries across the UK. 2025. Available at: https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2025/MBRRACE- UK%20Maternal%20Report%202025%20-%20Main%20v1.5.pdf. Last accessed: 18 August 2026. Abbreviations: ICD-10: International Classification of Diseases, 10th Revision; MDD: major depressive disorder; PPD: postpartum depression; vs: versus.
Note on PPD coding
PPD is currently not coded in the ICD-10 as a separate condition than MDD, but rather coded as MDD with a peripartum onset modifier.1
Maya has a formal diagnosis of moderate PPD. The next step is treatment planning. Given Maya's psychiatric history and family history of bipolar disorder, a psychiatry consultation is warranted prior to initiating treatment. This ensures that treatment selection is appropriately informed, particularly regarding the risk of mood destabilisation in a patient with a first-degree relative with bipolar disorder. A collaborative care model is initiated. Maya continues under the care of her OB-GYN, with the psychiatrist providing specialist input on treatment selection and risk management.
Consult with Psychiatrist/Collaborative Care
Collaborative Care in Perinatal Mental Health1,2 Collaborative care models, in which a primary provider retains the patient relationship while coordinating with a mental health specialist, have demonstrated superior outcomes to standard referral in perinatal depression. Benefits include improved symptom outcomes, higher treatment adherence, and reduced dropout rates.
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The agreed plan will address:
Treatment modality selection: psychological, pharmacological, or combined
Monitoring frequency and screening follow-up
Safety planning and escalation criteria
Coordination with Maya's wider care team
1. Grote NK et al. Collaborative care for perinatal depression in socioeconomically disadvantaged women: a randomized trial. Depress Anxiety. 2015;32(11):821-34. 2. Melville JL et al. Improving care for depression in obstetrics and gynecology: a randomized controlled trial. Obstet Gynecol. 2014;123(6):1237-46. Abbreviations: OB-GYN: obstetrics and gynaecology; PPD: postpartum depression.
Maya presented at her third trimester visit with vague symptoms she attributed to stress, but with an elevated EPDS screening score. By her 6-week postpartum visit, she met criteria for moderate perinatal depression. Which of the following best reflects the key clinical lesson from Maya's case?
Antenatal screening has limited value because clinically significant perinatal depression usually emerges only after delivery
Collaborative care should be initiated only once a formal diagnosis has been made
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A patient's risk profile, minimisation of symptoms, and clinical context must be considered alongside screening scores when making management decisions
Feedback: Maya's screening score, risk profile, and presentation signalled the need for closer follow-up. Waiting for scores alone to trigger action would have delayed recognition of a developing moderate depressive episode. Screening tools are a clinical aid, not a substitute for clinical judgement. Her case also illustrates the value of antenatal identification. By the time Maya returned at 6 weeks, the picture was clearer, but the groundwork had already been laid.
Screening tools are the most important factor in identifying PPD; scores below threshold can be safely monitored without further action
Take Home Conclusions
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Maya: 26 years old, OB-GYN patient of 2 years, moderate PPD, diagnosed at her 6-week visit.
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3
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Antenatal identification matters: Maya's risk factors were visible from the start: prior MDD, maternal bipolar disorder, and clinically significant EPDS scores at 33 weeks. Early recognition created the conditions for timely diagnosis postpartum. Screening informs rather than decides: Maya's EPDS results, combined with her clinical presentation and minimisation, was more informative than the individual result.1 Diagnosis requires clinical synthesis: A formal diagnosis of F53.0/F32.1 moderate PPD was reached by mapping Maya's symptoms to DSM-V criteria, duration, symptom threshold, and functional impairment, not by screening score alone.2,3 Collaborative care is best practice: Specialist input informed treatment selection without disrupting an established, trusted care relationship.4,5
1. Cox JL et al. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-6. 2. World Health Organization (WHO). International statistical classification of diseases and related health problems (11th ed.). 2019. Available at: https://icd.who.int/browse10. Last accessed: 7 August 2026. 3. American Psychiatric Association (APA), Diagnostic and Statistical Manual of Mental Disorders (2022) 5th edition, Washington, DC: American Psychiatric Publishing. 4. Grote NK et al. Collaborative care for perinatal depression in socioeconomically disadvantaged women: a randomized trial. Depress Anxiety. 2015;32(11):821-34. 5. Melville JL et al. Improving care for depression in obstetrics and gynecology: a randomized controlled trial. Obstet Gynecol. 2014;123(6):1237-46. Abbreviations: DSM-V: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition; EPDS: Edinburgh Postnatal Depression Scale; MMD: major depressive disorder; OB-GYN: obstetrics and gynaecology; PPD: postpartum depression.
EPDS: Cox JL et al. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-6.
Resources
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1. ACOG. Screening and diagnosis of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 4. Obstet Gynecol. 2023;141(6):1232-61. 2. Vigod SN et al. Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the management of perinatal mood, anxiety, and related disorders. Can J Psychiatry. 2025;70(6):429-89. 3. NICE. Antenatal and postnatal mental health: clinical management and service guidance. National Clinical Guideline no 192. 2014. Available at: https://www.nice.org.uk/guidance/cg192/resources/antenatal-and-postnatal-mental-health-clinical-management-and-service-guidance-pdf-35109869806789. Last accessed: 7 August 2026. Abbreviations: ACOG: American College of Obstetricians and Gynecologists; CANMAT: Canadian Network for Mood and Anxiety Treatments; NICE: National Institute for Health and Care Excellence; PPD: postpartum depression.
Thank you
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