Evaluation tools such as the Edinburgh Postnatal Depression Scale (EPDS) help determine if what you’re feeling is a sad mood or postpartum depression.

It’s natural to experience mood shifts as a part of pregnancy, and it’s true hormones can have you feeling all sorts of ways. Persistent low mood during or after pregnancy, though, is a reason to speak with a doctor.

According to the Centers for Disease Control and Prevention (CDC), as many as 1 in 8 people who give birth go on to experience postnatal or postpartum depression.

If you’re regularly experiencing feelings such as despair, anxiety, or unwarranted guilt, the EPDS can help a doctor determine an appropriate diagnosis.

The EPDS was first proposed in 1987 as a screening tool specifically for postnatal depression.

It was created by a team of three researchers who saw a gap in the ability of current depression scales to assess unique symptoms of depression after giving birth.

To help improve accurate postnatal depression evaluations, the team developed the EPDS, a 10-question, self-administered assessment. They then conducted a validation study to prove its effectiveness.

Since that time, the EPDS has become one of the most commonly used postnatal depression screening tests around the world.

Postnatal depression is depression that occurs after you’ve had a baby. It’s also known as postpartum depression.

It’s a type of depression covered under the term “perinatal depression,” which includes prenatal depression, depression during pregnancy, and postnatal depression.

Postnatal depression symptoms

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), considers postnatal depression to be a specific presentation of major depressive disorder (MDD).

According to the DSM-5-TR, this means symptoms are the same as MDD but are specifically related to pregnancy.

MDD symptoms include:

  • feelings of low mood almost all day, every day
  • inability to experience pleasure from joyful activities
  • loss of motivation toward daily tasks
  • sleep disturbances
  • unwarranted sense of guilt or worthlessness
  • weight changes
  • loss of energy
  • poor concentration
  • indecisiveness
  • motor function agitation or slowness
  • thoughts of death or dying
  • suicide ideation

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

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The DSM-5-TR categorizes postnatal depression as “MDD with peripartum onset,” but there are symptoms unique to giving birth not noted in the DSM.

In postnatal depression, you may also notice:

  • feeling emotionally detached from your baby
  • persistent doubts about your ability to care for the baby
  • thoughts about harming your baby
  • lack of motivation to care for your baby

The EPDS consists of the following 10 questions, answered based on your feelings over the last 7 days. Each question has four answer options that help determine the severity of each symptom.

  • I have been able to laugh and see the funny side of things.
  • I have looked forward to things with enjoyment.
  • I have blamed myself unnecessarily when things went wrong.
  • I have been anxious or worried for no good reason.
  • I have felt scared of panicky for no good reason.
  • Things have been getting to me.
  • I have been so unhappy I’ve had difficulty sleeping.
  • I have felt sad or miserable.
  • I have been so unhappy that I have been crying.
  • The thought of harming myself has occurred to me.

Each answer on the EPDS has a value of 0 to 3. Once you’ve completed all 10 questions, your answers are scored and tallied into a final count.

Traditionally, scoring above 9 suggests a high chance of postnatal depression. But, the EPDS creators note that the questionnaire can’t offer a definitive diagnosis. It’s also possible to score high on the assessment if you’re living with a condition such as post-traumatic stress disorder (PTSD) or an anxiety disorder, for example.

In the original validation study, the sensitivity and specificity ratings of the EPDS were 86% and 78%, respectively.

A sensitivity rating shows how often a test accurately identifies the presence of a condition. A specificity rating shows how often that test accurately determines when a condition isn’t present.

According to a 2020 review of studies of the EPDS, using a final score of 11 or higher as the marker for postnatal depression gives the EPDS a sensitivity rating of 81% and a specificity rating of 88%.

That suggests 81% of people living with postnatal depression will test positive on the EPDS, and 88% of people not living with postnatal depression will test negative.

It also means approximately 19% of people who live with postnatal depression may falsely test negative, and 12% of people not living with postnatal depression may falsely test positive.

Limitations of the EPDS

Aside from the chance for an inaccurate result, the EPDS is a screening tool only and can’t provide a definitive diagnosis.

The test also doesn’t cover all symptoms possible in postnatal depression. Emotional distancing from your infant, for example, or thoughts of harming your baby aren’t covered in the questionnaire.

Speaking with a mental health professional or doctor can ensure these important experiences are taken into consideration when making a diagnosis.

Postnatal depression is treatable. Like MDD, it’s often approached with a combination of antidepressants and psychotherapy.

Your doctor will discuss the safest options if you’re currently breastfeeding, but many people are able to start antidepressants even while nursing. As with all prescriptions, the benefits and risks of any medication are weighed before making a final decision.

If hormones play a role in your symptoms, your doctor may prescribe brexanolone, a postpartum-specific medication that works to rebalance hormone levels.

Depending on your symptoms and their severity, other medications may include:

Medications for depression can take weeks to have a noticeable effect. During that time, speaking with a mental health professional can help you develop coping strategies for your symptoms.

Cognitive behavioral therapy (CBT) and interpersonal therapy are evidence-based methods used in the treatment of perinatal depression. These psychotherapies can help you manage your depression and develop more beneficial patterns of thinking.

The EPDS was developed to help assess the specific experience of postpartum depression.

While the 10-question assessment can’t definitively diagnose depression, it can give your doctor or mental health professional insight about the likelihood of this condition.

You don’t have to accept chronic low mood as part of the pregnancy experience. Postnatal depression is real and is treatable with medications and psychotherapy.