# Postpartum depression - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ACOG Clinical Practice Guideline · Paroxetine 20 mg Tablets SmPC section 4.2 (eMC product 537) · LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) · Perinatal Depression - StatPearls - NCBI Bookshelf (NBK519070) - disease-level clinical article - Verified date: 2026-08 ## Verified against - Paroxetine 20 mg Tablets SmPC section 4.2 (eMC product 537) - LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) - Perinatal Depression - StatPearls - NCBI Bookshelf (NBK519070) - disease-level clinical article ## Treatment metadata - Sertraline — 50 mg — oral.solid - Paroxetine — 20 mg — oral.solid ## Complete treatment card ```text POSTPARTUM DEPRESSION Sources: ACOG Clinical Practice Guideline · Paroxetine 20 mg Tablets SmPC section 4.2 (eMC product 537) · LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) · Perinatal Depression - StatPearls - NCBI Bookshelf (NBK519070) - disease-level clinical article Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (12) - Five or more depressive symptoms, running at least 2 weeks, make the diagnosis - The window runs from during pregnancy through to 12 months after the birth - One of the five must be low mood or loss of pleasure [loss of interest · low mood] - Mood is down for most of the day, either as she describes it or as others see it - Nothing gives interest or pleasure any more, most of the day - Sleep is wrong in either direction, too little or too much - Movement and thought are slowed, or the opposite, restless and agitated [irritability] - She feels worthless or guilty, and has no energy left - Thoughts of killing herself, an actual attempt, or death coming to mind again and again - Concentration fails and decisions become impossible - Appetite or weight shifts, for instance by 5% over 1 month - Anxiety often rides along, and psychosis can occur, including voices telling her to harm the baby [anxiety] SIGNS - what you find (6) - The picture is the same as depression outside pregnancy, plus a pregnancy or birth in the history [low mood] - Mood is visibly low and both activity and energy have dropped - She tires after the smallest effort, sleeps badly and eats less - Guilt, worthlessness and a collapse of self-esteem and self-confidence are the usual accompaniment [collapse] - Bodily features: no pleasure, waking very early, agitation, weight loss, lost sex drive, poor appetite and markedly slowed movement [irritability · poor appetite · weight loss] - The features shift from day to day and do not lift when circumstances improve TESTS (10) - Every patient should be screened for perinatal depression using the Edinburgh scale - Screen both in pregnancy and again after the birth - The Edinburgh scale is 10 questions the patient fills in herself in a few minutes; PHQ-9 and GAD-7 are alternatives - Ask about drugs, alcohol and smoking, and about every prescribed and over-the-counter medicine - The aims are to settle the diagnosis, weigh the risk of suicide and of harm to others, and exclude other psychiatric illness - Check thyroid-stimulating hormone, since an overactive or underactive thyroid produces the same mood picture - The symptoms must not stem from a substance or another illness, and there must be no psychotic disorder and no past manic or hypomanic episode - DSM-5-TR calls it peripartum onset when the depressive episode begins in pregnancy or within 4 weeks of delivery - Roughly half of episodes labelled postnatal in fact start before the delivery - At every postnatal visit assess for a mood disorder, for suicide risk and for psychosis, both of which are emergencies IF NOT THIS - what else fits (12) - Baby blues: begins in the first week, settles around day 10 to 14, affects half to three- quarters of mothers and needs no treatment - The discriminator is function: blues do not stop her running her day or caring for the baby, though severe blues raise the later risk - Blues symptoms overlap closely, crying, low and irritable mood, anxiety, poor sleep and appetite change, but never reach full depressive criteria - An overactive or underactive thyroid can produce the same mood disturbance - Broken sleep on its own can look like this: flat mood, poor concentration and fatigue - Substance use, or being intoxicated, can show up as swinging mood - Postnatal anxiety, where relentless worry is the centre of the picture - Adjustment disorder: an emotional and behavioural reaction to the stress of birth, milder and shorter-lived - Post-traumatic stress disorder after a frightening birth, with trauma symptoms - Weigh peripartum major depression and bipolar I or II when symptoms outlast 2 weeks, above all with marked irritability - Postpartum psychosis: usually starts 3 to 10 days after birth, with hallucinations, agitation, odd behaviour, muddled thinking and delusions - That psychosis is an emergency carrying suicide and infanticide risk; it is rare, at 1 to 2 per 1000 pregnancies Source StatPearls "Perinatal Depression" - disease-level clinical article Status traced to the source above 1. SERTRALINE [1st line] Adult 50 mg once daily; if the response is inadequate, increase in steps of 50 mg at intervals of at least one week, to a maximum of 200 mg/day - at least 6 months Peds Adult-only condition - paediatric section not applicable Choice Sourced preference. This condition's own cited article, Perinatal Depression (NBK519070), makes sertraline a first-line choice for medical therapy; it supports paroxetine only conditionally, for a woman who has previously responded to it. Source LUSTRAL ® 50 mg film coated tablets SmPC section 4.2 Posology and method of administration (eMC product 1070) Why Perinatal Depression (StatPearls NBK519070) names sertraline a first-line choice for medical therapy, with extensive and reassuring safety research behind it. Caution There is an initial transient rise in anxiety or agitation during the first 2 weeks. Do not stop abruptly; taper to avoid discontinuation symptoms. Monitor a breastfed infant for irritability, poor feeding or sleep disturbance. Use in nursing mothers is not recommended unless, in the judgment of the physician, the benefit outweighs the risk. Concomitant intake of pimozide is contraindicated (see section 4.5). Egypt OPIRALINE 50 MG 20 F.C. TABS. EL-OBOUR 29.00 EGP (1.45/unit) AGRELOCIT 50 MG 20 TAB. MEMPHIS > ATM... 34.80 EGP (1.74/unit) DEPR-STAT 50MG 10 CAPS. MEMPHIS 21.60 EGP (2.16/unit) SESERINE 50MG 30 TAB. ADWIA 75.00 EGP (2.50/unit) SERPASS 50MG 30 F.C.TAB. GLOBAL NAPI P... 102.00 EGP (3.40/unit) SIRTO 50MG 10 F.C. TABS. HI-PHARM 34.00 EGP (3.40/unit) MOODAPEX 50 MG 30 F.C.TAB. MULTI-APEX 111.00 EGP (3.70/unit) LUSTRAL 50 MG 20 F.C.TABS. VIATRIS 136.00 EGP (6.80/unit) 2. PAROXETINE [2nd line] Adult 20 mg once daily in the morning, titrate by 10 mg increments up to max 50 mg daily if needed x 6-12 months Peds Adult-only condition - paediatric section not applicable Source Paroxetine 20 mg Tablets SmPC section 4.2 (eMC product 537) Why Alternative SSRI with minimal excretion into breast milk Caution Discontinuation syndrome is pronounced; slow taper required when stopping. Avoid if planning subsequent immediate pregnancy due to early first-trimester cardiac risk. Paroxetine is contraindicated in combination with thioridazine or with pimozide (see section 4.5). Sedation and weight gain are common. Egypt XANDOL 20MG 20 TAB. EUROPEAN EGYP... 42.00 EGP (2.10/unit) PAXETIN 20 MG 10 F.C.TABS. PHAROPHARMA 22.80 EGP (2.28/unit) DEPANX 20MG 10 F.C. TAB. GLOBAL NAPI P... 24.00 EGP (2.40/unit) PAROXETINE 20 MG 30 F.C.TABS. EVA PHARMA 93.00 EGP (3.10/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)