A 29-year-old woman, 7 weeks after an uncomplicated vaginal delivery, reports pervasive sadness, anhedonia, guilt about her poor bonding with the baby, and early morning waking that occurs even when the infant sleeps well. Symptoms began in week 3 and have worsened. Which is the most appropriate next step?
- A Diagnose postpartum depression and initiate pharmacological and psychological treatment ✓
- B Reassure that these are normal maternity blues and review after two weeks
- C Admit her urgently for observation of postpartum psychosis
- D Order serum TSH and treat presumptive postpartum thyroiditis
Correct answer: A. Diagnose postpartum depression and initiate pharmacological and psychological treatment
Explanation
Symptoms lasting more than two weeks with anhedonia, guilt, diurnal variation, and impaired bonding meet criteria for postpartum depression, which warrants active treatment with SSRI therapy and psychotherapy such as CBT or interpersonal therapy. Reassurance would be correct only if symptoms were within the two-week window of maternity blues; there are no hallucinations or confusion to suggest psychosis.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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