A 34-year-old woman presents to her obstetrician-gynecologist for routine follow-up 8 weeks after giving birth. She is experiencing difficulties adjusting to new motherhood, including trouble breastfeeding as well as constant worry over her baby. She is also increasingly anxious about having to return to work in 1 month. This ruminative thinking occupies a lot of her time, has caused her to lose sleep, and has impaired her daily functioning. She reports that she rarely leaves her house. She does not feel she is capable of caring for her baby and feels like her body is going to fail her imminently. She has no family close by to help her, and her husband works long hours and does not contribute to the care of the baby.

The patient has a history of miscarriage. She miscarried three times in 2 years before her current pregnancy, which was successful and resulted in a healthy baby. The birth was vaginal and without complications.

As she is describing her symptoms, her speech is very disorganized, and her affect is markedly flattened from her last follow-up 4 weeks ago. She appears restless. She was diagnosed with mild depressive disorder after her second miscarriage 2 years ago and was referred to group counseling, which she continued until her last pregnancy. She reports a worsening of her symptoms since the birth of her son.

Routine laboratory testing is performed and shows nothing remarkable.