A 26-year-old primigravida presents on postpartum day 4 with tearfulness, irritability, labile mood, and feeling overwhelmed while caring for her baby. She sleeps when the baby sleeps, eats adequately, denies thoughts of harming herself or the infant, and has no history of mood disorder. What is the most appropriate management?
- A Start low-dose sertraline immediately
- B Admit to hospital for observation of postpartum psychosis
- C Reassurance, emotional support, and follow-up, as spontaneous remission is expected ✓
- D Start lithium prophylaxis to prevent subsequent episodes
Correct answer: C. Reassurance, emotional support, and follow-up, as spontaneous remission is expected
Explanation
Postpartum blues begin within the first few days, peak around days 3 to 5, affect up to 80 percent of mothers, and remit spontaneously within 2 weeks without pharmacotherapy. Management is supportive with monitoring. Starting an antidepressant is reserved for postpartum major depression, which is more persistent and functionally impairing. Admission is indicated for postpartum psychosis, which would show delusions, hallucinations, disorganization, or risk to mother or infant.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.