Prognosis
Differing definitions of postnatal depression across studies make it difficult to interpret prognostic information. Outcomes depend on the severity and nature of the symptoms. Episodes of postnatal depression last 3-6 months on average, but may last for months or even years.[185] Untreated postnatal depression may recur as repeated depressive episodes.[186]
Risk of further episodes
Advice about future risk should be tailored to the individual patient. Women with a first episode of postnatal depression have a higher risk of subsequent postnatal depression (41% vs. 18%) but a lower risk of non-postnatal depression (38% vs. 62%).[187]
In the presence of clear psychosocial adversity and mild to moderate postnatal depression, the risk of subsequent depressive episodes may depend on the persistence of the adverse circumstances.[11] If the adversity was a discrete life event, such as the breakdown of a relationship, and has been resolved, then the risk of future postnatal depression may be low. However, the risk of future episodes in this situation depends not only on the life event itself but also on a wide range of patient-specific psychological and biological factors.[11]
Early-onset depression (within the first 6-8 weeks), severe depression, and depression with bipolar or psychotic symptoms suggest the presence of a specific puerperal trigger, and the risk of subsequent postnatal episodes may be higher in these patients.
Development of bipolar disorder
A prospective study assessing to what extent psychiatric disorders with postnatal onset are early manifestations of an underlying bipolar disorder followed up 120,378 women with a first-time psychiatric inpatient or outpatient contact with any type of mental disorder (excluding bipolar disorder) for 15 years to assess if any went on to have such a contact with a first-time diagnosis of bipolar disorder.[124] Women with a first-time psychiatric contact during the first postnatal month are significantly more likely to go on to receive a diagnosis of bipolar disorder within 15 years than those with an onset later in the postnatal period or those with a first psychiatric episode unrelated to childbirth.[124][125] Furthermore, a postnatal onset of psychiatric symptoms within 0-14 days after delivery predicted subsequent conversion to bipolar disorder (relative risk=4.26; 95% CI=3.11 to 5.85).
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