PMH-C Postpartum Depression 2 — Questions and Answers
Question 1: A mother at 6 weeks postpartum reports feeling 'numb' and detached from her baby, sleeping excessively, and losing interest in activities she previously enjoyed. Which specifier best applies if these symptoms have been present since delivery?
- With peripartum onset (Correct answer)
- With seasonal pattern
- With anxious distress
- With mixed features
Correct answer: With peripartum onset
DSM-5 applies the 'with peripartum onset' specifier when MDD onset occurs during pregnancy or within 4 weeks postpartum, though clinically symptoms arising within 12 months are often included.
Question 2: Which neurotransmitter system is most implicated in the rapid hormonal drop that contributes to postpartum depression vulnerability?
- Dopamine system
- GABA-allopregnanolone system (Correct answer)
- Acetylcholine system
- Glutamate system
Correct answer: GABA-allopregnanolone system
The steep postpartum decline in progesterone metabolite allopregnanolone, a potent GABA-A receptor modulator, is strongly linked to PPD vulnerability in susceptible individuals.
Question 3: A clinician uses the PHQ-9 to screen a postpartum patient who scores 14. What does this score indicate?
- Minimal depression
- Mild depression
- Moderate depression (Correct answer)
- Severe depression
Correct answer: Moderate depression
On the PHQ-9, a score of 10-14 indicates moderate depression, warranting further clinical evaluation and likely treatment intervention.
Question 4: Which of the following is the MOST evidence-based psychotherapy for postpartum depression?
- Psychodynamic therapy
- Dialectical behavior therapy
- Cognitive behavioral therapy (Correct answer)
- Acceptance and commitment therapy
Correct answer: Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) has the strongest evidence base for treating postpartum depression and is recommended as a first-line psychotherapy option.
Question 5: A postpartum woman taking sertraline for PPD is breastfeeding. What is the current clinical guidance regarding this situation?
- She must stop breastfeeding immediately
- Sertraline is compatible with breastfeeding and is considered a first-line option (Correct answer)
- She should switch to a non-SSRI medication
- Breastfeeding should be delayed 4 hours after each dose
Correct answer: Sertraline is compatible with breastfeeding and is considered a first-line option
Sertraline transfers minimally into breast milk and is considered one of the safest SSRIs for breastfeeding mothers, with no significant adverse effects reported in infants.
Question 6: Which of the following maternal behaviors is MOST associated with impaired mother-infant bonding in untreated postpartum depression?
- Increased skin-to-skin contact
- Reduced contingent responsiveness to infant cues (Correct answer)
- Excessive feeding frequency
- Heightened anxiety about infant safety
Correct answer: Reduced contingent responsiveness to infant cues
Untreated PPD is associated with reduced maternal sensitivity and contingent responsiveness, where mothers fail to consistently respond to their infant's emotional and social cues.
Question 7: A woman with PPD reports her husband is dismissive of her symptoms, saying she should 'just be happy about the baby.' Which intervention is MOST appropriate to address this relational barrier?
- Recommend couple's separation
- Educate both partners about PPD as a medical condition with neurobiological underpinnings (Correct answer)
- Advise the mother to minimize her symptoms around her husband
- Refer only the husband for individual therapy
Correct answer: Educate both partners about PPD as a medical condition with neurobiological underpinnings
Psychoeducation for both partners reduces stigma, improves partner support, and enhances treatment adherence by framing PPD as a medical condition rather than a personal failing.
PMH-C Postpartum Depression 2
A mother at 6 weeks postpartum reports feeling 'numb' and detached from her baby, sleeping excessively, and losing interest in activities she previously enjoyed.
Which specifier best applies if these symptoms have been present since delivery?