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MEDICAL YEAR
IN REVIEW

Peripartum Depression:

Clinical Medical Students’ Reflections

By Kristin Park, Emily Liu and Abby O. Lozano, MD

P eripartum depression is defined by the Diagnostic and Statis-

tical Manual of Mental Disorders, 5th Edition, as a major de-
pressive episode during pregnancy or occurring in the four
weeks after delivery. Clinical features include depressed mood or an-
hedonia, with four additional symptoms: sleep disturbances, excessive
guilt, low energy, concentration difficulties, appetite changes, psy-
chomotor agitation or retardation and suicidal ideation. Postpartum
depression affects approximately 10-15% of adult mothers yearly and
rates are particularly high in adolescent (25%) and African American
(35%) mothers.
Delayed medical and psychiatric care can exacerbate the symptoms
of mothers with peripartum depression, which can impact infant devel-
opment. During pregnancy, depressed women are more likely to partic-
ipate in smoking or cocaine use and have poorer maternal weight gain,
leading to low birth weight, maternal pre-eclampsia and premature de-
livery, amongst other complications. Furthermore, postpartum depres-
sion can impact maternal-infant interactions, which have been
associated with negative effects on cognitive and behavioral develop-
ment of infants and may have long-term effects on child development.
Therefore, it is critical to detect and treat peripartum depression as early
as possible. However, pregnant and postpartum women face unique bar-
riers to seeking care. One study found that only 13.8% of women screen-
ing positive for peripartum depression, at obstetric visits, reported
receiving any form of medication, psychotherapy or counseling.
Our first clinical rotation as medical students was with the obstet-
rics and gynecology (OBGYN) department. We expected to human-
ize the pathology we learned in our preclinical years and hone our
clinical acumen. Neither of us imagined how much each patient would
teach us. Here, we each reflect on how our respective encounters with
our patients affected by peripartum depression grew our understand- shared that she was overwhelmed. Once we began the patient interview,
ing of patient care. the mother said she was constantly worried about her premature infant,
especially since witnessing the baby having an apneic event. She reported
Kristin: that her partner recently became physically and emotionally abusive, re-
“A mother was brought to gynecology triage by a concerned social peatedly telling her that she should kill herself and that he no longer
worker. The patient had come in for a social work appointment, but the wanted to be with her. With this, she reported several concerning symp-
social worker quickly realized that the mother’s sadness was beyond cir- toms: feeling sad most of the time, having difficulty concentrating, lacking
cumstantial. As she was triaged, the patient tried her best to answer ques- energy, wanting to sleep “forever”, and yet not sleeping more than a couple
tions, while crying and caring for her baby. A nurse stepped in to help the of hours for the last few weeks. Later that day, psychiatry diagnosed the
mother finish changing and feeding the infant. Then, the patient tearfully patient with postpartum depression.”

30 SAN ANTONIO MEDICINE • December 2022