How Do Postpartum Depression and Major Depression Differ in Their Symptoms?

What you need to know

• Postpartum depression (PPD) and major depressive episodes (MDE) have different symptom profiles, with PPD showing more appetite disturbance, psychomotor symptoms, and fatigue.
• Suicidal thoughts play a more central role in PPD symptom networks compared to MDE.
• Sleep disturbances are more closely linked to other symptoms in PPD than in MDE.

Background

Postpartum depression (PPD) affects many new mothers and can have serious consequences for both mother and child. However, there has been debate about whether PPD is truly distinct from major depressive episodes (MDE) that occur at other times in life. This study aimed to compare the symptoms and symptom relationships in PPD and MDE to better understand their similarities and differences.

The study

Researchers analyzed data from 486 women with PPD and 871 women with a history of MDE from the IGEDEPP cohort in France. They compared the frequency of different depressive symptoms between the two groups and used a technique called network analysis to examine how symptoms were related to each other in PPD versus MDE.

Key findings

Differences in symptom frequency

After controlling for overall depression severity, the study found that women with PPD were more likely to experience:

• Appetite changes
• Psychomotor symptoms (physical restlessness or slowing)
• Fatigue

Women with PPD were less likely to report:

• Sadness
• Anhedonia (loss of interest or pleasure)
• Sleep disturbances
• Suicidal thoughts

These differences suggest that PPD may have a somewhat distinct symptom profile compared to MDE.

Symptom networks

The researchers used network analysis to examine how different symptoms were related to each other in PPD and MDE. This approach can reveal which symptoms play a more central role in the overall symptom network.

In PPD, the most central symptom was suicidal thoughts. This means that suicidal thoughts were more strongly connected to other symptoms in the network. In contrast, sadness was the most central symptom in MDE.

Sleep disturbances were more closely linked to other symptoms in PPD compared to MDE. This suggests that sleep problems may play a more important role in the overall symptom picture of PPD.

Feelings of guilt were more central in the MDE network than in PPD. This indicates that guilt may be more closely tied to other depressive symptoms in MDE compared to PPD.

What this means for patients and families

These findings highlight some key differences between PPD and MDE that may be important for patients, families, and healthcare providers to be aware of:

1. Appetite changes, psychomotor symptoms, and fatigue may be especially common in PPD. Paying attention to these physical symptoms could help with earlier identification of PPD.

2. While suicidal thoughts were less common overall in PPD, when present they were more closely linked to other symptoms. This underscores the importance of assessing suicide risk in women with PPD, even if they don’t display classic depressive symptoms like sadness.

3. Sleep disturbances appear to play a more central role in PPD. Addressing sleep issues may be particularly important in treating PPD.

4. Feelings of guilt may be less central to PPD compared to MDE. This could mean that cognitive therapies focused on addressing guilt may need to be adapted for PPD.

Limitations and future directions

It’s important to note that this study looked at a specific population of French women who tended to be highly educated. The results may not apply equally to all groups. Additionally, the MDE group was recalling past episodes, while the PPD group was assessed more recently, which could affect symptom reporting.

Future research could:

• Examine these symptom networks in more diverse populations
• Look at how symptom networks change over time during pregnancy and the postpartum period
• Investigate how different treatments affect the symptom networks in PPD versus MDE

Conclusions

• PPD shows some distinct features compared to MDE, including differences in symptom frequency and in how symptoms relate to each other.
• Suicidal thoughts and sleep disturbances may play a more central role in PPD compared to MDE.
• These findings support considering PPD as a distinct form of depression that may require tailored assessment and treatment approaches.